2019 OPEN ENROLLMENT GUIDE · Gateway Charter Academy offers dental coverage through Cigna. You...

DISCOVER YOUR BENEFITS

OPEN ENROLLMENT GUIDE2019

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WELCOME

OPEN ENROLLMENT is from August 8th to August 16th

You play an important role in our success. That’s why we strive to provide you with a benefits program that rewards you for the hard work and dedication you put forth every day.

Our comprehensive and competitive benefits program is an important component of your total compensation package. This guide provides valuable information to help you better manage your supplemental benefit elections.

During open enrollment, you have the opportunity to review your coverage needs, consider the benefit plans available to you, and select benefits that will provide the most value to you.

Open Enrollment for 2019-2020 coverage – your one chance to make changes to your benefits¹ – begins August 8th and will remain open August 16th . The benefits you choose will become effective on September 1, 2019.

You must participate in Open Enrollment if you wish to do any or all of the following:

• Make changes to your medical, dental, or vision coverage for the upcoming plan year• Contribute to a Health Care and/or Dependent Care Flexible Spending Account (FSA)

If you don’t enroll in benefits, you may default into the same or comparable coverage that you elected last year. However, you won’t be automatically enrolled in any FSAs – you need to make an election to participate each year. Review this guide to choose which benefits are right for you. If after reading this guide you need more information, please contact Human Resources.

1 You can change your coverage during the year if you experience a “Qualified Status Change,” including but not limited to marriage, domestic partnership, divorce, birth or adoption of a child or death of spouse or child.

OPEN ENROLLMENT Full-time employees (working a minimum of 30 hours per week) and their eligible dependents can participate in Gateway Charter Academy Charter Academy’s benefits. Eligible dependents include:

• Your spouse • Child(ren) up to age 26 (23 and Full Time Student for Supplemental Life Insurance) • Child(ren) of any age if you support the child and he or she is incapable of self-support due to disability

Contact Gateway Charter Academy Human Resources for additional details regarding eligibility.

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EMPLOYEE CONTRIBUTIONS

The values below indicate how much you’re responsible for contributing towards coverage. Amounts are taken directly from your paycheck.

MONTHLY CONTRIBUTION SUMMARY

Benefit EmployeeOnly

Employee + Spouse

Employee + Child(ren)

Employee + Family

ActiveCare 1 – HD - Aetna $78.00 $766.00 $422.00 $1,115.00 ActiveCare Select/ActiveCare Select Whole Health - Aetna $256.00 $1,067.00 $602.00 $1,418.00

ActiveCare 2 (no new enrollments) $552.00 $1,720.00 $967.00 $2,089.00

Blue Cross Blue Shield TX (HMO)* $186.56 $877.52 $461.96 $949.00

FirstCare (HMO)* $260.50 $1,116.52 $592.16 $1,154.80

Scott and White (HMO)* $258.54 $1,006.58 $576.76 $1,157.28

Dental PPO Plan $37.74 $75.48 $96.22 $133.96

Dental HMO plan $9.58 $15.90 $19.62 $27.68

Vision Plan $8.25 $16.49 $17.17 $26.12

Supplemental Life See page 11

Supplemental Short-Term Disability (STD) See page 12

Supplemental Long-Term Disability (LTD) Paid by Gateway

*HMO’s are based on your zip code

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DENTAL BENEFITS

Gateway Charter Academy offers dental coverage through Cigna. You have the opportunity to choose from the DMO or PPO dental plan options. Each type of plan has unique advantages. Understanding the differences between them have the opportunity to help you choose the coverage that best meets the needs of you and your family.

Key Features In-Network Only Out-of-Network

Calendar Year Deductible (Individual / Family) $50 / $150 $50 / $150Preventive Services (no deductible)

Cleanings, Routine X-rays, Sealants 100%, No Deductible 100%, No Deductible

Basic ServicesFilings, Oral Surgery, Anesthetics, Periodontics 90%, After Deductible 90%, After Deductible

Major ServicesBridges, Crowns, Inlays, Onlays, Dentures 60%, After Deductible 60%, After Deductible

Implants 50%, After Deductible 50%, After DeductibleOrthodontics Children up to age 19 50%, No Ortho Deductible 50%, No Ortho Deductible

Orthodontics Lifetime Maximum $1,000 $1,000Annual Calendar Year Maximum $2,000 $2,000

The information above is a summary of coverage only. For more information, visit www.cigna.com or contact Human Resources or Epic Brokers.

PPO DENTAL PLAN SUMMARY

Plan Plan Features

DMO• Provides benefits only if you see an in-network dentist • Requires you to choose a primary care dentist to coordinate all your care• Provides benefits based on a copay schedule

PPO• Allows you to receive care from a dentist in the network or outside the network• Pays a portion of your expenses after you meet your annual deductible, except for preventive

care which is covered at 100%

Coverage Monthly Cost

Employee Only $37.74Employee + Spouse $75.48Employee + Child(ren) $96.22Employee + Family $133.96

PPO DENTAL PLAN COST

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DENTAL BENEFITS

The information above is a summary of coverage only. For more information, visit www.cigna.com or contact Human Resources or Epic Brokers.

Plan Summary With Cigna Dental Without DentalCoverage

Cleaning-2 per calendar year $0 $69-139 each

Oral evaluation $0 $40-$126Topical fluoride-two per calendar year $0 $28-$57

X-rays – bitewings 2 films $0 $32-$66X-rays – panoramic film $0 $83-$168Sealant – per tooth $17 $41-$84Amalgam filling silver colored – 2 surfaces $28 $116-$237

Composite filling tooth – colored $33 $119-$241

Molar root canalexcluding final restoration $595 $847-$1,720

Comprehensive orthodontic treatment of the adolescent detention $515 $987-$2,004

Periodontal (gum) scaling & root planning $135 $182-$367

Periodontal (gum) maintenance $93 $107-$217

Removal / extraction of erupted tooth $64 $123-$250

Removal / extraction of impacted tooth $300 $366 - $743

Crown – porcelain fused to high noble metal $480 $845 - $1,717

Implant supported retainer for porcelain fused to metal fixed partial denture $780 $1,200 - $$2,437

Occlusal appliance, by report for treatment of TMJ $575 $632 - $1,284

HMO DENTAL PLAN SUMMARY



HMO DENTAL PLAN COST

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VISION BENEFITS

You and your dependents have access to vision coverage through Humana. The plan pays benefits for both in-network and out-of-network services. However, you will receive maximum value from your vision benefits when you choose in-network providers. If you see a network provider, you will pay copays for most services. If you receive care outside the network, you will need to pay the full cost and file a claim to be reimbursed for a portion of the costs.

VISION PLAN SUMMARY

Key Features In-Network Out-of-Network Frequency

Exam $10 copay $10 copay 12 months

Lenses $15 copay $15 copay 12 months

Frames $15 copay$120 retail allowance

$15 copay$120 retail allowance 24 months

Contact Lenses (instead of glasses)

Elective: Up to $130 allowanceMedically Necessary: $15 copay

Elective: Up to $130 allowanceMedically Necessary: $15

copay12 months

For more information, visit www.humana.com or contact Human Resources or Epic Brokers.



VISION PLAN COST

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For less than a gourmet-blend coffee a week, you could have access to the following money-saving, time-saving, convenient benefits and services. Includes experts to help you with healthcare or insurance-related questions, legal services, as well as discounts on prescriptions, eyeglasses, contact lenses and more! With the addition of identity theft monitoring and restoration, emergency travel assistance, and roadside towing, you will have peace of mind knowing help is one phone call away. Packages:

Advantage Plans

Advantage Advantage Plus Advantage Premier

TeladocHealth Advocate Solutions Doctors Online Vitamins Diabetic Supplies Pharmacy Home Connection Guru

All Benefits in Advantage Plan PLUS

Vision Dental Hearing Aides Lab Testing MRI & CT Scans

All Benefits in Advantage Plus Plan PLUS

ID Sanctuary Enhanced Family Global Travel Assistance Roadside Assistance

$8 per month $10 per month $17.97 per month

Membership includes employee, spouse, and legal dependents under the age of 26.

DISCLOSURES: This plan is NOT insurance. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR 5.00. It contains a 30-day cancellation period, provides discounts only at the offices of contracted health care providers, and each member is obligated to pay the discounted medical charges in full at the point of service. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. Member shall receive a reimbursement of all periodic membership fees if membership: is cancelled within the first 30 days after the effective date. Discount Plan Organization: New Benefits, Ltd., Attn: ComplianceDepartment, PO Box 803475, Dallas, TX 75380-3475, 800-800-7616. Website for participating providers: MyMemberPortal.com. © 2018 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

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Teladoc ($0 Visit Fee) Feel better now! 24/7 access to a doctor is only a call or click away—anytime, anywhere with no per visit fee. You can talk to a doctor by phone or online video to get a diagnosis, treatment options and prescription if medically necessary. Save time and money by avoiding crowded waiting rooms in the doctor’s office, urgent care clinic or ER.

Health Advocacy Healthcare is becoming harder to understand. Personal Health Advocates help you find your way through insurance and healthcare systems. They can also locate doctors, specialists, hospitals, dentists and pharmacies. Advocates research treatments, resolve claims and provide medical explanations so you can make more informed decisions.

Medical Bill Saver™ Major issues can add up to major bills! Call Medical Bill Saver™ and rest easy. Skilled negotiators will attempt to negotiate discounts on your behalf, no matter your benefit status. Negotiations can lead to a reduction in your costs.

NurseLine™ You’re in good hands. You and your family have a place to turn to for trusted advice and information when you need it most. Rest assured—highly trained registered nurses are on-c all 24/7 to answer your questions.

Doctors Online The fast, easy way to get health information from an online resource you can trust. You have 24/7 access to doctors, pharmacists, psychologists, dentists, dieticians and more by email or smartphone app. You’ll get treatment options and advice you understand. With Doctors Online, the doctor’s always in!

VitaminsEveryone has different health goals, and Vitacost has the products to help you reach them. Find the best prices online for the most trusted brands of vitamins, supplements, health foods, sports nutrition and wellness products. Take an additional 10% off already low prices on products for you, your family and even your pets.

Advantage Plans Benefits

Vision Your eyes are the windows to your health. Now you and your family can see better savings at thousands of vision providers nationwide, including national chains and local retailers. You save 10% to 60% on glasses, contacts, laser surgery, exams and even designer eyewear.

Dental Smile brighter with big savings on dental services such as cleanings, X-rays and crowns. In most instances, save 15% to 50% per visit* on services from general dentistry to special procedures. Use your card over and over again to keep your teeth sparkling clean! *Actual costs and savings vary by provider, service and geographical area.

ID Sanctuary Family Thieves want to steal your identity. Don’t let them get away with it! ID Sanctuary provides the proactive tools and recovery assistance you need to quickly respond to an identity or fraud crisis. With ID Sanctuary, you can rely on immediate, personalized attention from a fraud specialist whenever you need it. Fraud specialists are armed with the knowledge to help reduce the risk of identity theft and provide unlimited resolution assistance should you fall victim—giving you emotional support and peace of mind. Includes the employee and up to the four legal dependents 18 and over.

Roadside Assistance Stranded? Car trouble is no trouble. Roadside Assistance is there for you and your immediate family to help with a flat tire, lock-out, battery, collision and even towing—with coverage up to $80. They will even bring you fuel, oil, fluid and water 24/7!

Global Travel Assistance Got a trip planned? Protect yourself and your loved ones. When traveling 100 miles or more from home, you can rest easy knowing you have a global network of doctors, assistance personnel and emergency benefits. Get medical help around the world with emergency medical evacuation, monitoring of treatment, replacement of lost or stolen travel documents and more. Global Travel Assistance not available to FL, NY, OR or WA residents.

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Legal Services Have legal questions? Get legal answers from experienced lawyers at discounted rates. Attorneys help with traffic tickets, bankruptcy, divorce, and spousal and child support. Additional services are also available at no cost to you!

Lab Testing Know your numbers! You have direct access to major clinical laboratories nationwide where you can save 10% to 80% on typical costs for lab work. Find a location near you and order online or by phone. Confidential results are available online in as little as 24 hours for most tests. Lab benefit not available in MD, ND, NJ, NY and RI.

Pharmacy Save 10% to 85% on most prescriptions at 60,000 pharmacies nationwide including CVS, Walgreens, Target and more.

Advantage Plans Benefits

MRI & CT Scans A better image leads to a better diagnosis, better treatment and a better recovery. Save 40% to 75% on usual charges for MRI and CT Scans at thousands of credentialed radiology centers nationwide.

Instant Deals There’s an app for that! Find instant discounts on-the-go at thousands of merchants nationwide from restaurants and shopping to entertainment and travel. Hearing Aids Want to save big on hearing aids? We hear you! You’ll save 35% off the suggested retail price (MSRP) at thousands of retail locations nationwide.

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FLEXIBLE SPENDING ACCOUNTS (FSAs)

Flexible Spending Accounts (FSAs) allow you to set aside money from your paycheck to pay Health Care and Dependent Care expenses with tax-free dollars. When you contribute to FSAs, your pre-tax contributions reduce your taxable income.

Account What it can be used for: Most you can contribute in 2019:

Health Care FSA

To pay medical, dental, vision, and hearing expenses not covered by your health care plans, such as deductibles, coinsurance and copayments.

$2,700

Dependent Care FSA

Dependent care expenses such as day care and after school programs for children under age 13, or elder care expenses, so you and your spouse can work or attend school full time

$5,000, or $2,500 if married and filing separate tax returns

HOW THE FSAs WORK: • The total amount you choose to contribute to your Health Care FSA is

available immediately. You can spend the dollars in your Dependent Care FSA as they are deposited each pay period.

• Health Care and Dependent Care Accounts are separate. The money in one account cannot be used to pay for expenses from the other account.

• If you enroll in the Health Care FSA or Limited Purpose Health Care FSA, you will receive a debit card that you can use to pay for eligible health care expenses at the point of service. Otherwise, you can pay for services and submit a claim for reimbursement or request reimbursement online.

• If you enroll in the Dependent Care FSA, you will pay for services and submit a claim for reimbursement or request reimbursement online.

• FSA elections do not automatically roll over from one year to the next. You must re-enroll each year to participate.

• For a complete list of eligible Health Care and Dependent Care FSA expenses, visit www.tasc.com.

Use-It or Lose-ItThe Health and Dependent Care FSA is a use-it-or-lose-it account. Any unused funds left in your account at the end of the year will be forfeited.

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INCOME PROTECTION BENEFITS

In addition to health benefits, Gateway Charter Academy also offers eligible employees income protection benefits. These benefits are intended to provide financial assistance for you and your beneficiaries in the event of disability, accident, ordeath.

Gateway Charter Academy offers the following benefits: Basic Life and Accidental Death & Dismemberment (AD&D) Insurance • Supplemental Life and Accidental Death & Dismemberment (AD&D) Insurance • Short-Term Disability (STD)• Long-Term Disability (LTD)

BASIC LIFE AND AD&D Gateway Charter Academy provides you with Basic Life and AD&D insurance in the amount of $15,000, at no cost to you. If your death is the result of an accident, you will receive an additional Accidental Death & Dismemberment (AD&D) benefit. If you lose a limb or your eyesight as the result of an accident, the AD&D plan will pay a percentage of your AD&D benefit amount. *The Basic Life plans reduce at a certain age. This plan reduces at age 70 by 35% and it reduces again at age 75 by another 15%. Please note that it will terminate at retirement

SUPPLEMENTAL LIFE AND AD&D You have the option to supplement your company-paid coverage by purchasing additional Life and AD&D insurance for yourself, your spouse and your children. You are required to purchase coverage for yourself in order to enroll your family members.

In the event you are a new hire and you have satisfied the waiting period, you are eligible for $100,000 on yourself, $25,000 on your spouse, and $10,000 on your dependents without having to go through a physical or even answer medical questions. If you choose to decline coverage and wait until next year you will have to qualify medically in order to get this coverage. Take advantage of this huge opportunity, even if it is for only $10,000 because it gives you the opportunity to increase coverage each year without medical questions.*The Voluntary Group Term Life plans reduce at a certain age. This plan reduces at age 65 by 35%, again at age 70 by another 25% , it reduces again at age 75 by another 15% and reduces at age 80 by another 15%. Please note that it will terminate at retirement.

Please note: Evidence of insurability may be required if you enroll after your initial eligibility period or if you elect amounts over the policy's Guarantee Issue amount.

Age Rate [(per $10,000 of benefit per month)]

0-29 $.55

30-34 $.55

35-39 $.95

40-44 $1.35

45-49 $1.95

50-54 $3.35

55-59 $5.15

60-64 $5.35

65-69 $9.75

70-74 $20.55

75-79 $61.45

80+ $61.45

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Short-Term Disability (STD)STD coverage replaces a portion of your income if you are unable to work due to an illness, pregnancy, or non-work-related injury.

Short Term Disability Benefits

Elimination Period: 1 day for accident 7 days for sickness (including maternity)

Benefit Duration 13 weeks

Protection 60% of weekly salary up to $1,000 a week

Pre-existing condition 3/6

Contribution 100% paid by employee

$ ________________Weekly salary (annual salary /52)

X 0.0506Premium rate

= $ ________________Monthly premium

The information above is a summary of coverage only. For more information, visit www.lfg.com or contact Human Resources or Epic Brokers.

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Long-Term Disability (LTD)Gateway Charter Academy provides Long Term Disability Insurance at no cost to you.

Long Term Disability Benefits

Elimination Period: 90 days for Accident90 days for Sickness

Benefit Duration Social Security Normal Retirement Age

Protection 60% up to $6,000 per month

Pre-existing condition 3/12

Contribution 100% paid by Gateway Charter Academy

The information above is a summary of coverage only. For more information, visit www.unum.com or contact Human Resources or Epic Brokers.

Wellness

Employee Employee + Spouse Employee + Child(ren) Family

Rates

Plan Design

$25,000

$50,000

Blood/Plasma/Platelets once per person per covered accident

Ambulance

Ground Ambulance / Air Ambulance

Burns

Accidental Death (Employee Benefit)

Common Carrier (Employee Benefit)

once per person per covered accident

Additional


Concussion once per person per covered accident

Eye Injury once per person per covered accident

$13.54 $19.82 $26.02 $32.32

***Please note that the above benefits description is a brief summary and may not include all the details in the policy proposal. Please refer to your contract for full benefit details.***

Monthly Rate



$100

$200

$200 / $1,000

Up to $7,500

Up to $10,000 once per person per covered accident

Follow- Up Visits once per person per covered accident



Hospital Benefits

Initial Hospitalization Benefit

Daily Hospital Benefit

$100

$1,500

$200

24 Hour Coverage Limitation

Emergency Room Treatment / Urgent Care once per person per covered accident

Accident Treatment

Health Screening Benefit once per calendar year

Benefit Amount

$50

$200

Accident benefits make accidents less painful financially. When you are injured, accident benefits pay benefits over and above what your medical plan may pay. These benefits are important because accidents happen out of the blue with no time to prepare for the associated medical costs. Gateway Charter Academy offers accident benefits for you to consider for your peace of mind in the result of an accident.

Fractures



Physical Therapy per visit, up to 6 visits

Accident Treatment

ICU Benefit

Surgery


$400

$1,250

$50

$300

Up to $4,000

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Dislocations

ACCIDENT BENEFITS

Guaranteed Issue Family Coverage Available

Fully Portable Convenient Payroll DeductionHIGHLIGHTS

Critical Illness Benefits

Cancer

EmployeeEmployee+

SpouseEmployee + Child(ren)

Family EmployeeEmployee+

SpouseEmployee + Child(ren)

Family

$33.50$21.86$20.26

$16.14 $24.38

$40.76

$50.96

$63.94

$78.50

$98.00

$122.04

$148.58

$181.38

$39.16

$49.36

$62.34

$76.90

$96.42

$120.44

$147.00

$179.78

$26.32

$32.10

$39.48

$47.80

$58.60

$71.82

$87.62

$109.14

$68.50

71-75 $122.80 $75.20 $148.62 $107.54

66-70

$49.04

$59.56

$83.24

$100.94

$50.34

$60.86

$84.52

$102.22

$70.24

$86.02

61-65

$30.34

$46.22

$57.00

51-55

46-50

$22.56

$27.48

$35.84

$44.50

$23.84

$28.78

$37.14

$45.78

$30.50

$37.90

41-45

56-60

$33.04

$40.22

$54.20

$67.22

$34.32

$41.52

$55.50

Heart Attack


Included

End Stage Renal Disease Included

Loss of Sight

Internal or Invasive Cancer

$24.74

$31.9031-35

$11.92 $18.12 $13.20 $19.42 $14.54 $22.78

36-40

$15.74

18-30

$73.92

100%

100%

Percentage of Benefit

100%

Stroke 100% Included

Included

Monthly Rates (Non-Tobacco)

$10,000 Employee Benefit, Spouse at 50%, Child at 10% $15,000 Employee Benefit, Spouse at 50%, Child at 10%

$18.72

$24.22

$29.06

$17.02

$20.00

$25.50

Coronary Artery Disease

Major Organ Failure

Critical Illness insurance is designed to come to the rescue of those budget-conscious families by helping pay the costs associated with the initial occurrence of a heart attack, stroke, or other serious illness as defined in the policy. You choose your benefit amount. Benefits are also available for your spouse and eligible children.

Included

Included

Health Screening Benefit $50 per calendar year

Included

Percentage of Benefit

100%

25%

100%

Plan DetailsWellness

CRITICAL HEALTH EVENTSAdministered by: Trustmark

Employee Guaranteed Issue: $15,000, Spouse: $7,500, Child:$1,500

Family Options Available

Fully Portable Convenient Payroll DeductionHIGHLIGHTS

Plan Details Guaranteed Issue Amounts

Employee

Spouse

Child(ren)

55 $45.02 $86.45

60 $60.97 $118.34

$39.22

45 $27.39 $51.13

50 $33.97 $64.31

40 $21.41

$22.75

$26.00

$31.20

$50,000

The greater of $3 per week or $5,000

The greater of $3 per week or $5,000

$25,000 $50,000

Example Monthly Non-Tobacco Rates for Employee

Age

25

30

35

$13.13

$14.73

$17.33


There is no way to know what will happen tomorrow. But there is a way to help ensure you are protected against the unexpected. Universal life insurance can help meet your family's future financial needs in the event of your premature passing. Prudent financial planning can help protect your family's future, offering them peace of mind.

UNIVERSAL LIFEEVENTSAdministered by: Trustmark

Guaranteed Issue Restoration of Benefits Included

Fully Portable Long Term Care Included

HIGHLIGHTS

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NOTES

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15

NOTES

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KEY CONTACTS

For Questions About Carrier Phone Number

Medical & Prescription Drug TRS-ActiveCare Customer 800-222-9205

Dental Cigna 800-244-6224

Vision Humana 866-537-0229

Flexible Spending Accounts (FSAs) TASC 800-422-4661

Life and AD&D Insurance Unum 800-321-3889

Short-Term Disability (STD) Lincoln 800-487-1485

Long-Term Disability (LTD) Unum 800-321-3889

Accident, Critical Illness, Universal Life Trustmark 800-918-8877

Epic Brokers Michelle Dickinson 469-270-6774

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