E F F E C T I V E J A N U A R Y 1 , 2 0 1 9

EmployeeBenefit Summary

M E D I C A L , D E N TA L ,

V I S I O N , D RU G , F S A ,

L I F E I N S U R A N C E ,

4 0 3 ( b ) & 4 5 7 ( b ) ,

A N D R E T I R E M E N T

B E N E F I T S

Employee and Retiree Service Center ¡ 45 W. Gude Drive, Suite 1200, Rockville, MD 20850301-517-8100 ¡ www.montgomeryschoolsmd.org/departments/ersc

2 0 1 9

C H A N G E S F O R 2 0 1 9

¡ Life insurance vendor is changing to MetLife. (See page 28 for details.)

VISIONWe inspire learning by providing the greatest public education to each and every student.

MISSIONEvery student will have the academic, creative problem solving, and social emotional skills to be successful in college and career.

CORE PURPOSEPrepare all students to thrive in their future.

CORE VALUESLearning Relationships Respect Excellence Equity

Board of EducationMr. Michael A. DursoPresident

Mrs. Shebra L. EvansVice President

Ms. Jeanette E. Dixon

Dr. Judith R. Docca

Mrs. Patricia B. O’Neill

Ms. Jill Ortman-Fouse

Mrs. Rebecca K. Smondrowski

Ms. Ananya TadikondaStudent Member

Montgomery County Public Schools (MCPS) AdministrationJack R. Smith, Ph.D.Superintendent of Schools

Maria V. Navarro, Ed.D.Chief Academic Officer

Kimberly A. Statham, Ph.D.Deputy Superintendent of School Support and Improvement

Andrew M. Zuckerman, Ed.D.Chief Operating Officer

850 Hungerford Drive Rockville, Maryland 20850 www.montgomeryschoolsmd.org

M C P S N O N D I S C R I M I N A T I O N S T A T E M E N T

Montgomery County Public Schools (MCPS) prohibits illegal discrimination based on race, ethnicity, color, ancestry,

national origin, religion, immigration status, sex, gender, gender identity, gender expression, sexual orientation, family/

parental status, marital status, age, physical or mental disability, poverty and socioeconomic status, language, or other

legally or constitutionally protected attributes or affiliations. Discrimination undermines our community’s long-standing

efforts to create, foster, and promote equity, inclusion, and acceptance for all. Some examples of discrimination include

acts of hate, violence, insensitivity, harassment, bullying, disrespect, or retaliation. For more information, please review

Montgomery County Board of Education Policy ACA, Nondiscrimination, Equity, and Cultural Proficiency. This Policy

affirms the Board’s belief that each and every student matters, and in particular, that educational outcomes should never

be predictable by any individual’s actual or perceived personal characteristics. The Policy also recognizes that equity

requires proactive steps to identify and redress implicit biases, practices that have an unjustified disparate impact, and

structural and institutional barriers that impede equality of educational or employment opportunities.

For inquiries or complaints about discrimination against MCPS staff *

For inquiries or complaints about discrimination against MCPS students *

Office of Employee Engagement and Labor RelationsDepartment of Compliance and Investigations850 Hungerford Drive, Room 55Rockville, MD 20850240-740-2888OCOO-EmployeeEngagement@mcpsmd.org

Office of School Administration Compliance Unit850 Hungerford Drive, Room 162Rockville, MD 20850240-740-3215 COS-SchoolAdministration@mcpsmd.org

* Inquiries, complaints, or requests for accommodations for students with disabilities also may be directed to the supervisor of the Office of Special Education, Resolution and Compliance Unit, at 240-740-3230. Inquiries regarding accommodations or modifications for staff may be directed to the Office of Employee Engagement and Labor Relations, Department of Compliance and Investigations, at 240-740-2888. In addition, discrimination complaints may be filed with other agencies, such as: the U.S. Equal Employment Opportunity Commission, Baltimore Field Office, City Crescent Bldg., 10 S. Howard Street, Third Floor, Baltimore, MD 21201, 1-800-669-4000, 1-800-669-6820 (TTY); or U.S. Department of Education, Office for Civil Rights, Lyndon Baines Johnson Dept. of Education Bldg., 400 Maryland Avenue, SW, Washington, DC 20202-1100, 1-800-421-3481, 1-800-877-8339 (TDD), OCR@ed.gov, or www2.ed.gov/about/offices/list/ocr/complaintintro.html.

This document is available, upon request, in languages other than English and in an alternate format under the

Americans with Disabilities Act, by contacting the MCPS Department of Public Information and Web Services at 240-

740-2837, 1-800-735-2258 (Maryland Relay), or PIO@mcpsmd.org. Individuals who need sign language interpretation

or cued speech transliteration may contact the MCPS Office of Interpreting Services at 240-740-1800, 301-637-2958

(VP) or MCPSInterpretingServices@mcpsmd.org. MCPS also provides equal access to the Boy/Girl Scouts and other

designated youth groups.

07/01/2018

2019

Employee Benefit Summary

summary

www.montgomeryschoolsmd.org/departments/ersc

You are not enrolled automatically in the MCPS employee benefit plan. New employees must enroll online within 60 days following employment or wait for a future Employee Benefits Open Enrollment, typically held for four weeks beginning in early October, with coverage effective January 1 of the following year. To enroll online, new employees must log in to the Benefits Enrollment System (BES) by visiting the Employee Self Service (ESS) web page at:

www.montgomeryschoolsmd.org/departments/ersc/employees/employee-self-service/

From there, click the Benefits enrollment for new employees link, log in with your Outlook username and password, and follow the onscreen instructions.

During Open Enrollment, employees visit the ESS web page and click the Open Enrollment link to log in to the BES and make changes to their benefits. Outside of Open Enrollment, employees who experience a qualifying life event or return from long-term leave must visit ESS and click the Benefits enrollment/changes due to a qualifying life event link to log in to BES and re-enroll in or make changes to their benefits.

BES also can be used at any time to designate and change beneficiaries for basic employee term life insurance.

2019

2019

Specialty Drug Coverage .................................................................................................................... 25 Generic Drug Step Therapy ................................................................................................................ 25 Primary Preferred Drug List ............................................................................................................... 25 Compound Drug Preauthorization ...................................................................................................... 25 Morphine Milligram Equivalent Based Limits ................................................................................... 25 CVS Retail Pharmacy or CVS/Caremark Mail Service Pharmacy ..................................................... 26 Diabetic Supplies ................................................................................................................................ 26

Kaiser Permanente Prescription Plan .......................................................................................................... 26 Retail Pharmacy .................................................................................................................................. 27 Mail Order Service .............................................................................................................................. 27

Life Insurance ............................................................................................................................ 28 Employee Life Insurance ............................................................................................................................ 28

Basic Employee Term Life Insurance ................................................................................................. 28 Accelerated Death Benefit .................................................................................................................. 28 Optional Employee Life Insurance ..................................................................................................... 28

Dependent Life Insurance ........................................................................................................................... 29 Basic Dependent Life Insurance ......................................................................................................... 29 Optional Dependent Life Insurance .................................................................................................... 29

Flexible Spending Accounts .................................................................................................... 29

403(b) Tax Shelter Savings and 457(b) Deferred Compensation Plans .............................. 31 Applying for Distribution of Funds from 403(b) and/or 457(b) Accounts After Retirement ............. 32

Well Aware: Employee Wellness Program ............................................................................. 32

Retirement Benefits .................................................................................................................. 32 Social Security ............................................................................................................................................ 32 Pension Plans .............................................................................................................................................. 33

Membership ........................................................................................................................................ 33 Enrollment .......................................................................................................................................... 33 Contribution Rates .............................................................................................................................. 33 Pension Changes ................................................................................................................................. 33

Pension Benefits for Employees Hired Prior to July 1, 2011 ..................................................................... 33 Eligibility to Retire: Normal Retirement ............................................................................................ 33 Early Retirement ................................................................................................................................. 34 Benefit Amount ................................................................................................................................... 34

Pension Benefits for Employees Hired on or after July 1, 2011 ................................................................. 35 Eligibility to Retire: Normal Retirement ............................................................................................ 35 Early Retirement ................................................................................................................................. 35 Benefit Amount ................................................................................................................................... 35

Postretirement Health Benefits ................................................................................................................... 35 Learn More about Retirement ..................................................................................................................... 36

Employee Benefit Rate Charts ........................................................................................................... 37

2019

1

Eligible Dependents

o

o

o

o

o

Disabled Dependents

2019

2

Consolidated Omnibus Budget Reconciliation Act

(See Enrollment Basics in this booklet for benefits enrollment instructions.)

If you submit your online enrollment:

Your coverage will begin on:

On or before January 20 February 1

Between January 21 and February 20 March 1

On February 21 April 1

Special Rule for 10-Month Employees

(See Enrollment Basics in this booklet for benefits enrollment instructions.)

2019

3

Qualifying Life Event Forms Required Deadline to Add Newborn/adopted child Social Security number*

Birth certificate/registration* or Legal court documentation

60 days from the date of birth or adoption

Legal guardianship/custody Social Security number* Legal court documentation

60 days from the court award of legal guardianship

Spouse Social Security number Marriage certificate

60 days from the date of marriage

Loss/gain of coverage Insurance cancellation form or COBRA notice

60 days from the date of loss/gain of coverage

* If you cannot provide a Social Security number and a birth certificate or birth registration within the 60-day time frame, you may enroll your newborn with evidence that you have applied for a social security number and a birth certificate or birth registration. You must provide the social security number and birth certificate or birth registration to ERSC upon receipt. Failure to provide this information in a timely manner will result in termination of coverage.

2019

4

www.montgomeryschoolsmd.org/departments/ersc/employees/employee-self-service/

*It is recommended that you notify ERSC promptly because removing a dependent could change your coverage level and reduce your cost. You must provide evidence of other coverage in order to drop a dependent from coverage.

Loss of Non-MCPS Coverage

e

Special Rule for 10-month Employees

2019

5

www.montgomeryschoolsmd.org/departments/ersc/employees/leave/.

Flexible Spending Account Election

2019

6

www.montgomeryschoolsmd.org/departments/ersc/employees/leave/

Birthday Rule

2019

7

Retiree Benefit Summary www.montgomeryschoolsmd.org/uploadedFiles/retiree_benefit_summary_current.pdf.

2019

8

www.montgomeryschoolsmd.org/departments/ersc/employees/employee-self-service/.

during Open Enrollment each fall you must attest online as to whether or not you will be tobacco free for 12 months as of January 1 of the upcoming plan year

Quit for GoodWellness Initiatives

2019

9

Benefit Your Options Protecting Your HealthMedical Point-of-Service (POS) Health Plans Health Maintenance Organizations (HMO) Health Plans

CareFirst BlueChoice Advantage (POS) CareFirst BlueChoice HMO Kaiser Permanente HMO

Prescription Drug CVS Caremark Prescription Drug

(only available to CareFirst BlueChoice plan participants) Kaiser Permanente Prescription Drug (only available to Kaiser Permanente plan participants)

Dental CareFirst Preferred Dental Plan (PPO)

Aetna Dental Maintenance Organization (DMO) Kaiser Permanente Dental Plan (available only to Kaiser Permanente medical plan participants)

Vision Davis Vision (provided through CareFirst) Kaiser Permanente Vision Plan (available only to Kaiser Permanente medical plan participants)

Wellness Initiatives Health Risk Assessments Biometric Health Screenings Smoker (Tobacco-user) Surcharge CareFirst disease-management programs for diabetes, high cholesterol, and hypertension

Protecting Your IncomeFlexible Spending Accounts Medical spending account (up to $2,650/year)

Dependent care account (up to $5,000/year or $2,500/year if filing separately) Basic Term Life Insurance MetLife—

Employee (83 percent paid by MCPS)—2 times annual salary Dependent (paid by MCPS)—$2,000/spouse, $1,000/each eligible dependent child up to age 23

Optional Life Insurance MetLife— Employee—1 times annual salary (paid by employee) Dependent—$10,000/spouse or each eligible dependent child (paid by employee)

Protecting Your FutureDefined Contribution Plans 403(b) Tax Shelter Savings Plan 457(b) Deferred Compensation Plan

Fidelity—Elect a percentage or flat amount of your salary to contribute to each account, up to annual IRS limits (available at www.netbenefits.com/mcps)

Defined Benefit Pension Plans By completing the appropriate forms, you are enrolled in state and/or county-sponsored pension plans.

2019

10

www.montgomeryschoolsmd.org/departments/ersc/employees/benefits/wellness-initiatives.aspx

www.webmdhealth.com/kp/750/landing

www.carefirst.com/mcps

www.kp.org

Health Information Portability and Accountability Act

2019

11

Surcharge Waiver Option Quit for

Good

Quit for Good

2019

12

o

o

CareFirst BlueChoice Advantage POS Plan

2019

13

CareFirst BlueChoice HMO

www.carefirst.com/mcps

*AFHC is an out-of-area program that provides benefits for CareFirst BlueChoice plan participants residing outside of their home network service area for 90 days or more. Some areas of the country do not participate in AFHC. Members must reapply to the program every year. To take advantage of the AFHC program or to reapply, members should contact

CareFirst BlueChoice at 1-888-452-6403 for more information and enrollment procedures.

Kaiser Permanente HMO

www.kp.org

Patient Protection and Affordable Care Act,

2019

14

Preventive Services Covered with Zero Copay for Adults* Preventive Service Covered Who is Eligible, Additional Details Abdominal Aortic Aneurysm Screening one-time screening for men of specified ages who have ever smoked Alcohol Misuse Screening and Counseling all adults Aspirin Use men and women of certain ages Blood Pressure Screening all adults Cholesterol Screening adults of certain ages or at higher risk Colorectal Cancer Screening adults over 50 Depression Screening all adults Type 2 Diabetes Screening adults with high blood pressure Diet Counseling adults at higher risk for chronic disease HIV Screening

all adults at higher risk

Immunizations for: Hepatitis A Hepatitis B Herpes Zoster Human Papillomavirus Influenza Measles, Mumps, Rubella Meningococcal Pneumococcal Tetanus, Diphtheria, Pertussis Varicella

doses, recommended ages, and recommended populations vary

Obesity Screening and Counseling all adults Sexually Transmitted Infection (STI) Prevention Counseling adults at higher risk Tobacco Use Screening all adults and cessation interventions for tobacco users, expanded

counseling for pregnant tobacco users * Using in-network providers only

2019

15

Preventive Services Covered with Zero Copay for Women * Preventive Service Covered Who is Eligible, Additional Details Annual well-woman visit all women Syphilis Screening all pregnant women, all adults at higher risk Anemia Screening pregnant women, on a routine basis Bacteriuria Urinary Tract or Other Infection Screening pregnant women BRCA Counseling about Genetic Testing women at higher risk Breast Cancer Mammography Screenings women over 40, every 1 to 2 years Breast Cancer Chemoprevention Counseling women at higher risk Breast Feeding Interventions women (to support and promote breast feeding) Breast Feeding Support, Supplies, and Counseling women (to support and promote breast feeding) Cervical Cancer Screening sexually active women Chlamydia Infection Screening younger women and other women at higher risk Contraceptive Methods and Counseling (FDA-approved**), including:

Female Condom (OTC) Diaphragm (P) with Spermicide (OTC) Sponge (OTC) with Spermicide (OTC) Cervical Cap (P) with Spermicide (OTC)] Spermicide (OTC) Oral Contraceptive (P) Combined Pill Progestin Extended/Continuous Patch (P) Vaginal Contraceptive Ring (P) Shot/Injection (P) Morning After Pill (over 17 years of age OTC; under 17 years of age P) IUD (P) Implantable Rod (inserted by doctor) Sterilization Surgery Sterilization Implant

(OTC) Over the Counter (P) Prescription Required

all women

Folic Acid Supplements women who may become pregnant Gonorrhea Screening all women at higher risk Gestational Diabetes Screening pregnant women Hepatitis B Screening pregnant women at their first prenatal visit Human Immunodeficiency Virus (HIV) Counseling and Screening

all women, on an annual basis

Human Papillomavirus (HPV) Testing all women Interpersonal and Domestic Violence Screening and Counseling

all women

Osteoporosis Screening women over age 60 depending on risk factors Rh Incompatibility Screening all pregnant women and follow-up testing for women at higher risk Sexually Transmitted Infections Counseling all women, on an annual basis

* Using in-network providers only ** Includes surgical, prescription, medical, and OTC services/products. Sterilization is considered a contraceptive method. Abortion IS NOT considered a contraceptive method.

2019

16

Preventive Services Covered with Zero Copay for Children* Service Who is Eligible, Additional Details Alcohol and Drug Use Assessments adolescents Autism Screening children at 18 and 24 months Behavioral Assessments children of all ages Cervical Dysplasia Screening sexually active females Congenital Hypothyroidism Screening newborns

Developmental Screening children under age 3, and surveillance throughout childhood Dyslipidemia Screening children at higher risk of lipid disorders Fluoride Chemoprevention Supplements children without fluoride in their water source Gonorrhea Preventive Medication for the Eyes all newborns Hearing Screening all newborns Height, Weight, and Body Mass Index Measurements children of all ages Hematocrit or Hemoglobin Screening children of all ages Hemoglobinopathies or Sickle Cell Screening newborns HIV Screening adolescents at higher risk Immunization Vaccines for:

Diphtheria, Tetanus, Pertussis Haemophilus Influenzae Type B Hepatitis A Hepatitis B Human Papillomavirus Inactivated Poliovirus Influenza Measles, Mumps, Rubella Meningococcal Pneumococcal Rotavirus Varicella

children from birth to age 18; doses, recommended ages, and recommended populations vary

Iron Supplements children ages 6 to 12 months at risk for anemia Lead Screening children at risk of exposure Medical History all children, available throughout development Obesity Screening and Counseling children of all ages Oral Health Risk Assessment young children Phenylketonuria (PKU) Screening for Genetic Disorder newborns Sexually Transmitted Infection (STI) Prevention Counseling adolescents at higher risk Tuberculin Testing children at higher risk of tuberculosis Vision Screening children of all ages

* Using in-network providers only

2019

17

Health Maintenance Organization (HMO) Plans Kaiser Permanente HMO CareFirst BlueChoice HMO Annual Deductible None None Preventive CareRoutine Physical Exam Covered in full $10 copay* Well Baby/Child Care Covered in full (under age 5) $10 copay* Childhood Immunizations Covered in full (under age 5) $10 copay* Physician Services Physician Office Visit $10 copay $10 copay Specialist Office Visit $20 copay $20 copay Lab Work and X-rays Covered in full Covered in full

Allergy Shots $10 copay $10 copay $20 specialist copay

Maternity Care Prenatal and Postnatal Care $10 copay, no charge once pregnancy is

confirmed* $10 copay; no charge once pregnancy is confirmed*

Physician Services Covered in full Covered in full Hospital Services Covered in full Covered in full Emergency Services (when medically necessary) Urgent Care Centers $20 copay $20 copay Emergency Room $150 copay (waived if admitted) $150 copay (waived if admitted) Emergency Physician Services Covered in full Covered in full

Emergency Ambulance Covered in full if authorized Covered in full Hospital Services—Inpatient Semi-Private Room Covered in full Covered in full Professional Services Covered in full Covered in full Surgical Procedures Covered in full Covered in full Specialty Care/ Consultation Covered in full Covered in full Anesthesia Covered in full Covered in full Radiology and Drugs Covered in full Covered in full Intensive Care Covered in full Covered in full Coronary Care Covered in full Covered in full Hospital Services—Outpatient Surgical Procedures $20 copay $20 copay

Professional Fees Covered in full $10 copay ($20 copay for specialist)

Mental Health/Substance Abuse Services Inpatient Days Covered in full Covered in full Outpatient Visits $10 copay $10 copay Other Services Catastrophic Illness Covered in full Covered in full Durable Medical Equipment Covered in full You pay 25%* Home Health Care Covered in full Covered in full Hospice Care Covered in full Covered in full Skilled Nursing Care Covered in full up to 100 days per contract year Covered in full

*Applies to services not specifically listed in the previous preventive care charts. **Does not include diabetic supplies such as lancets, glucose strips, etc. See CVS/Caremark Prescription for details.

2019

18

Open Point-of-Service (POS) Plan CareFirst BlueChoice Advantage

(POS) In-Network Out-of-Network

Annual Deductible None $300 individual, $600 family

Preventive Care Routine Physical Exam $15 copay* Not covered Well Baby/Child Care $15 copay* 80%, no deductible Childhood Immunizations Covered in full 80%, no deductible Physician Services Physician Office Visit $15 copay 80% after deductible Specialist Office Visit $25 copay 80% after deductible

Lab Work and X-rays Covered in full Diagnostic: 80% after deductible Routine: not covered

Allergy Evaluations $15 copay each visit 80% after deductible Allergy Shots Covered in full 80% after deductible Maternity Care Prenatal and Postnatal Care $25 copay first visit, covered in full after* 80% after deductible Physician Services Covered in full 80% after deductible Hospital Services Covered in full 80% after deductible Emergency Services (when medically necessary) Urgent Care Centers $25 copay Paid as in-network Emergency Room $150 copay (waived if admitted) $100 copay (waived if admitted) Emergency Physician Services Covered in full Covered in full Emergency Ambulance Covered in full Covered in full Hospital Services—Inpatient Semi-Private Room Covered in full 80% after deductible up to 180 daysProfessional Services Covered in full 80% after deductible Surgical Procedures Covered in full 80% after deductible Specialty Care/ Consultation Covered in full 80% after deductible Anesthesia Covered in full 80% after deductible Radiology and Drugs Covered in full 80% after deductible Intensive Care Covered in full 80% after deductible Coronary Care Covered in full 80% after deductible Hospital Services – Outpatient Surgical Procedures $25 copay 80% after deductible Professional Fees Covered in full 80% after deductible Mental Health/Substance Abuse Services Inpatient Days Covered in full 80% after deductible (up to 180 days) Outpatient Visits $15 copay 80% after deductible Other Services Catastrophic Illness Covered in full Covered in full after $1,000 out-of-pocket expenses

(excludes deductible) Durable Medical Equipment** Covered in full 80% after deductible Home Health Care/ Skilled Nursing Care

Covered in full 80% after deductible (up to 60 visits in- and out-of-network)

Hospice Care Covered in full 80% after deductible *Applies to services not listed in the previous preventive care charts. **Does not include diabetic supplies such as lancets, glucose strips, etc. See CVS/Caremark Prescription for details. Please Note: All percentages shown for out-of-network services are up to the allowed benefit, as determined by CareFirst BlueChoice. The description of benefits and services is only a summary. For complete information, please refer to the evidence of coverage on the ERSC website.

2019

19

www.montgomeryschoolsmd.org/departments/ersc/employees/benefits/

www.montgomeryschoolsmd.org/departments/ersc/employees/employee-self-service/

www.netbenefits.com/MCPS

CareFirst Preferred Dental Plan (PPO)

www.carefirst.com/mcps

New employees eligible for benefits are enrolled in the basic term life insurance plan automatically. You will need to designate a beneficiary for basic life insurance when you enroll in benefits via the BES. If you wish to decline basic term life insurance coverage, you must do so online by electing “decline” life insurance coverage. See the Life Insurance section of this document for additional details. You may update your life insurance beneficiaries at any time by using the BES. Make sure to update beneficiary designations as your circumstances change.

2019

20

Aetna Dental Maintenance Organization (DMO)

www.aetna.com/docfind

Kaiser Permanente Dental Plan

www.montgomeryschoolsmd.org/departments/ersc/employees/benefits/health/medical/kaiser.aspx

2019

21

Dental Benefits CareFirst PPO Aetna DMO

In-Network Plan pays:

Out-of-Network Plan pays:

In-Network OnlyPlan pays:

Maximum Annual Benefit $2,000 $2,000 None Annual Deductible Class I Class II Class III

None $50 $50

None $100 $100

None None None

Diagnostic (Class I) Routine exams X-rays Prophylaxis (includes scaling and polishing) Fluoride (one treatment per year up to age 18) Sealants (one treatment every three years on permanent molars only under age 16) Oral Hygiene Instruction

100% Oral Hygiene Instruction not covered

80% Oral Hygiene Instruction not covered

100%

Basic (Class II) Amalgam Composite Filling (anterior tooth only) Pulp Capping Root Canal Therapy with X-rays and Cultures (other than molar root canal) Scaling and Root Planing

100% 80% 100%

Basic (Class II) Space Maintainers Molar Root Canal Therapy Osseous Surgery (periodontal surgery) General Anesthesia

100% 80% 75%

Major (Class III) Inlays, Onlays, and Crowns Full and Partial Dentures Bridge Pontics, and Abutments

50% 40% Maximum eligible charge per service: $400

75%

Major (Class III) Surgical Removal of Impacted Teeth 100%

80% Maximum eligible charge per service: $400

75%

Orthodontics (Class IV) Orthodontic Appliances and Treatment (one lifetime treatment per covered dependent child only if treatment begins prior to age 20 while covered under the MCPS plan)

50%, up to $1,000 lifetime maximum

30%, up to $1,000 lifetime maximum

50%, no lifetime maximum

Dental Implants 50% N/A N/A

2019

22

Davis Vision Plan

Service Maximum Benefit

Limits

Exams: Optometrist Ophthalmologist

$50 $66

One exam during any consecutive 18-month period

Frames: Frames only

$40

One set of frames during any consecutive 18-month period (in lieu of contact lenses)

Lenses only, per pair: Single vision Bifocal Trifocal Lenticular Contact Lenses: Medically Necessary** Standard or Disposable

$40 $70 $90 $240 $230 $80

Two lenses during any consecutive 18-month period (in lieu of contact lenses) In lieu of lenses & frames

**Contact lenses are covered up to $230 only if they are prescribed after cataract surgery or when needed to restore the visual acuity of the person’s healthier eye to 20/70 or better, and if this cannot be accomplished with regular glasses. Otherwise, they are covered at $80 in lieu of glasses.

www.DavisVisionContacts.com

2019

23

www.carefirst.com/mcps

Kaiser Vision Plan

www.montgomeryschoolsmd.org/departments/ersc/employees/benefits/health/medical/kaiser.aspx

KAISER PERMANENTE VISION PLAN

COPAYS

Exams: Optometrist Ophthalmologist

$10 per visit $15 per visit

Lenses and frames: (Limited to a select group)

No charge for one pair per contract year

Contact lenses: (Limited to a select group)

No charge for initial fit and first purchase per contract year

Medically necessary contact lenses: (Limited to a select group)

No charge

Low vision aids: (Unlimited low vision aids from available supply)

No charge

CVS/Caremark Prescription Plan

2019

24

Retail (up to 30-day

supply)

CVS/Caremark Mail Service

Pharmacy or CVS retail pharmacy

(up to 90-day supply)

Generic $10 copay One refill allowed for maintenance medications

$10 copay

Preferred Brand Name (no generic equivalent)*

$25 copay One refill allowed for maintenance medications

$25 copay

Non-Preferred Brand Name**

$40 copay One refill allowed for maintenance medications

$40 copay***

*Detailed information is available on the CVS/Caremark website. **If you purchase a brand name drug when a generic equivalent exists, you pay the generic drug copay plus the difference between the non-preferred brand name drug and generic drug cost. Example: Generic drug cost is $100, Non-Preferred Brand Name drug cost is $200, and your copay is $110. ***There is no penalty for purchasing a brand name drug that has a generic equivalent if a letter of medical necessity is filed. See details on following page.

You can purchase your 90-day supply of maintenance medication at a CVS pharmacy for the same copay as the CVS/Caremark Mail Service pharmacy.

If you choose not to purchase a maintenance medication at a CVS pharmacy or through CVS/Caremark Mail Service after two fills at another retail pharmacy, you will pay the corresponding copay, plus the difference between the mail order and retail prescription cost.

2019

25

www.caremark.com

www.caremark.com

—

www.caremark.com

2019

26

www.caremark.com

Kaiser Permanente Prescription Plan

2019

27

Kaiser Medical Center

Pharmacy (up to 60-day

supply)

Kaiser Network Pharmacy (up

to 60-day supply)

Mail Order (up to 90-day

supply)

Kaiser Generic

$10 copay $15 copay $10 copay

Kaiser Brand Name (only when no generic equivalent is available)

$15 copay $20 copay $10 copay

www.kp.org

2019

28

Basic Employee Term Life Insurance

*For 10-month employees reporting for the school year in August, coverage begins October 1.

An employee with a salary of $52,300 would have $104,000 of employee basic term life insurance coverage ($52,000 times 2).

Employee Benefit Plan Enrollment

Optional Employee Life Insurance

2019

29

e

Basic Dependent Life Insurance

Optional Dependent Life Insurance

Optional Employee Term Life Insurance Enrollment/Cancellation

plan year

plan year. calendar year

calendar year

2019

30

www.benstrat.com/ for a completelisting of eligible expenses for dependentcare and medical flexible spending accounts.

.

www.benstrat.com/

All expenditures are subject to audit. It is important to retain all receipts.

2019

31

(Defined Contribution Plans)

2019

32

www.netbenefits.com/mcps

www.irs.gov www.netbenefits.com/mcps

Applying for Distribution of Funds from 403(b) and/or 457(b) Accounts After Retirement

www.irs.gov

www.netbenefits.com/mcps

As a plan participant, you are responsible for the review and selection of any and all investment options. You must review them carefully before making any investment decisions. Neither MCPS nor any of its employees has any liability or responsibility for investment options that you select.

2019

33

www.ssa.gov

Membership

Enrollment

Contribution Rates

Pension Changes

Eligibility to Retire: Normal Retirement

Age at Retirement Minimum Eligibility Service

62 5 years

63 4 years

64 3 years

65 2 years

Any age 30 years

2019

34

Early Retirement

Benefit Amount

Benefit Formula for Employees with Service Prior to July 1, 1998

.008 x average final salary(AFS) up to the SSIL plus .015 x AFS in excess of the SSIL

X credited service before 7/1/98

OR .012 x AFS x credited service before 7/1/98

PLUS

.018 x AFS x credited service after 7/1/98

.0008 x AFS up to the SSIL plus .0015 x AFS in excess of the SSIL x

credited service before 7/1/98 plus

.002 x average final salary x credited service after 7/1/98

2019

35

Benefit Formula for Employees Hired Between July 1, 1998, and June 30, 2011

.018x AFS x credited service

.002 x AFS x credited service

Eligibility to Retire: Normal Retirement

Early Retirement

Benefit Amount

Benefit Formula for Employees Hired On or After July 1, 2011

1.5% x average final salary x credited service

.2% x average final salary x credited service

2019

36

MCPS Eligible Service upon Retirement

Retiree Pays MCPS Pays

10 up to 15 years 60% 40% 15 up to 20 years 50% 50% 20 or more years 36% 64%

Understanding Your Retirement

PenPoint

sra.state.md.us

Active Employee Cost - Calendar Year 2019Healthcare Costs

Non-Tobacco-User; Completed Neither Health Risk Assessment nor Biometric Health ScreeningBase Employee Cost Share*

Effective January 1, 2019

Medical PlansCoverage Level

Employee Percentage

Biweekly10-Month Employee

Biweekly12-Month Employee

Point of Service PlansCareFirst BlueChoice Adv POS Individual 17% 52.90 40.69

Individual + Spouse 17% 105.79 81.37Individual + Child 17% 105.79 81.37Family (Individual + Spouse + Child(ren)) 17% 143.93 110.72Family (Individual + Children) 17% 143.93 110.72

Health Maintenance Organization PlansCareFirst BlueChoice HMO Individual 12% 28.43 21.87

Individual + Spouse 12% 53.43 41.10Individual + Child 12% 53.43 41.10Family (Individual + Spouse + Child(ren)) 12% 87.54 67.34Family (Individual + Children) 12% 87.54 67.34

Kaiser Permanente HMO Individual 12% 38.36 29.51Individual + Spouse 12% 76.56 58.89Individual + Child 12% 76.56 58.89Family (Individual + Spouse + Child(ren)) 12% 110.91 85.32Family (Individual + Children) 12% 110.91 85.32

Supplemental PlansCoverage Level

Employee Percentage

Biweekly10-Month Employee

Biweekly12-Month Employee

Caremark Prescription Individual 17% 17.46 13.43Individual + Spouse 17% 34.88 26.83Individual + Child 17% 34.88 26.83Family (Individual + Spouse + Child(ren)) 17% 43.04 33.11Family (Individual + Children) 17% 43.04 33.11

Kaiser Permanente Prescription Individual 17% 7.02 5.40Individual + Spouse 17% 13.88 10.68Individual + Child 17% 13.88 10.68Family (Individual + Spouse + Child(ren)) 17% 20.11 15.47Family (Individual + Children) 17% 20.11 15.47

CareFirst Dental PPO Individual 17% 3.34 2.57Individual + Spouse 17% 6.67 5.13Individual + Child 17% 6.67 5.13Family (Individual + Spouse + Child(ren)) 17% 9.80 7.54Family (Individual + Children) 17% 9.80 7.54

Aetna Dental DMO Individual 17% 2.20 1.69Individual + Spouse 17% 4.40 3.38Individual + Child 17% 4.40 3.38Family (Individual + Spouse + Child(ren)) 17% 6.46 4.97Family (Individual + Children) 17% 6.46 4.97

Davis Vision Individual 17% 0.16 0.12Individual + Spouse 17% 0.29 0.22Individual + Child 17% 0.29 0.22Family (Individual + Spouse + Child(ren)) 17% 0.37 0.28Family (Individual + Children) 17% 0.37 0.28

*Your rates may vary based on your participation in the Wellness Initiatives program. Visit the Employee Benefits web page to see all of the rate combinations. Employee Benefits web page

Employee Life Insurance 100% rate = $.059 per thousand of insurance per monthBased on two times current salary rounded to the nearest $1,000

Active Employee Cost - Calendar Year 2019LEAVE RATE SCHEDULE100% ACTIVE EMPLOYEE RATE

Effective January 1, 2019

Component CostMONTHLY ANNUAL

CareFirst BlueChoice Adv POS Individual 518.56 6,222.72Individual + Spouse 1,037.11 12,445.32Individual + Child 1,037.11 12,445.32Family (Individual + Spouse + Child(ren)) 1,411.11 16,933.32Family (Individual + Children) 1,411.11 16,933.32

CareFirst BlueChoice HMO Individual 394.85 4,738.20Individual + Spouse 742.12 8,905.44Individual + Child 742.12 8,905.44Family (Individual + Spouse + Child(ren)) 1,215.84 14,590.08Family (Individual + Children) 1,215.84 14,590.08

Kaiser Permanente HMO Individual 532.82 6,393.84Individual + Spouse 1,063.35 12,760.20Individual + Child 1,063.35 12,760.20Family (Individual + Spouse + Child(ren)) 1,540.41 18,484.92Family (Individual + Children) 1,540.41 18,484.92

Caremark Prescription Individual 171.16 2,053.92Individual + Spouse 341.95 4,103.40Individual + Child 341.95 4,103.40Family (Individual + Spouse + Child(ren)) 421.99 5,063.88Family (Individual + Children) 421.99 5,063.88

Kaiser Permanente Prescription Individual 68.85 826.20Individual + Spouse 136.16 1,633.92Individual + Child 136.16 1,633.92Family (Individual + Spouse + Child(ren)) 197.14 2,365.68Family (Individual + Children) 197.14 2,365.68

CareFirst PPO Dental Individual 32.68 392.16Individual + Spouse 65.39 784.68Individual + Child 65.39 784.68Family (Individual + Spouse + Child(ren)) 96.06 1,152.72Family (Individual + Children) 96.06 1,152.72

Aetna DMO Dental Individual 21.55 258.60Individual + Spouse 43.12 517.44Individual + Child 43.12 517.44Family (Individual + Spouse + Child(ren)) 63.38 760.56Family (Individual + Children) 63.38 760.56

Davis Vision Individual 1.55 18.60Individual + Spouse 2.86 34.32Individual + Child 2.86 34.32Family (Individual + Spouse + Child(ren)) 3.62 43.44Family (Individual + Children) 3.62 43.44

Active Employee Cost - Calendar Year 2019Optional Term Life Insurance (Employee and Dependent)

Effective January 1, 2019

10-month 12-monthUnder 25 0.014 0.01125 - 29 0.017 0.01330 - 34 0.019 0.01535 - 39 0.023 0.01840 - 44 0.026 0.02045 - 49 0.040 0.03150 - 54 0.057 0.04455 - 59 0.111 0.08560 - 64 0.168 0.12965 - 69 0.325 0.250

70 and over 0.530 0.408

$46,000.0046

$1.10

$10,000.00

$1.15

$1.50

Bi-weekly payroll deduction for 12-month employees

Bi-weekly payroll deduction for 10-month employees

Coverage Amount (one times the annual salary)Thousands of CoverageBi-weekly Cost = 46 x .024

Optional Dependent Term Life InsuranceYou must be enrolled in Basic Employee Term Life coverage to elect Optional Dependent Term Life coverage. Coverage for qualified dependent children will continue until September 30 following their 23rd birthday.

Coverage Amount for each qualified dependent spouse and/or dependent child(ren)

Optional Employee Term Life InsuranceEligible employees enrolled for basic term life insurance are entitled to purchase additonal one times their salary (rounded down to the nearest thousand) in life insurance. The cost of optional life insurance is based on age and is paid entirely by the employee through payroll deductions.

Age BracketBi-weekly Employee Deductions

(per thousand of coverage)

SAMPLE CALCULATION: Optional Term Life Insurance Coverage rates for a 37 year-old, 10-month employee who earns $46,000 a year.

/

VISIONWe inspire learning by providing the greatest public education to each and every student.

MISSIONEvery student will have the academic, creative problem solving, and social emotional skills to be successful in college and career.

CORE PURPOSEPrepare all students to thrive in their future.

CORE VALUESLearning Relationships Respect Excellence Equity

Board of EducationMr. Michael A. DursoPresident

Mrs. Shebra L. EvansVice President

Ms. Jeanette E. Dixon

Dr. Judith R. Docca

Mrs. Patricia B. O’Neill

Ms. Jill Ortman-Fouse

Mrs. Rebecca K. Smondrowski

Ms. Ananya TadikondaStudent Member

Montgomery County Public Schools (MCPS) AdministrationJack R. Smith, Ph.D.Superintendent of Schools

Maria V. Navarro, Ed.D.Chief Academic Officer

Kimberly A. Statham, Ph.D.Deputy Superintendent of School Support and Improvement

Andrew M. Zuckerman, Ed.D.Chief Operating Officer

850 Hungerford Drive Rockville, Maryland 20850 www.montgomeryschoolsmd.org

M C P S N O N D I S C R I M I N A T I O N S T A T E M E N T

Montgomery County Public Schools (MCPS) prohibits illegal discrimination based on race, ethnicity, color, ancestry,

national origin, religion, immigration status, sex, gender, gender identity, gender expression, sexual orientation, family/

parental status, marital status, age, physical or mental disability, poverty and socioeconomic status, language, or other

legally or constitutionally protected attributes or affiliations. Discrimination undermines our community’s long-standing

efforts to create, foster, and promote equity, inclusion, and acceptance for all. Some examples of discrimination include

acts of hate, violence, insensitivity, harassment, bullying, disrespect, or retaliation. For more information, please review

Montgomery County Board of Education Policy ACA, Nondiscrimination, Equity, and Cultural Proficiency. This Policy

affirms the Board’s belief that each and every student matters, and in particular, that educational outcomes should never

be predictable by any individual’s actual or perceived personal characteristics. The Policy also recognizes that equity

requires proactive steps to identify and redress implicit biases, practices that have an unjustified disparate impact, and

structural and institutional barriers that impede equality of educational or employment opportunities.

For inquiries or complaints about discrimination against MCPS staff *

For inquiries or complaints about discrimination against MCPS students *

Office of Employee Engagement and Labor RelationsDepartment of Compliance and Investigations850 Hungerford Drive, Room 55Rockville, MD 20850240-740-2888OCOO-EmployeeEngagement@mcpsmd.org

Office of School Administration Compliance Unit850 Hungerford Drive, Room 162Rockville, MD 20850240-740-3215 COS-SchoolAdministration@mcpsmd.org

* Inquiries, complaints, or requests for accommodations for students with disabilities also may be directed to the supervisor of the Office of Special Education, Resolution and Compliance Unit, at 240-740-3230. Inquiries regarding accommodations or modifications for staff may be directed to the Office of Employee Engagement and Labor Relations, Department of Compliance and Investigations, at 240-740-2888. In addition, discrimination complaints may be filed with other agencies, such as: the U.S. Equal Employment Opportunity Commission, Baltimore Field Office, City Crescent Bldg., 10 S. Howard Street, Third Floor, Baltimore, MD 21201, 1-800-669-4000, 1-800-669-6820 (TTY); or U.S. Department of Education, Office for Civil Rights, Lyndon Baines Johnson Dept. of Education Bldg., 400 Maryland Avenue, SW, Washington, DC 20202-1100, 1-800-421-3481, 1-800-877-8339 (TDD), OCR@ed.gov, or www2.ed.gov/about/offices/list/ocr/complaintintro.html.

This document is available, upon request, in languages other than English and in an alternate format under the

Americans with Disabilities Act, by contacting the MCPS Department of Public Information and Web Services at 240-

740-2837, 1-800-735-2258 (Maryland Relay), or PIO@mcpsmd.org. Individuals who need sign language interpretation

or cued speech transliteration may contact the MCPS Office of Interpreting Services at 240-740-1800, 301-637-2958

(VP) or MCPSInterpretingServices@mcpsmd.org. MCPS also provides equal access to the Boy/Girl Scouts and other

designated youth groups.

07/01/2018

ROCKVILLE, MARYLAND

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COPYRIGHT © 2018 MONTGOMERY COUNTY PUBLIC SCHOOLS