Download Benefit Summary - Aurora Public Schools

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2014 Benefit Summary
Benefits Overview
Benefit Plans Offered
You share the costs of some benefits (medical and dental), and Aurora Public
Schools provides other benefits at no cost to you (life, accidental death &
dismemberment, EAP, and if you are not yet eligible for PERA, Long-Term Disability).
„„ Medical
„„ Dental
„„ Life Insurance
„„ Accidental Death & Dismemberment
(AD&D) Insurance
„„ Flexible Spending Account (FSA)
„„ Employee Assistance Program (EAP)
„„ Long-Term Disability
(for those not eligible for PERA)
Aurora Public Schools is proud to offer a comprehensive benefits package to
eligible employees. The complete benefit package is briefly summarized in this
booklet. You will receive plan booklets, which give you more detailed information
about each of these programs.
IMPORTANT
This document is an outline of the coverage proposed by the carrier(s), based on information
provided by your company. It does not include all of the terms, coverage, exclusions,
limitations, and conditions of the actual contract language. The policies and contracts
themselves must be read for those details. Policy forms for your reference will be made
available upon request.
The intent of this document is to provide you with general information regarding the status of,
and/or potential concerns related to, your current employee benefits environment. It does not
necessarily fully address all of your specific issues. It should not be construed as, nor is it
intended to provide, legal advice. Questions regarding specific issues should be addressed
by your general counsel or an attorney who specializes in this practice area.
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Eligibility
You and your dependents are eligible
for Aurora Public Schools medical and
dental benefits on the first of the month
following date of employment if you are
hired between the 1st and the 15th of
the month or the first of the month
following 30 days of employment if you
are hired between the 16th and the end
of the month. You are covered on your
date of hire for Life, AD&D and if
applicable, LTD.
Eligible dependents are your spouse or
domestic partner, children under age
26, and disabled dependents of any
age. Elections made now will remain
until the next open enrollment unless
you or your family members experience
a qualifying event. If you experience a
qualifying event, you must contact the
Benefits office within 30 days.
Medical Benefits
Administered by United Healthcare and Kaiser Permanente
Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of
unexpected illness and injury. A little prevention usually goes a long way — especially in healthcare. Regular preventive care
provides a no cost review of your health. Small problems can potentially develop into large expenses. By identifying the
problems early, often they can be treated at little cost.
Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an
excellent medical plan through Aurora Public Schools.
Aurora Public Schools offers you a choice of United Healthcare’s Navigate plan or Kaiser’s deductible HMO (DHMO) medical
plan.
With both plans you must receive your medical services from in-network providers.
With the Navigate plan, you must select a primary care physician (PCP). Women may see a network OB/GYN for their annual
exam without a referral from their PCP.
All care must be provided or coordinated by your PCP, with the exception noted above, if you are in the Navigate plan.
The Kaiser plan strongly recommends that you select a PCP, but it is not required.
MEDICAL BENEFITS
UHC Navigate Plan
Lifetime Benefit Maximum
Kaiser DHMO Plan
Unlimited
Annual Deductible
(single/family)
$1,000/$3,000
$1,000/$3,000
Annual Out-of-Pocket Maximum
(including deductible)
$3,000/$6,000
$4,000/$9,000
10%
10%
$20/$40 copay
$25/$50 copay
No charge
No charge
Retail—Generic Drug
(30-day supply)
$15 copay
$15 copay
Retail—Formulary Drug
(30-day supply)
$30 copay
$30 copay
Retail—Non-Formulary Drug
(30-day supply)
$50 copay
$50 copay
$37.50 copay
$30 copay
Mail Order—Formulary Drug
(90-day supply)
$75 copay
$60 copay
Mail Order—Non-Formulary Drug
(90-day supply)
$125 copay
$100 copay
Coinsurance
DOCTOR’S OFFICE
Office Visit
(PCP/Specialist)
Wellness Care
(routine exams, x-rays/tests, immunizations,
well baby care and mammograms)
PRESCRIPTION DRUGS
Mail Order—Generic Drug
(90-day supply)
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MEDICAL BENEFITS
UHC Navigate Plan
Kaiser DHMO Plan
$300 copay
$250 copay
No separate deductible
No separate deductible
Inpatient
Deductible / 10%
Deductible / 10%
Outpatient Surgery
Deductible / 10%
Deductible / 10%
Ambulance Service
Deductible / 10%
10% up to $500 per trip
Deductible / 10%
Deductible / 10%
$20 copay
$25 copay
Deductible / 10%
Deductible / 10%
$20 copay
$25 copay
Office copay applies to initial visit only
Deductible / 10%
Deductible / 10%
Deductible / 10%
$40 copay
20 visits per policy year
Not covered
Physical, Occupational and
Speech Therapy Services
$20 copay
20 visits per therapy type per policy year
$25 copay
20 visits per therapy type per policy year
TMJ and Related Services
Not covered
Not covered
Private Duty Nursing
HOSPITAL SERVICES
Emergency Room
Hospital Deductible
MENTAL HEALTH SERVICES
Inpatient Services
Outpatient Services
SUBSTANCE ABUSE SERVICES
Inpatient Services
Outpatient Services
OTHER SERVICES
Maternity Services
(Prenatal care)
All other maternity hospital/
physician services
Chiropractic Services
Not covered
Deductible / 10% if medically necessary
Other Services
(Artificial limbs and other prosthetic
devices; blood and blood components; leg,
arm and neck braces; surgical dressings;
casts and splints)
Deductible / 10%
Deductible / 10%
Vision Services
(Exam only)
$20 copay
1 exam every year
$25 copay
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Dental Benefits
Administered by Delta Dental
Vision
EyeMed —Through Delta Dental
Good oral care enhances overall physical health, appearance and mental wellbeing. Problems with the teeth and gums are common and easily treated health
problems. Keep your teeth healthy and your smile bright with the Aurora Public
Schools dental benefit plan.
If you are enrolled in the dental plan you
are eligible for vision care savings
through EyeMed Vision Care. By
accessing an EyeMed network provider
you will receive discounts on eye
exams, glasses and contact lenses.
In-Network
Out-of-Network PPO
Annual Deductible
(single/family)
$50/$150
Combined in and out of network
$50/$150
Combined in and out of network
Annual Benefit Maximum
$1,250
Combined in and out of network
$1,250
Combined in and out of network
Preventive Dental Services
(cleanings, exams, x-rays)
100%
80%
Basic Dental Services
(fillings)
80%
80%
Major Dental Services
(extractions, crowns, inlays,
onlays, bridges, dentures, repairs)
50%
50%
Not covered
Not covered
Orthodontic Services
Life and Accidental Death
& Dismemberment
Insurance
Insured by Cigna
Life Insurance
Life insurance provides financial
security for the people who depend on
you. Your beneficiaries will receive a
lump-sum payment if you die while
employed by Aurora Public Schools.
The School District provides basic life
insurance of 2 times your annual
compensation to a maximum of
$250,000 at no cost to you.
Accidental Death and
Dismemberment (AD&D)
Insurance
Accidental Death and Dismemberment
(AD&D) insurance provides payment to
you or your beneficiaries if you lose a
limb or die in an accident. Aurora Public
Schools provides AD&D coverage of 2
times your annual compensation to a
maximum of $250,000 at no cost to you.
This coverage is in addition to your
company-paid life insurance described
above.
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Flexible Spending Accounts (FSAs)
Administered by Discovery Benefits
You can save money on your health care and/or dependent day care expenses with
an FSA. You set aside funds each pay period on a pretax basis and use them taxfree for qualified expenses. You pay no federal or state income taxes on your
contributions to an FSA. (That’s where the savings comes in.) Your FSA
contributions are deducted from your paycheck before taxes are withheld, so you
save on income taxes and have more disposable income.
Healthcare Spending Limit
$2,500
Dependent Care Spending Limit $5,000
Discovery Benefits is the administrator of two individual Flexible Spending
Accounts — one for health care expenses and one for dependent childcare and
elder care expenses. You can enroll in one or both FSAs. You use each account
separately, but they work similarly.
Here’s How an FSA Works
1.You decide the annual amount (see above for the limit for each account) you want
to contribute to either or both FSAs based on your expected health care and/or
dependent childcare/elder care expenses.
2.Your contributions are deducted from each paycheck before income taxes, and
deposited into your FSA.
3.You can pay with the Health Care FSA debit card for eligible health care
expenses. For dependent care, you pay for eligible expenses when incurred, and
then submit a reimbursement claim form or file the claim online.
4.You are reimbursed from your FSA, so you actually pay your expenses with taxfree dollars.
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Employee Assistance
Program (EAP)
Administered by Horizon Health
The EAP can provide you with support
for a variety of concerns ranging from
coping with stress to relationship
issues, finding child care, and help with
legal and financial matters. All services
are confidential and available 24/7
online or by phone.
Long-Term Disability
Insurance
Insured by Cigna
Meeting your basic living expenses can
be a real challenge if you become
disabled. Your options may be limited to
personal savings, spousal income and
possibly Social Security. Disability
insurance provides protection for your
most valuable asset — your ability to
earn an income. Aurora Public Schools
provides Long-Term Disability insurance
(LTD) coverage at no cost for those
employees who do not have five years
vested with PERA.
LTD coverage provides income when
you have been disabled for 180 days or
more. Your benefit is 60% of your
monthly earnings, up to $1,500 per
month. This amount may be reduced by
other deductible sources of income or
disability earnings. Benefit payments
can continue to age 65 if you are under
age 60 at the time of disability.
Contact Information
If you have specific questions about any of the benefit plans, please contact the administrator listed below, or your local human
resources department.
ADMINISTRATOR
PHONE
WEBSITE/EMAIL
Medical
BENEFIT
United Healthcare
855.828.7715
www.myuhc.com
n/a
Medical
Kaiser
303.338.3800
www.kp.org
n/a
Delta Dental
800.610.0201
www.deltadentalco.com
n/a
Delta Dental/EyeMed
866.246.9041
www.EyeMedVisionCare.com/
DeltaDental
n/a
Life and AD&D Insurance
Cigna
800.732.1603
n/a
n/a
Long-Term Disability
Cigna
800.732.1603
n/a
n/a
Discovery Benefits
866.451.3399
www.discoverybenefits.com
[email protected]
Horizon Health
800.284.1819
www.horizoncarelink.com
Dental
Vision
FSA
Employee Assistance Program
Employee Contributions for Benefits — Full Time Employees
BENEFIT PLAN
MONTHLY
UNITED HEALTHCARE
Employee
$31.35
Employee + Spouse
$790.01
Employee + Children
$532.94
Family
$1,159.93
KAISER
Employee
$24.51
Employee + Spouse
$612.52
Employee + Children
$416.50
Family
$906.60
DENTAL
Employee
$6.39
Employee + Spouse
$33.64
Employee + Children
$46.45
Family
$68.71
Employee Contributions for Benefits — Part Time Employees
HOURS PER DAY
4.0
4.25
4.5
4.75
5.0
5.25
5.5
5.75
6.0
6.25
6.5
6.75
KAISER
Employee
$256.43
$241.83
$227.23
$212.62
$198.02
$183.42
$168.82
$154.22
$139.62
$125.01
$110.41
$95.81
Employee + Spouse
$823.99
$808.10
$792.22
$776.34
$760.46
$744.58
$728.70
$712.82
$696.94
$681.06
$665.18
$649.30
Employee + Children
Family
$634.79
$619.33
$603.88
$588.42
$572.97
$557.51
$542.06
$526.61
$511.15
$495.70
$480.24
$464.79
$1,107.83
$1,091.31
$1,074.79
$1,058.27
$1,041.75
$1,025.23
$1,008.71
$992.19
$975.67
$959.15
$942.63
$926.11
UNITED HEALTHCARE
Employee
Employee + Spouse
Employee + Children
Family
$328.36
$309.70
$291.03
$272.37
$253.70
$235.04
$216.37
$197.71
$179.05
$160.38
$141.72
$123.05
$1,067.43
$1,047.54
$1,027.65
$1,007.76
$987.88
$967.99
$948.10
$928.21
$908.32
$888.43
$868.54
$848.65
$817.00
$797.53
$778.05
$758.58
$739.11
$719.63
$700.16
$680.68
$661.21
$641.74
$622.26
$602.79
$1,427.80
$1,407.31
$1,386.83
$1,366.34
$1,345.86
$1,325.37
$1,304.89
$1,284.40
$1,263.92
$1,243.43
$1,222.94
$1,202.46
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This benefit summary prepared by
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