employee benefits plan year july 1, 2018 june 30, 2019...q:\2014\gbs\17\nichename\20\dcn#.pptx...

$: Employee Benefits Plan Year July 1, 2018 June 30, 2019...Q:\2014\GBS\17\NicheName\20\DCN#.pptx Medical, Dental & Vision Eligibility For Employees Hired/Rehired or becoming benefits$
Q:\2014\GBS\17\NicheName\20\DCN#.pptx

Updated 5212018

1

Employee Benefits Plan Year

July 1, 2018 – June 30, 2019


Arizona State Retirement System (ASRS)

Defined-benefit retirement plan

Mandatory unless you can use the 65+ Waiver (see next slide)

Local phone (520) 239-3100

You must register your account online at www.azasrs.gov

2

2018-2019 ASRS contribution ratesRetirement Pension Long Term Disability Total

Employee 11.64% .16% 11.8%

Employer 11.64% .16% 11.8%

http://www.azasrs.gov/


Arizona State Retirement System (ASRS)

Age 65+ Waivers To be eligible, a person must:

• Become employed after the person is at least 65 years old

• Not be an active, inactive or retired ASRS member

• Not be receiving LTD benefits and

• Not have any credited or prior ASRS service.

To opt-out, an eligible person must make the election in writing within 30 days of employment, not 30 days from becoming ASRS eligible (if different than the first day of employment). The election is irrevocable and constitutes a waiver of all benefits under ASRS.

Please ensure that you complete the Age 65+ Waiver form within 30 days of employment if you wish to take this waiver option. The 65-Plus Membership Waiver form is available from the Benefits office.3


Medical, Dental & Vision Eligibility

For Employees Hired/Rehired or

becoming benefits eligible after July 1,

2012:

Certified employees holding a 75% or

greater contract

Classified employees who work 30 or

more hours per week

http://www.google.com/url?sa=i&rct=j&q=eligibility&source=images&cd=&cad=rja&docid=-mvYABW9jwq53M&tbnid=1wRZg2BGc0uciM:&ved=0CAUQjRw&url=http://www.nationalschoolofaccountancy.com/cpa-review/eligibility-requirements&ei=dCJTUfuTB4XXiAK_2IEY&bvm=bv.44342787,d.cGE&psig=AFQjCNFxTGsnDxc5FAU5PfTZJ8pyC53imA&ust=1364489168661505

http://www.google.com/url?sa=i&rct=j&q=eligibility&source=images&cd=&cad=rja&docid=-mvYABW9jwq53M&tbnid=1wRZg2BGc0uciM:&ved=0CAUQjRw&url=http://www.nationalschoolofaccountancy.com/cpa-review/eligibility-requirements&ei=dCJTUfuTB4XXiAK_2IEY&bvm=bv.44342787,d.cGE&psig=AFQjCNFxTGsnDxc5FAU5PfTZJ8pyC53imA&ust=1364489168661505


Dependent Coverage

Spouse & Children up to age 26:

ASBAIT Medical

Teladoc

Delta Dental

EDS Dental

Vision

A Certification of Dependent Eligibility and necessary documentation must be completed for any dependents being added to medical, dental or vision.


6

AMPHITHEATER PUBLIC SCHOOLS CALENDAR2018-2019 SCHOOL YEAR

Deductions occur 20

times:

Start-Aug 31, 2018

End- May 24, 2019


Additional Benefits

District Paid:

Basic Life / AD&D

Short Term Disability

Elective Benefits:

Additional Life & AD

Flexible Spending Accounts

Health Savings Account (with HDHP enrollment)

Employee Assistance Program

Pet Insurance

403B/457 Retirement Savings Plans

Free Kindergarten for your child(ren)

Paid Holidays

Sick Time

Vacation Time (fiscal year employees only)

To be Benefits eligible- 30 or more hours per week.

2


Medical Benefits

In-Network

Choice of Plans Classic Gold Plan Classic Silver Plan HDHP $ 1,350

Office Visits $25 copay Primary

$35 copay Specialist

$30 copay Primary

$40 copay Specialist

Plan pays 80% you

pay 20% after

$1,350 deductible

Major Medical

Services

Plan pays 85%, you

pay 15% after $300

deductible

Plan pays 80%, you

pay 20% after $500

deductible

Plan pays 80% you

pay 20% after

$1,350 deductible

Preventive

Services

Plan pays 100%

(deductible waived)

Plan pays 100%

(deductible waived)

Plan pays 100%

(deductible waived)


Medical Benefits

In-Network

Refer to schedule of benefits for full detailsClassic Gold Plan Classic Silver Plan HDHP $ 1,350

Calendar Year Deductible$300 Single

$900 Family

$500 Single

$1,000 Family

$1,350 Single

$2,700 Family

Calendar Year Out-of-Pocket

Maximum (includes medical and rx

copays)

$4,000 Single

$8,000 Family

$4,500 Single

$9,000 Family

$6,000 Single

$12,000 Family

Primary Care Office Visits 100% after $25 copay 100% after $30 copay 80% after deductible

Specialists Office Visit 100% after $35 copay 100% after $40 copay 80% after deductible

Urgent Care Facility 85% after $50 copay 80% after $50 copay$50 copay then 80% after

deductible

Emergency Services Facility Charges 85% after deductible 80% after deductible 80% after deductible


Medical Benefits

In-Network

Refer to schedule of benefits for full

detailsClassic Gold Plan Classic Silver Plan HDHP $ 1,350

Maternity (Prenatal & Postnatal) 85% after $250 copay 80% after deductible 80% after deductible

Surgery (Outpatient) Facility 85% after deductible 80% after deductible 80% after deductible

Surgery (Outpatient) Professional Services 85% after deductible 80% after deductible 80% after deductible

Hospital Facility (Inpatient) 85% after $250 copay 80% after $250 copay$250 copay then 80% after

deductible

Physical Therapy (Outpatient)

100% after $25 copay per

visit, 60 visit maximum per

calendar year

100% after $30 copay per

visit, 60 visit maximum

per calendar year

80% after deductible, 60 visit

maximum per calendar year

Diagnostic Testing, X-Ray & Lab Services

(Outpatient)

85% after deductible80% after deductible 80% after deductible


Medical Plan: Classic Gold & Classic Silver

Pharmacy Benefit

Benefits In Network Out of Network

Generic / Level 1 $15 $15

Preferred Brand / Level 2 Preferred Brand 20%

(Minimum $25 - Maximum $80)

Level 3Non-Preferred Brand 40%

(Minimum $40-Maximum $110)

Level 4 (Specialty Rx) Non-Preferred Brand 20%


Mail Order (90 day supply)

Level 1 = $30

Level 2 = Preferred Brand 20%


Level 3 = Non-Preferred Brand 40%


HDHP $1,350 all

medications are

subject to deductible

and coinsurance

Prescriptions

Teladoc1-800-Teladoc (1-800-835-2362)

All employees who enroll in the District medical insurance are enrolled in Teladoc.

There is NO copay or fee on your end to use Teladoc! You will pay for any prescribed medications

Dependents DO NOT have to be enrolled under your medical plan to use Teladoc

Telephonic or video/webcam physician consultations

Board Certified physicians authorized to write prescriptions (you pay for cost of Rx)

Available 24/7/365

English & Spanish speaking consultants and physicians

Who can use Teladoc?

E a ples of o o alls to Telado ….. Sinus Infections

Common Cold

Pink Eye

Flu

Allergies

Bronchitis

Ear Infections

Bladder Infections

UTI

Upper Respiratory Infection


Who is Eligible for the Health Savings Account?

You must be covered under the $1,350 HDHP pla (Ca ’t be enrolled in the Gold or Silver plan)

Cannot be covered under a health plan with less than a

$1,350 deductible (specific illness/accident policies are

okay)

Not enrolled for benefits under Medicare, Tricare, or

AHCCCS

Not covered as a depe de t u der a other perso ’s ta return (other than your spouse)


$1,350 Deductible

Option

Two Components:

THE INSURANCE PIECE

Access to a network of Aetna contracted

providers

Meritain processes your claims

Meritain provides customer service

THE HEALTH SAVINGS ACCOUNT

PIECE

Investment options

Rolls over from one year to the next

Meritain Financial Custodian

Health Equity

What does Health Equity handle vs. Meritain if I enroll in the

$1,350 Deductible Option?


Why Enroll in the $1,350 HDHP with the Health Savings

Account (HSA)?

HDHP $1,350 per pay period cost will be $10 for employee only coverage and the District will

contribute $14.14 per pay period to the e plo ee’s Health Savi gs Accou t (H.S.A). Total District

contribution toward the HDHP plan including the H.S.A. contribution matches the $364.90 per

month.

Lower premiums offer an affordable cost option to cover dependents

You can make pre-tax contributions via payroll deduction and receive tax free distributions for

eligible expenses

Once enrolled, you will receive a debit card to pull money from the savings account to pay for

qualified medical expenses

You own the savings account and the money stays with you

The balance rolls over from one year to the next (no use-it-or-lose-it rule)

Use the funds in your HSA account to cover eligible expenses for your dependents even if they are

not covered under your Amphitheater medical plan!!!

Long-term savings for healthcare expenses after retirement

* Note you will have a $3.95 fee charged to your bank account if you have funds in your HSA and terminate the HDHP $1,300 or if you move to another medical plan


HSA vs. FSA

Health Savings Accounts (HSA)

Flexible Spending Accounts (FSA)

Annual Contribution Limit

$3,450 for individuals (2018)

$6,900 for families (2018)

+ $1,000 catch up for 55+

$2,650 for Health FSA

$5,000 for DependentCare FSA

Unused Balances Roll Over Annually Yes No

$ Stays with Employee (if Retires or Changes Jobs)

Yes No


Flexible Spending Account (FSA)

BASIC

Health FSA maximum $2,550

Dependent Care FSA maximum $5,000

Use it or lose it rule reminder

No cost to participate in the FSA

The fees are paid by Amphi as an employee benefit

If enrolled in the $1,350 deductible HSA medical plan you can enroll in both the HSA and a Limited Purpose FSA but the Limited Purpose FSA can ONLY be used for Dental, Vision and Dependent Care NOT MEDICAL.


Medical Rates2017-2018

Individual only Individual +

Spouse

Individual +

Children

Individual +

Family

Classic Gold $83.00

($49.80/pay)

$522.00/mo

($313.20/pay)

$459.00/mo

($275.40/pay)

$833.00/mo

($499.80/pay)

Classic Silver $63.00/mo

($37.80/pay)

$482.00/mo

($289.20/pay)

$422.00/mo

($253.20/pay)

$779.00/mo

($467.40/pay)

HDHP $16.67/mo

($10.00/pay)

$339.10/mo

($203.46/pay)

$290.10/mo

($174.06/pay)

$585.10/mo

($351.06/pay)

14

Deductions are taken over 20 paychecks (August- May)


Flexible Spending Account (FSA)

BASIC

Plan year is July 1st – June 30th

You contribute money over 10 months from

your paycheck

You have 14.5 months to incur the expenses to

clea out our fu d

You have an additional 15 days to submit

receipts

http://www.google.com/url?sa=i&rct=j&q=flexible+spending+account&source=images&cd=&cad=rja&docid=rxAvK2R4sphX2M&tbnid=1QlhEcSajGn96M:&ved=0CAUQjRw&url=http://www.oregon.gov/DAS/PEBB/Pages/2009benefits/FSA.aspx&ei=eyRTUYffD-inigLyhIGoCQ&bvm=bv.44342787,d.cGE&psig=AFQjCNHDMFY-kAndukn1HuZynL3ncgl84w&ust=1364489697497730

http://www.google.com/url?sa=i&rct=j&q=flexible+spending+account&source=images&cd=&cad=rja&docid=rxAvK2R4sphX2M&tbnid=1QlhEcSajGn96M:&ved=0CAUQjRw&url=http://www.oregon.gov/DAS/PEBB/Pages/2009benefits/FSA.aspx&ei=eyRTUYffD-inigLyhIGoCQ&bvm=bv.44342787,d.cGE&psig=AFQjCNHDMFY-kAndukn1HuZynL3ncgl84w&ust=1364489697497730


If you use your FlexCard for

tra sa tio s… Do NOT send in receipts unless BASIC asks for them

Over the Counter Items (OTCs):

Your FlexCard will not work for OTCs drugs/medicines

Insulin and diabetic supplies are an exception to this rule

However, OTC medicines are eligible:

IF you must submit a prescription or Letter of Medical Necessity along with the receipts.

Letter of Medical Necessity Form is available on-line under the FSA section

KEEP ALL RECEIPTS: While receipts may not be required for all medical and daycare expenses there may be times when BASIC will request receipts for medical and daycare. In addition, BASIC will require receipts for all dental and vision expenses.


Employers Dental Service

Lower Cost Dental Option

No deductibles or claim forms to file

No waiting period for covered

services

No yearly maximums

No missing tooth clause

Select a general dentist from our

Directory of Participating General

Dentists and Specialists (available

on our website)

Your enrolled dependents will be

seen by your chosen dentist

Change your dentist by calling our

customer service department or

via our website


EDS Sample Copays

Me er osts listed elo are for ser i es pro ided a e rollee’s hose EDS ge eral dentist. If an enrollee receives services from an authorized EDS specialist, the enrollee

re ei es a dis ou t off the spe ialist’s usual a d usto ar UCS fee.

No yearly maximum

Procedures: 700N

D9431 - Routine Office Visit $5 Copay

D0120 - Oral Exam - Periodic No Charge

D0210 - Complete Series X-rays $25 Copay

D1110 - Routine Cleaning $7 Copay

D2140 - Amalgam Restoration (1 surface) $15 Copay

D2750 - Porcelain Crown (High noble metal)

$305 Copay + Lab fees

D3330 - Root canal-Molar $315 Copay

D7140 - Simple Extraction $65 Copay

D7240 - Complete Bony Impaction $130 Copay

D0277 - Vertical bitewings, 7 to 8 films $50 Copay


Higher Cost Dental Option

• = after deductible is met

In-Network = Delta Dental “PPO” Dentist, you can also seek treatment from a Dentist with the words “Premier” by their name in the provider directory but you will pay the least

out of pocket when you seek treatment from a Dentist with “PPO” wording by their name on the directory.

No waiting periods for timely entrants

https://www.deltadentalaz.com/

Benefits

In

Network

Premier

Dentist

Out of

NetworkAnnual Calendar Deductible

Individual $50 $50 $50

Family $150 $150 $150

Annual Plan Maximum Benefit $1,500 $1,500 $1,500

Type I - Diagnostic & Preventive 0% 0% 0%

Type II - Basic Services 20%* 20%* 20%*

Type III - Major Services 50%* 50%* 50%*

Type IV - Orthodontic Services 50% 50%* 50%

Age Limit Age 19

Lifetime Maximum $1,500 $1,500 $1,500

Periodontic Coverage 20%* 20%* 20%*

Endodontic Coverage 20%* 20%* 20%*



Dental Rates


Spouse

Individual +

Children

Individual +

Family

EDS $0.00/mo

($0.00/pay)

$8.29/mo

($4.97/pay)

$14.00/mo

($8.40/pay)

$16.63/mo

($9.98/pay)

DELTA DENTAL $29.39/mo

($17.63/pay)

$69.49/mo

($41.69/pay)

$71.55/mo

($42.93/pay)

$95.61mo

($57.37/pay)

24


• For a complete list of

in-network

providers

near you, use

our Enhanced

Provider

Locator on

www.eyemed.com

or

call 1-866-723-0596.

• For Lasik providers, call

1-877-5LASER6.

AH2015

Benefits


Vision Rates


Spouse

Individual +

Children

Individual +

Family

Eye Med $5.80/mo

($3.48/pay)

$10.95/mo

($6.57/pay)

$11.55/mo

($6.93/pay)

$16.90/mo

($10.14/pay)

26


© 2015 GALLAGHER BENEFIT SERVICES, INC. 27

You can search the Aetna provider directory at: http://aetna.com/docfind/custom/mymeritain and choose

“Aetna Choice POSII (Open Access)

Delta DentalPhone: 800-352-6132www.deltadentalaz.com/

Employers Dental Service (EDS) DentalPhone: (520) 696-4343Employers Dental Service Provider Search

PROVIDER SEARCH INFORMATION:

http://aetna.com/docfind/custom/mymeritain


http://eds.go2dental.com/member/dental_search/provsel.cgi


Employee Assistance Program (EAP)-

Alliance Work Partners

Toll Free 800-343-3822

EAP Teen Line

800-334-TEEN (8336)100% Confidential

1-5 short term counseling sessions per problem per year, which

includes assessment, referral and crisis services.

❂ Depe de ts a d part ers residi g i the e ployee’s household are covered.

❂ The EAP is available at no cost to the employee or family member

and is completely confidential.

Anger management

Legal and financial

issues

Grief and bereavement

Stress management

Substance abuse

Marital difficulties

Communication skills

Managing depression

and anxiety

Child and elder care

resources

Parenting support


Basic & Voluntary Life and AD&D

The Standard

Basic Life / AD&D – 100% paid by the District!!!

$25,000 benefit

Coverage reduced for employees over age 70

Voluntary Life / AD&D* – Available via payroll deduct

Available in the following increments:

$25,000, $50,000, $100,000 or $200,000

*If you do not enroll when you are first eligible, or if you apply for an amount higher than the guarantee issue, you will be required to complete a series of

medical questions (Evidence of Insurability aka EOI) and your requested amount will be reviewed and approved by the insurance company based on medical

conditions.


Short Term Disability

The Hartford

100% paid by Amphi!!!

60% of weekly earnings

Maximum $1,500 per week

Elimination Period: Injury 45 days, Illness 45 days

Benefits could continue for up to 20 weeks if you qualify

Benefits will be reduced by other income you receive


Long Term Disability

ASRS

Both the employee and employer contribute (contributions are mandatory).

The employee contributes .16% of their after-tax pay for this benefit.

Benefits provide income at 66 2/3% of your pay, after 6 months of approved disability, until disability ends, retirement, or death.

If you are approved for Long Term Disability, you continue to accrue credited service towards your retirement. You are also eligible, based on years of service, for a subsidy (from ASRS) to help defray the costs of medical insurance if provided through District COBRA or ASRS.


403B and 457

Plans

This example is hypothetical and for illustrative purposes only. It does not represent the performance of any particular investment vehicle. Investment returns cannot be guaranteed. Calculations were based on 8% per annum compounded monthly. No mortality, morbidity and withdrawal rates were assumed in the calculations.

TSA Consulting Group 888-777-5827


Pet Insurance

United Pet Care

Veterinary savings program that makes veterinary care

easy and affordable

ALL pets are eligible!

Saves you 20%-50%on EVERY visit to the veterinarian!

Rates start at $8.75 per month per pet (additional pets

are discounted) through payroll deduct

Can save you hundreds of dollars a year!


© 2015 GALLAGHER BENEFIT SERVICES, INC. 34

Required Notices: Employee Notification Documents: (see link on Employee Benefits Center)

HIPPA- Health Insurance Portability & Accountability Act of 1996

CHIP-Premium Assistance under Medicaid & Chldrens Health Insurance

Program.

WHCRA - The Women's Health and Cancer Rights Act (WHCRA) of 1998 NMHPA -Newborns' and Mothers' Health Protection Act USERRA -The Uniformed Services Employment and Reemployment Rights Act GINA -The Genetic Information Nondiscrimination Act of 2008 QMCSO (Qualified Medical Child Support Order) MHPA/MHPAEA -Mental Health Parity and Addiction Equity Act FMLA -Family Medical Leave Act (FMLA) COBRA - continuation coverage


Employee Benefits Center

Medical summaries of benefits coverage (SBC) can e fou d u der the edi al ta

Cli k the E ploy e t ta on the home page of the

Amphi website

The sele t E ployee Be efits Ce ter fro the drop down menu