RETIREE Benefit Newsletter€¦ · School District of Clayton 2019 Annual Enrollment Page 5 Cigna...
Transcript of RETIREE Benefit Newsletter€¦ · School District of Clayton 2019 Annual Enrollment Page 5 Cigna...
RETIREE
Benefit Newsletter
Page 1
Table of Contents
SUBJECT PAGE MEDICAL Base Plan. . . . . . . . . . . . . 2 Buy-Up Plan. . . . . . . . . . . 2 QHDHP……... . . . . . . . . . 3 DENTAL PPO - Delta Dental . . . . . . 4 DHMO - Cigna . . . . . . . . . 5 VISION.—EyeMed . . . . . . . . 6 ADDITIONAL INFORMATION Medicare & H.S.A. . . . . . . 7 Medicaid/CHIP Notice . . . 8 OPEN ENROLLMENT Access Information. . . . . . 9 Enrollment Dates . . . . . . . 9 Non-Discrimination Disclosure. . . . . . . . . . . . . 10 How to Enroll. . . . . . . . . . . . 11
2019 OPEN ENROLLMENT The School District of Clayton is getting ready for the 2019 benefit year which begins on January 1, 2019. The District’s benefit package will continue to offer Medical, Dental, and Vision benefit plans, Anthem Blue Cross Blue Shield will continue to be our medical carrier for the upcoming year. The benefits offered to you contain three medical plan options. These include a Base, Buy-Up, and a Qualified High Deductible Health Plan. The Qualified High Deductible Health Plan allows those who are not enrolled in Medicare to enroll in a Health Savings Account. You will once again have the choice between two dental plans, a PPO and a DHMO. The PPO plan will be provided by Delta Dental and allows you to move freely between In-Network and Non-Network providers. The DHMO plan is again offered through CIGNA. This type of plan offers a greater benefit, however, it is more restrictive as you must choose a network provider for your dental care. You will receive all services from that provider and be referred to a specialist for any specialty dental procedures. The vision plan will be administered through EyeMed. A brief summary of all our benefit plans along with rates based upon the coverage you select are provided in this newsletter. Open enrollment begins on October 22 and ends on October 29. Mary Jo Gruber Chief Financial Officer PLEASE NOTE: IF YOU DO NOT WANT TO MAKE ANY CHANGES THIS YEAR TO YOUR BENEFITS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH OUR 2019 CARRIERS. IF YOU WANT TO MAKE CHANGES TO YOUR BENEFITS, YOU WILL NEED TO LOG INTO THE PORTAL AND MAKE THE NECESSARY CHANGES . YOU CAN ALSO CALL EXPLAIN MY BENEFITS AT 1-888-734-6937 Option 3 AND THEY WILL ASSIST WITH YOUR ELECTIONS AND/OR CHANGES.
Type of Coverage
Monthly Cost
Employee Only $660.00
Employee & Spouse $1,265.00
Employee & Children $1,040.00
Employee & Family $1,640.00
Benefit/Service In Network Non-Network
YOU PAY YOU PAY
Deductible $750 / Individual $1,500 / Family
$1,500 / Individual $3,000 / Family
Coinsurance 10% 40%
Out-of-Pocket Maximum
$3,500 / Individual $7,000 / Family
$6,000 / Individual $12,000 / Family
Office Visit $30 Primary Care
$60 Specialist 40%
After Deductible
Preventive Care 100% Covered 40%
After Deductible
Inpatient Hospital
10% After Deductible
40% After Deductible
Outpatient Hospital
10% After Deductible
40% After Deductible
Urgent Care $50 Co-Pay 40%
After Deductible
Emergency Room
$300 Co-Pay $300 Co-Pay
Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3
$10 Co-Pay $40 Co-Pay $70 Co-Pay
$20 Co-Pay $80 Co-Pay
$140 Co-Pay
Not Covered
Not Covered
BASE PLAN
Benefit/Service In Network Non-Network
YOU PAY YOU PAY
Deductible $250 / Individual $500 / Family
$500/ Individual $1,000 / Family
Coinsurance 0% 30%
Out-of-Pocket Maximum
$2,500 / Individual $5,000 / Family
$4,000 / Individual $8,000 / Family
Office Visit $25 Primary Care
$50 Specialist 30%
After Deductible
Preventive Care 100% Covered 30%
After Deductible
Inpatient Hospital
0% 30%
After Deductible
Outpatient Hospital
0% 30%
After Deductible
Urgent Care $50 Co-Pay 30%
After Deductible
Emergency Room
$200 Co-Pay $200 Co-Pay
Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3
$10 Co-Pay $40 Co-Pay $70 Co-Pay
$20 Co-Pay $80 Co-Pay
$140 Co-Pay
Not Covered
Not Covered
BUY UP PLAN - MONTHLY COST BASE PLAN - MONTHLY COST
Retiree Cost
The deductible, co-pays, and prescription drug co-pays count towards the out-of-pocket maximum.
This option offers the lowest out-of-pocket maximum . The co-pays, and prescription drug co-pays count towards the out-of-pocket maximum.
Traditional PPO Medical Plans BUY-UP PLAN
Type of Coverage
Monthly Cost
Employee Only $795.00
Employee & Spouse $1,560.00
Employee & Children $1,290.00
Employee & Family $2,080.00
Retire Cost
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School District of Clayton 2019 Annual Enrollment
Benefit/Service In Network Non-Network
YOU PAY YOU PAY
Deductible $3,000/ Individual $6,000 / Family
$6,000 / Individual $12,000 / Family
Coinsurance 10% 30%
Out-of-Pocket Maximum
$4,000 / Individual $8,000 / Family
$9,000 / Individual $15,000 / Family
Office Visit Deductible 30%
After Deductible
Preventive Care 100% Covered 30%
After Deductible
Inpatient Hospital 10%
After Deductible 30%
After Deductible
Outpatient Hospital 10%
After Deductible 30%
After Deductible
Urgent Care 10%
After Deductible 30%
After Deductible
Emergency Room 10%
After Deductible 30%
After Deductible
Prescription Retail & Mail Order
Deductible then
10%
Not Covered
If you elect the Qualified High Deductible Health Plan (QHDHP) you can also participate in a Health Savings Account (HSA) if you are not enrolled in, or eligible for, Medicare. You cannot be covered elsewhere under a non-qualified plan.
All expenses count towards the deductible, which has to be satisfied first before you receive benefits under this plan.
The single deductible applies to the family deductible. Once the single deductible has been satisfied, benefits for that member are payable subject to coinsurance. Once the family deductible has been satisfied, benefits for the family will be payable subject to coinsurance.
School District of Clayton 2019 Annual Enrollment
Qualified High Deductible Health Plan (HSA Qualified)
Type of Coverage Monthly
Cost
Employee $535.00
Employee & Spouse/ $915.00
Employee & Child(ren) $755.00
Employee & Family $1,250.00
QUALIFIED HIGH DEDUCTIBLE PLAN
Retiree Cost
ANTHEM BLUE CROSS BLUE SHIELD
To find helpful medical benefit information and tools, log on to
anthem.com Log on to: My Online Services
Find Doctors and Hospitals
Check Claim Status
Order New ID Cards
Print Temporary ID Cards
View Benefits
Refill Mail Order Prescriptions
Access Anthem’s Drug List
Member Services: 1-800-490-6145
Policy No. 00252877
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The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA.
Employees age 55 and over may contribute an additional $1,000 annually to their HSA.
You cannot be enrolled in another health plan that is not a QHDHP.
If you are enrolled in Medicare you cannot participate in the Health Savings Account.
You or your spouse cannot participate in a Medical Flexible Spending Account.
You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP.
IRS rules dictate calendar year maximum deposits into Health Savings Accounts. You cannot exceed these set maximums. Maximum allowed deposits for the calendar year 2019 are:
Individual Accounts: $3,500 Family Accounts: $7,000
You have two dental plan options. One option is a PPO plan with Delta Dental. This option offers you more freedom to choose any dentist. The second option is a Dental Health Maintenance Organization (DHMO) with Cigna (Shown on Page 5) .
Benefits PPO PREMIER NON-
NETWORK
You Pay You Pay You Pay
Deductible Individual Family
$50 $150
$50 $150
$50 $150
Coinsurance
Diagnostic/Preventive
Basic Services
Major Services
Orthodontia (child)
0%
Deductible is Waived
10%
Deductible Applies
40%
Deductible Applies
50% Deductible Does
Not Apply
0%
Deductible is Waived
20% Deductible Applies
50%
Deductible Applies
50% Deductible Does
Not Apply
0% Deductible is Waived
20% Deductible Applies
50% Deductible Applies
50% Deductible Does
Not Apply
90%
Percentile
Annual Maximum Benefit
$1,500/person
Ortho Lifetime Max. $1,000/child
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Dental - PPO
School District of Clayton 2019 Annual Enrollment
Met Life our PPO dental carrier.
Log on to: www.deltadentalmo.com
Find a Dentist
Check Claim Status
Order New ID Cards
Member Services: 800-335-8266
Customer Service: [email protected]
Policy Number: 01190301
Type of Coverage Monthly
Cost
Employee $41.08
Employee & Spouse $82.17
Employee & Child(ren) $94.71
Employee & Family $135.42
Retiree Cost - PPO
Plan Highlights
If you believe your dental procedure will exceed $300, have your dentist contact Met Life for an estimate.
Is your dentist a non-network dentist? Benefits will be paid at the 90th percentile, which means what 9 out of 10 dentists charge in area where your dentist is lo-cated. This could cause you to have higher out-of-pocket expenses.
Dental - DHMO
The CIGNA DHMO patient charge schedule is not changing for 2019. Following is a sample schedule:
CODE PROCEDURE PATIENT PAYS
D1110 Adult Cleaning No Charge
D0270 Bitewings No Charge
D0330 Panoramic X-Ray No Charge
D2330 Composite - Surface No Charge
D2140 Amalgam - 1 surface No Charge
D2752 Crown - Porcelain $425
D6794 Crown - Titanium $460
D3310 Root Canal - Anterior $210
D3320 Root Canal - Bicuspid $245
D3330 Root Canal - Molar $335
D4210 Gingivectomy 4 per Quad $180
D5110 Full Upper Denture $625
D5120 Full Lower Denture $625
D6065 Implant supported porcelain/ceramic crown
$790
Ortho 24-Month Treatment Fee $2,040
School District of Clayton 2019 Annual Enrollment
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Cigna our DHMO Dental Carrier Log on to: www.cigna.com
Find a Dentist
Check Claim Status
Order New Id Cards
Member Services: 1-800-244-6224
Policy Number: 10050105
Plan Highlights
You are responsible for a $5 Office Visit Fee per patient, per office visit.
You have to be on the dentist’s roster in order to receive treatment.
Check the Patient Charge Schedule K1-V9 before receiving services to know what your responsibility is.
The Patient Charge Schedule K1-V9 is located in Custom Solutions or you can contact Barb Daves in the Business Office for a copy.
If a procedure is not shown in the schedule, it is not covered.
Type of Coverage Monthly
Cost
Employee $26.67
Employee & Spouse/SSDP $46.74
Employee & Child(ren) $49.46
Employee & Family $74.96
Retiree Cost - DHMO
Benefit/Service In Network Non-
Network
You Pay Reimbursement
Exam Co-pay 0% $35
Frequency Exam Lenses Frames
Every 12 months Every 12 months Every 24 months
Lenses Single Bifocal Trifocal
$5 Co-pay then
0% 0% 0%
$35 $45 $60
Frames
0%
$50 Wholesale $125 to $150
Retail
$35
Contacts Medically Necessary Cosmetic
UCR* $130 Allowance
$250 $130 Allowance
* UCR refers to Usual Customary and Reasonable charges. To determine the UCR, EyeMed takes the procedural charge of area providers and calculates an average. Charges above this average become your responsibility.
Vision Plan
School District of Clayton 2019 Annual Enrollment
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Type of Coverage Monthly
Cost
Employee $4.40
Employee & Spouse $8.36
Employee & Children $8.80
Employee & Family $12.94
Retiree Cost
PLAN HIGHLIGHTS If you visit one of EyeMed’s providers you
do not have to obtain a voucher. Your vi-sion provider can receive your benefits electronically.
Non-Network benefits are based on a reimbursement schedule.
You are eligible for savings on Lasik vision services. Savings range from 40% to 50% off the national average price of traditional Lasik.
Contact lens allowance is for lenses. In network providers are contracted to charge no more than $40 for the standard contact lens fit and follow up exam.
EyeMed is our vision carrier Log on to: www.eyemed.com
To find a provider
Member Services: 866-939-3633
Policy Number: 1018839
Additional Information
School District of Clayton 2019 Annual Enrollment
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How Your Medical Plan Works with Medicare
THIS IS IMPORTANT IF YOU ARE A RETIREE AGE 65 OR OLDER...
If you are a retiree of The School District of Clayton who elects to be covered under the medical plan and you are age 65 or older, you MUST enroll in Medicare Part A and Part B. The reason: The medical plan provided to you through your retirement from The School District of Clayton is offered as secondary or supplemental coverage to Medicare.
Failure to enroll in Medicare Part A and Part B will cause you to have more out of pocket expenses because Medicare pays first under Medicare Secondary Payer rules established by the Center for Medicare Services. Anthem will consider the claim after Medicare payment has been determined.
If you do not have Medicare Part A and Part B coverage, Anthem will pay the claim as if Medicare paid and consider only the remaining amount if allowable under Clayton’s benefit plan leaving you to pay what Medicare would have paid and your deductible.
If you are not currently signed up for Medicare Part A and Part B, please contact the Department of Social Security for details.
Additional HSA Information
The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA.
Employees age 55 and over may contribute an additional $1,000 annually to their HSA.
You cannot be enrolled in another health plan that is not a QHDHP.
If you are enrolled in Medicare you cannot participate in the Health Savings Account.
If you are a retiree and not participating in Medicare, you are allowed to set up a Health Savings Account at your selected financial institution. If you retire and are currently participating in the HSA with Anthem, you will be required to pay the associated fees.
If you enroll any family member, you must satisfy the family deductible before benefits are paid.
You or your spouse cannot participate in a Medical Flexible Spending Account. You can participate in a Dependent Care Flexible Spending Account.
You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP.
Save your receipts. The IRS is notified of all distributions.
Want To Know What Medicare Covers?
Here is how you do it… 1. Go to www.medicare.gov 2. Go to the top of the page, on the tool bar go to
“What Medicare Covers”. 3. Under “What Medicare Covers” click on “Your
Medicare Coverage”. 4. In the dialog box, enter what medical care you are
needing to determine if covered. 5. Click on “Go” after you have entered the
information. 6. View results.
OR You may call Medicare with your questions: Phone: 1-800-633-4227
Open Enrollment
Our benefit plan year is from January 1 through December 31. You are asked to make your elections for the 2019 plan year through the online enrollment process which is October 22 through October 29. When your en-rollment period is closed, you will not be able to make any changes to your elected coverage until the next open en-rollment period or you experience a qualifying life change event. A life change event includes death, marriage, di-vorce, birth or adoption of a child, or if your spouse loses
or gains coverage through his or her employer.
Medicaid Children’s Health Insurance Program (CHIP)
Offer Free Or Low-Cost Health Coverage To Children And Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. CBIZ Custom Solutions provides a copy of the form listing the states that offer assistance. Please access www.cbizesc.com/Clayton and locate forms or contact the Business Office. You can also contact: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565
Important Notice
School District of Clayton 2019 Annual Enrollment
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Additional Information - Continued
School District of Clayton 2019 Annual Enrollment
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On Line Enrollment
Enroll in the Online system
School District of Clayton provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible
Retirees the ability to make group insurance benefit elections and changes online during the annual open enrollment and qualifying
events.
Enrollment has never been easier. Accessible 24 hours a day, information about all of your benefit election options, including
premiums and carrier contact information are available to help you make informed decisions.
You can also log into the Explain My Benefits portal at anytime or download the Mobile App, to review your benefits, access carrier
links, update your personal information for yourself and your dependents, and process qualifying life events.
Self-Service Visit explainmybenefits.com/clayton on any computer, click on the blue “Log into Your Benefit System” button and move through the enrollment system at your own pace. Or, download the new Mobile App on your phone or tablet and move through the enrollment at your own pace.
Be sure to click “submit” at the end of the process and make note of your confirmation number. If you do not receive a confirmation number, you have not completed your enrollment and you will not be enrolled in your benefits.
Return to the system anytime and click your confirmation number to view your confirmation statement.
For assistance, please call Customer Service at 1-888-734-6937; Option 3
PLEASE REMEMBER — IF YOU ARE NOT MAKING ANY CHANGES TO YOUR CURRENT BENEFIT ELECTIONS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH THE 2019 CARRIERS.
Review Your Benefits
Visit our benefits portal to review your benefit guide, Important documents and watch
benefit education videos.
ExplainMyBenefits.com/clayton
School District of Clayton 2019 Annual Enrollment
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Non-Discrimination Disclosure
It is the policy of the School District of Clayton not to discriminate on the basis of race. color, religion, gender, national origin, age, or disability in its programs or employment practices as required by Title VI and VII of the Civil Rights Act of 1964. Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Dis-crimination Act of 1975 and Title II of the Americans with Disabilities Act of 1990. Behavior that is not unlawful or does not rise to the level of illegal discrimination or harassment might be unacceptable for the workplace or the educational environment. Demeaning or otherwise harmful actions are prohibited, particularly if directed at personal characteristics. Accordingly, the District prohibits discrimination or harassment on the basis of sexual orientation, perceived sexual orientation or gender identity. Inquires related to the District’s employment practices should be directed to Dr. Tim Dilg, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri 63015 or by phone at (314) 854-6032. Inquiries related to the District’s student programs should be directed to Kashina Bell, Assistant Superintendent of Student Services, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri 63015 or by phone at (314) 854-6013. Inquiries or concerns regarding civil rights compliance by school districts should be directed to the local school district Title IX/non-discrimination coordinator. Inquiries and complaints may also be directed to the Kansas City Office, Of-fice for Civil Rights, US Department of Education, 8930 Ward Parkway, Suite 2037, Kansas City, MO 64114; (816) 268-0550; TDD (877) 521-2172.
School District of Clayton #2 Mark Twain Circle
Clayton, Missouri 63015 (314) 854-6000
About This Bulletin
The purpose of this booklet is to describe the highlights of your benefit program. Your specific rights to benefits under the Plans are governed solely, and in every respect, by the official Plan documents and insurance con-tracts, and not by this booklet. If there is any discrepancy between the description of the Plans as described in this material and official Plan documents, the language of the documents shall govern.