2016 - 2017Enrollment Guide

Medical, Dental, & Vision Insurance Insured by: Blue Cross Blue Shield of Montana (BCBS)

Benefit Description Option 1$1,500 Traditional

Option 2$2,600 HDHP

Option 3$5,000 HDHP

Option 4$6,350 HDHP

Deductible - Embedded(calendar year)

$1,500 Individual$3,000 Family

$2,600 Individual$5,200 Family

$5,000 Individual$10,000 Family

$6,350 Individual$12,700 Family

Coinsurance(deductible applies) 80/20% 80/20% 100% 100%

Out of Pocket Max(includes deductible)

$3,000 Individual$6,000 Family

$4,000 Individual$8,000 Family

$5,000 Individual$10,000 Family

$6,350 Individual$12,700 Family

Office Visit Coinsurance Deductible + Coinsurance Deductible applies Deductible applies

Adult and Well Child Preventive Care Covered 100%; deductible waived

Prescription Benefits

Generic Covered 100% Generic: Applies to deductible then covered 100%Preventive Generic: Covered 100%

Formulary Deductible + 20% Preventive: $40 co-pay

Non-Formulary Deductible + 20% Preventive: 50% co-pay

Vision (Must be enrolled in health plan to receive vision benefits)

Benefits 75% of all services up to $250 annual benefit per individual

Dental (Reimbursement plan administered by Bozeman School District)

Benefits 100% of the first $200; 50% up to a maximum of $800

Group Life Insurance Insured by: Voya

Life and AD&D Benefit Amount

Administrators 3 times annual salary up to $500,000

Certified Drivers & Education Staff $80,000

Certified Staff Working More Than Half Time $50,000

Certified Staff Half Time or Less $25,000

Classified Staff Half Time or More $20,000

This policy is at no cost to the employee and they designate the beneficiary. Please update your beneficiary online if necessary.

Voluntary Life Insurance Insured by: Voya

Benefits Employee Spouse Child(ren)

Increments $10,000 $10,000 $1,000

Benefit Maximum $500,000 $250,000 $25,000

Guarantee Issue * $200,000 $50,000 $25,000

* Guarantee issue increase of $20,000 (up to $200,000) is available for employees currently enrolled with supplemental coverage. All other guarantee issues (employee, spouse, children) are for new hires within 31 days of hire.

BCBS Blue Access for Members (BAM)Your Online ResourceWould you like to know when your medical claims are paid and the payment amounts? Do you need to confirm who in your family is included under your coverage? BAM, the secure member portal from Blue Cross Blue Shield of Montana, can help. Get immediate online access to health and wellness information, and:

• Check the status of a claim and your claim history.• Confirm the family members who are covered under your plan• View and print Explanation of Benefits (EOB) statement for a claim.• Select an option to stop receiving EOBs by mail.• Set your preferences to receive notifications for claim status and wellness updates through email or text alerts.• Locate a doctor or hospital in the network.• Request a new or replacement member ID card or print a temporary ID card.

Getting Started with BAM1. Go to www.BCBSMT.com2. Click the Register Now button in the BAM section. Click the Member Online Services link for registration information.3. Use the information on your BCBS ID card to complete the registration process.

BCBS Special Beginnings Maternity ProgramSpecial Beginnings can help you better understand and manage your pregnancy. Available at no additional cost, this maternity program supports you from early pregnancy until six weeks after delivery through:

• Pregnancy risk factor identification to determine the risk level of your pregnancy and appropriate range for ongoing communication/monitoring

• Educational material including a complimentary book about having a healthy pregnancy and baby • Personal telephone contact with program staff to address your needs and concerns and to coordinate care

with your physician • Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia• Special Beginnings Online is an additional resource that provides information for each week of your pregnancy.

The site can be accessed through Blue Access for MembersEnrollment is easy and confidential. Just call the Customer Service number on the back of your member ID card.

All participants that fully complete the program are eligible for a gift from BSD.

BCBS Mobile AppGo to www.BCBSMT.com/Mobile to learn about and download BCBSs Mobile Applications available to you and your enrolled family members. The Mobile Application includes member resources, electronic ID card access, coverage information, claims center, doctor and hospital finder and other helpful tools for you as a BCBS member.

Employee Assistance Program (EAP)Receive help with various live problems including addictions, adolescence, anxiety, child care, credit, depression, financial, grief/loss, parenting, relationships, stress, substance abuse, violence, career, change, conflict, impairment, return to work and work stress. Call (406) 587-3792 for assistance.

Travel Assistance ProgramING Travel Assistance Services are available to all eligible employees and their dependents covered under the Bozeman School District group life insurance policy.

To access the ING Travel Assistance website at www.EuropAssistance-USA.com Username: ing Password: assistance

BCBS 24/7 Nurseline Health concerns don’t always follow a 9-5 schedule. Fortunately, registered nurses are on call at (877) 213-2565 to answer your health questions, wherever you may be, 24 hours a day, seven days a week.

The 24/7 Nurseline’s registered nurses can understand your health concerns and give general health tips. Get trusted guidance on possible emergency care, urgent care, family care and more.

Flex Online ResourcesOnline CalculatorThis tool can help you estimate your FSA expenses for the year. Visit the website to estimate your annual deductions and see your tax savings. www.ConnectYourCare.com/EECalculators

CYC Mobile ApplicationConnectYourCare (CYC) offers a secure, interactive mobile application for Android, iOS, and Windows devices. www.ConnectYourCare.com/Mobile-Apps

Features include:• View account balance, account alerts, and transaction history.• View/submit claims.• Online bill pay and click-to-pay (if applicable).• Receive important account alerts.

Tax Advantaged AccountsFlexible Spending Account Must be elected or declined for 9/1/16 through the online enrollment portal.Flexible Spending Accounts (FSA) provide employees with an important tax advantage that can help pay medical care expenses on a pre-tax basis. An FSA can help lower taxable income by anticipating health care costs for the next plan year and electing to place that money in this account. The maximum amount you can contribute in a year is $2,550. A healthcare payment card, similar to a credit card, can be utilized with this account at qualified merchants. Explanation of Benefits or invoices still need to be submitted for proof of claim. This is a use-it-or-lose-it plan.

Dependent Care Account Must be elected or declined for 9/1/16 through the online enrollment portal.The purpose of a Dependent Care Flexible Spending Account is to allow payment for child care, elder care or handicapped dependent care required for any employees or dependents on a pre-tax basis. The maximum amount you can contribute in a year is $5,000. This is a use-it-or-lose-it plan.

Health Savings AccountA Health Savings Account (HSA) is available for eligible employees enrolled in a High Deductible Health Plans (HDHP). Under the HSA, pre-tax contributions are placed into an employee’s account to allow payment for out-of-pocket eligible expenses for medical, prescription, dental, and vision costs. A healthcare payment card, similar to a credit card, can be utilized with this account at qualified merchants.

Contribution Limits 2016 2017

Individual Employee $3,350 $3,400Employee + 1 or more $6,750 $6,750Age 55+ Catch-up $1,000 $1,000

Learn more about FSAs!

NEW! Total Health Management (THM)Coming Fall 2016! Watch for information at the fall wellness meetings presented by Bruce Colton.Wellness programs have been around for a long time--with mixed results. Total Health Management (THM) is different. Using sound clinical guidelines, specific goals, and effective incentives, THM gives employers a clear path to engaging employees and achieving results.

Just what the doctor ordered. In coordination with a primary care provider, THM gives members clear, specific, achievable goals--like controlling weight, blood pressure, and cholesterol levels. The program then offers members the resources they need to be successful, rewarding them for achieving results.

Why Participate in THM? THM enhances the relationship between members and their primary care providers—emphasizing screening and preventive care, capturing a detailed picture of health status, and charting a path for improved health.

Potential benefits to employees:• Enhanced well-being and morale.• Decreased health risks and healthcare costs. • Better work-life balance and increased job satisfaction. • Helpful support and convenient tools and resources.

HSA/FSA Eligible Expenses• Abortion• Acupuncture• Alcoholism treatment• Ambulance• Annual physical examination• Artificial limb• Artificial teeth• Bandages• Birth control pills• Body scan• Braille books and magazines• Breast pumps and supplies• Breast reconstruction surgery• Capital expenses (improvements or special

equipment installed to a home, if meant to accommodate a disabled condition)

• Car modifications or special equipment installed for a person with a disability

• Chiropractor• Christian Science practitioner • Contact lenses• Crutches• Dental treatment (not including teeth

whitening)• Diagnostic devices• Disabled dependent care expenses• Drug addiction treatment• Eye exam• Eye glasses• Eye surgery• Fertility enhancement (in vitro fertilization or

surgery)• Guide dog or other service animal• Health institute fees (if treatment is prescribed

by a physician)• Intellectually or developmentally disabled

care, treatment or special home• Laboratory fees• Lactation expenses• Lead-based paint removal (if a child in the

home has lead poisoning)• Learning disability care or treatment• Legal fees associated with medical treatment

• Lifetime care, advance payments or “founder’s fee”

• Lodging at a hospital or similar institution • Long-term care• Medical conference expenses, if the

conference concerns a chronic illness of yourself, your spouse or your dependent

• Medical information plan• Medications, if prescribed• Nursing home fees• Nursing services• Operations• Optometrist• Organ donors• Osteopath • Oxygen• Physical examination• Pregnancy test kit• Prosthesis• Psychiatric care• Psychoanalysis• Psychologist • Special education• Sterilization• Stop-smoking programs• Surgery• Special telephone for hearing-impaired

individual• Television for hearing-impaired individuals• Therapy received as medical treatment• Transplants • Transportation for medical care• Tuition for special education• Vasectomy• Vision correction surgery• Weight-loss program if it is a treatment for a

specific disease• Wheelchair• Wig • X-ray

Source: www.irs.gov/publications/p502/ar02.html#en_US_publink1000178947

FAQs on Health Savings Accounts

How do I manage my HSA?Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will use HSA dollars to pay the out-of-pocket expenses associated with their high-deductible health plan, such as a deductible or coinsurance.

What expenses are eligible for reimbursement from my HSA?HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse and dependents. Qualified medical expenses are outlined within IRS Section 213(d) which states that “the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness.” In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA:• COBRA premiums• Health insurance premiums while receiving

unemployment benefits• Qualified long-term care premiums• Any health insurance premiums paid, other than

for a Medicare supplemental policy, by individuals ages 65 and over

Are dental and vision care qualified medical expenses under an HSA?Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic dentistry, would not be considered qualified medical expenses.

Can I use my HSA dollars for non-eligible expenses?Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the account holder and is subject to a 20 percent tax penalty—unless over age 65, disabled or upon death of the account holder.

When can I start using my HSA dollars?You can use your HSA dollars immediately following your HSA account activation and once contributions have been made.

When do I contribute to my HSA account, and how often can I?You, your employer or others can contribute to your HSA account through payroll deductions or as a lump sum deposit. You can contribute as often as you like, provided you and your employer’s total annual contributions do not exceed the annual contributions determined by the IRS. Individuals who are age 55 or older are eligible to make “catch-up” contributions up to $1,000.

What if I have HSA dollars left in my account at year-end?The money is yours to keep. It will continue to earn interest and will be available for you and your health care costs next year. Any dollars left in your HSA account at year-end will automatically roll over into next year’s HSA account.

What happens to my HSA dollars if I leave my employer?• The funds are yours to keep. You may elect one of

the following options:• Leave your funds in the current HSA account• Transfer your funds to an HSA with your new

employer• Transfer your funds to another qualifying account

within 60 days

Can my HSA dollars be used for retirement health care costs?Yes, but only for expenses eligible for reimbursement.

Can I use the money in my account to pay for my dependents’ medical expenses?You can use the money in the account to pay for the medical expenses of yourself, your spouse or your dependent children. You can pay for expenses of your spouse and dependent children even if they are not covered by your HDHP.

What Happens to My HSA When I Die?If you are married, your spouse becomes the owner of the account and can use it as if it were his or her own HSA.If you are not married, the account will no longer be treated as an HSA upon your death. The account will pass to your beneficiary or become part of your estate (and be subject to any applicable taxes).

Can couples establish a “joint” account and both make contributions to the account, including “catch-up” contributions?“Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in his or her own name. This allows you to both make catch-up contributions when you are 55 or older.

FAQs on Flexible Spending AccountsHow can I find out my account balance and review transactions?Account Balance and Claims Status information is available 24 hours a day, seven days a week:Visit www.ConnectYourCare.com to log into your online account. If it is your first time visiting the site, click on the “Register” button to select your user name and password. Call the number on the back of your healthcare payment card for balance information.

How will I be able to access my funds?You will receive a healthcare payment card to access your FSA funds. You can also pay for eligible expenses with any other form of payment and request reimbursement from your account. Dependent Care Account funds may only be accessed by paying out of pocket and requesting reimbursement.

When can I request reimbursement from my FSA?You will have access to the funds in your account on the first day of your plan effective date.

How will I receive my reimbursements?You are eligible to receive funds by check or direct deposit. For quicker reimbursements, sign up for direct deposit in your online account.

How do I set up direct deposit?Log into your account and select Direct Deposit from the Home page under My Account.Complete the short, secure form. Be sure to have your bank account and routing numbers on hand. Choose Direct Deposit as your preferred method of Claim Reimbursement and click the Confirm button.

Can I order a replacement or additional card for my spouse or dependent?Yes. There is a $5.00 fee for an additional or replacement card. Simply log on to your online account or contact Customer Service to request an additional card.

What happens if I use my account for a non-eligible expense?If you file a manual request for reimbursement, the request will be denied. If you used your healthcare payment card and the expense is deemed ineligible, you will be required to reimburse your account for that transaction.

How will I know if I need to submit a receipt?You can review if your claim requires receipts online by logging into your account and visiting the Claim Center. You need to submit receipts if you see a notice. If a receipt is needed, you will also be notified by e-mail or letter within a week of your payment card swipe. You should always save your receipts even if you have not received such a notice.

What if I don’t submit my receipts?You must provide the receipts within the time requested, or the transaction will be deemed ineligible, and you will be required to refund the amount of the transaction. If you fail to submit required receipts within 45 days, your payment card will be deactivated. If you fail to reimburse the account, the amount of the ineligible expenses may be added to your W-2 or withheld from your pay.

Is the healthcare payment card a debit card?No, your healthcare payment card is a prepaid card. It is provided to give you quick access to the funds in your flexible spending account.

Where can I use my healthcare payment card?Your healthcare payment card can be used nationwide at qualified merchants. Examples of qualified merchants may include pharmacies, doctors’ offices, vision centers, and hospitals. Visit www.ConnectYourCare.com/Stores for a list of approved merchants. Your card should only be used to pay for medical expenses eligible under your plan, and you should always save your receipts.

Do I need to keep my receipts when I use my card? YES! We may request documentation any time you use your payment card. Therefore, always hold on to your receipts in case further documentation is requested. Receipts must contain the following information:

• Date of service• Name and address of service provider/merchant

description of the service or expense provided amount charged

• Name of person receiving care or service

Non-itemized cash register tapes, credit card receipts and cancelled checks alone do not provide proper substantiation.

Benefit Contact Information

Medical Blue Cross Blue Shield of Montana(800) 447-7828

www.BCBSMT.com

Group Life Voluntary Life

Voya(855) ONE-VOYAwww.Voya.com

Flexible Spending Account (FSA)

ConnectYourCare(877) 292-4040

www.ConnectYourCare.com

Health Savings Account (HSA)

Big Sky Western Bank(406) 587-2922

Employee Assistance Program (EAP)

Joni Patterson-Croskey(406) 587-3792

(406) 586-3333 Help Center(406) 580-9417 After Hours

Benefit SpecialistDental/Vision Administrator

Bozeman School DistrictLacy Clark

(406) 522-6045lacy.clark@bsd7.0rg

Benefit Contact

PayneWest InsuranceBeth Glover

Account Coordinator(406) 327-6427

BGlover@PayneWest.com

• This information is only a summary of benefits and does not supersede the actual summary of benefits. Benefits and general provisions described herein are subject to the terms of the Summary Plan Description or Group Contract.

• All eligible employee contributions will be deducted on a pre-tax basis unless otherwise requested.• Premiums deducted on a pre-tax basis can not be changed except during the open enrollment period unless

the employee experiences a qualifying event.• Employees who do not request a change in their coverage will be automatically re-enrolled in the coverage

closest to the existing coverage with corresponding payroll deductions as shown.