2019 EMPLOYEE BENEFITS GUIDE - KCKPS

within the overall compensation package
provided to all of our eligible employees. This
year when we reviewed our employee benefits
options, we focused not only on providing
quality medical plans but also on controlling
the cost and financial risk for our employees.
We offer multiple options to meet the individual
needs of our employees and their dependents.
2019 BENEFITS AT A GLANCE
For those employees who enroll in
either the BlueSelect Plus $2500 PPO
plan or the BlueSelect Plus High
Deductible Plan, the District will to
contribute towards a Flexible
12) or a Health Savings Account
( refer to page 11).
questions you may have.
their address and date of birth on
their own simply by logging on to
the employee portal at the District's
website. For corrections to a
misspelled name or gender, please
contact HR at 913.279.2262.
change documentation (court
document, marriage license,
with enrollment. You will have
access to this site. If you choose to
reset your password on the CBIZ
enrollment portal, please contact
(see page 3 for contact
information).
NOT SURE HOW TO GET STARTED?
DON’T WORRY!
instructions to help you make your benefit decisions.
All benefit eligible employees are REQUIRED to speak
with a Benefit Counselor . Please see website and
phone number listed above to schedule your
consultation.
During your consultation you will review your medical
plan options to ensure your selection is the best for you
and your family
If you have questions about benefit you will have
access to knowledgeable, licensed and non-
commissioned Benefit Counselor so you can make the
best choice for you and your family.
Review benefits before hand at :
http://benefits-direct.com/KCKPS/
kckps.org
As always, we value you as a member of the Kansas
City Kansas Public Schools family and look forward
to a healthy and safe 2019.
Visit http://benefits-direct.com/KCKPS/
Enrollment Information ....................................................... 4
Wellness ............................................................................... 10
Dental Insurance ............................................................... 14
Vision Insurance ................................................................. 16
www.mybluekc.com
866.811.4589
Short-Term Disability
[email protected]
913.279.2200
ENROLLMENT INFORMATION
HOW DO I MAKE CHANGES?
Unless you have a qualified change in status, you cannot make changes to the benefits you
elect until the next annual enrollment period. Qualified changes in status include birth of a child,
adoption, marriage, death, divorce, a court order requiring provision of insurance to a
dependent, loss of coverage (if you or your spouse/dependents are covered under another
plan and then lose that coverage), Medicare eligibility, going from part-time to full-time, move or
transfer out of the plan’s service area, or a reduction in hours that makes you ineligible for
coverage.
Should you wish to make changes to your elections due to a qualifying event, you have 31 days
from the event to notify the Employee Service Center at www.cbizesc.com/kckps. If the
Employee Service Center is not notified within this time frame, you must wait until the next open
enrollment period to adjust your benefits.
If you are eligible to enroll in the Federal Marketplace (Exchange) due to a Special Enrollment
during the year, you will be permitted to drop coverage under this plan.
If you or your dependents become ineligible for Medicaid or CHIP, you may be able to enroll in USD
#500’s plan; you must request enrollment within 60 days. Additionally, if you or your dependents
become eligible for premium assistance from Medicaid or CHIP, you may be able to enroll yourself
and your dependents in USD #500’s plan; you must request enrollment within 60 days.
WHO IS ELIGIBLE?
working 30 hours or more per week are considered
eligible to participate. Please discuss with Human Resources your employment status to
determine eligibility and your benefit effective date.
Dependents of eligible employees may also be eligible for coverage under many of these
benefit plans.
Your spouse
Unmarried children through the end of the year (December 31) in which they turn 26
Unmarried dependent children over age 26 who are incapable of supporting themselves
because of mental or physical handicaps (upon approval).
OPTION 7: Preferred Care Blue HDHP
OPTION 8: BlueSelect Plus Blue Saver HDHP
YOUR HEALTH PLAN OPTIONS
As a full-time employee of Kansas City Kansas Public Schools, you have the
choice between eight medical plan options: HMO, EPO, Preferred-Care Blue
$500, $1,000, $2,500, HDHP, or BlueSelect Plus $2,500, HDHP.
For each, your deductible will run from January 1−December 31.
While all plans except the HMO and EPO plans, give you the option of using out-
of-network providers, you can save money by using in-network providers
because Blue Cross Blue Shield of Kansas City has negotiated significant
discounts with them. If you choose to go out-of-network, you’ll be responsible for
the difference between the actual charge and Blue Cross Blue Shield of Kansas
City UCR (Usual, Customary and Reasonable) charge, plus your out-of-network
deductible and coinsurance.
HMO : With an HMO, there’s no deductible. Your share of the costs includes
copayments for many services. You choose a primary care physician (PCP) who
will provide most of your care and recommend specialists as needed. To visit a
specialist who participates in the Blue-Care Network, simply select the specialist
and make an appointment. No referral is required. An HMO generally does not
cover any services from non-participating providers, except for emergencies.
The HMO plan utilizes the Blue-Care Network.
Preventative care covered at 100%
Higher Premiums/No deductible
EPO : Like an HMO, the EPO has no deductible to meet. Your share of the costs
includes copayments for many services. You must receive all care from in-
network providers. The only exception to this is for emergency services. Non-
emergency services received out-of-network will not be covered.
The EPO plan utilizes the BlueSelect Plus Network.
Preventative care covered at 100%
Higher Premiums/No deductible
PPO : A PPO allows you to see participating and non-participating providers.
Three of the PPO plans utilize the Preferred-Care Blue Network and one
utilizes the BlueSelect Plus Network. Preventative Care is covered at 100%
First Dollar Coverage. Three of the PPO plans offered through BCBS offer first
dollar coverage (Both 2500 PPOs and the 1000 PPO). For each covered person,
the plan pays the first $250 of eligible expenses for covered services from
participating providers. The First Dollar benefit does not apply to copayments,
office visits, prescription drugs, or any services from non-participating providers.
Once the plan has paid the First Dollar Amount, you pay all other expenses until
you reach your deductible.
These plans are good options if you rarely visit the doctor or take prescription
medications. These plans also include a safety net to cover a catastrophic
health event, such as serious illness or injury.
HDHP : An HDHP allows you to contribute towards a Health Savings Account.
A Health Savings Account (HSA) is a special, tax exempt account used in
conjunction with the high deductible health plan. It provides funding to pay for
qualified medical expenses NOT covered by the insurance. The HSA account is
provided by UMB Bank and is available as an option ONLY to those who enroll in
either of the BlueSaver HDHPs.
The District will make a contribution on your behalf to your HSA if you enroll in the
BlueSelect Plus BlueSaver HDHP! Please refer to the rate section of this book for
the specific contribution amounts. It is important to note that you must open an
HSA through UMB Bank in order to receive the District contribution. Additionally,
it is your responsibility to make sure that you are eligible to contribute to an HSA.
FREQUENTLY ASKED QUESTIONS
to be eligible for insurance
benefits?
working a minimum of 30 hours per
week on a regular basis.
Will I receive a new Medical
ID card?
mail if you are electing medical
coverage for the first time.
Does the deductible run on
a calendar year or policy
year basis?
dependent children?
year in which they turn age 26.
I just got hired. When will my
benefits become effective?
month following your date of
hire.
your insurance by using
MEDICAL NETWORKS
Belton Regional Medical Center X
Cass Regional Medical Center X
Center Point Medical Center X
Children’s Mercy Hospitals (Hospital Hill & South)
X X
Liberty Hospital X X
Menorah Medical Center X
Olathe Medical Center X X
Overland Park Regional X
Providence Medical Center X
Research Medical Center X
St. Joseph’s Medical Center
St. Luke’s (Multiple Locations) X
St. Mary’s Medical Center
Truman Medical Center (Hospital Hill & Lee’s Summit) X X
University of Kansas Hospital X X
2019 Medical Networks
gives members more choices in medical
providers and facilities.
network plan option for participants in 2019. This
narrow network offers coverage in 5 counties:
Johnson and Wyandotte in Kansas and
Jackson, Platte, and Clay in Missouri. It also
offers much greater savings for services
compared to the Preferred-Care Blue Network.
To find a participating provider before
making your enrollment decision follow
these steps:
select “Your Plan” under the “All
Plans” link at the top of the page
Then, choose the “BlueSelect Plus”
or “Preferred-Care Blue” medical
provider, specialty, clinic, etc.
provider’s name, if it appears
Finally, click “Plans Accepted”
information to verify that the
provider is in the network you
identified.
are effective, you can log in to search
for a provider. Your network will
automatically be selected for you.
1
2
3
4
5
7
6
8
CARE OPTIONS AND WHEN TO USE THEM
While we recommend that you seek routine medical care from your primary care physician whenever
possible, there are alternatives available to you. Services may vary, so it’s a good idea to visit the care
provider’s website. And, be sure to check that the facility is in-network by calling the toll-free number on the
back of your medical ID card, or by visiting www.mybluekc.com
Routine, primary/
preventive care
Non-urgent treatment
Common infections
minor sunburn, poison ivy)
treatment, we recommend going to your doctor’s office.
Your doctor knows you and your health history and has
access to your medical records. You may also pay the
least amount out of pocket.
CONVENIENCE CARE
These providers are a good alternative when you are not
be able to get to your doctor’s office and your condition is
not urgent or an emergency.
They are often located in malls or retail stores (such as CVS
Caremark, Walgreens, Wal-Mart and Target), and
generally serve patients 18 months of age or older without
an appointment. Services may be provided at a lower out-
of-pocket cost than an urgent care center.
URGENT CARE
Sometimes you need medical care fast, but a trip to the
emergency room may not be necessary.
During office hours, you may be able to go to your
doctor’s office. Outside regular office hours—or if you
can’t be seen by your doctor immediately—you may
consider going to an Urgent Care Center, where you can
generally be treated for many minor medical problems
faster than at an emergency room.
EMERGENCY ROOM
(including severe pain) which you believe that without
immediate medical care may result in any of the following:
Serious jeopardy to your health or the health of an
unborn child
Serious dysfunction of any bodily organ or part
If you obtain care at an emergency room, you will likely
pay more out of pocket than if you were treated at your
doctor’s office, a Convenience Care Center, or Urgent
Care facility.
in-network. If you receive treatment for an emergency in
a non-network facility, you may be transferred to an in-
network facility once your condition has been stabilized.
URGENT
CARE
PRIMARY
CARE
CONVENIENCE
CARE
EMERGENCY
ROOM
Heavy
bleeding
injuries
If you believe you are experiencing a medical emergency, go to the nearest emergency room or call 911, even if your symptoms are not described here.
CALL 9-1-1
Blue Cross Blue Shield
BlueSelect Plus
$500 PPO
Preferred-Care Blue
$1,000 PPO
Preferred-Care Blue
Employee Cost Per Pay Period Costs are based on completed wellness requirements. If not completed add $20 per month to the listed cost.
Employee Only
Employee & Spouse
Employee & Child(ren)
Employee & Family
Special Family
member per
calendar year
No benefit
Out-of-Pocket Maximum
$25 / $50
copay (office
visit only)
30% after
covered services) Covered at
received in an urgent
Mail Order (90-day supply)
contraceptives covered at
contraceptives covered
at 100%)
covered at 100%)
covered at 100%) Out-of-Network: Refer to
Plan Summary for details
covered at 100%)
covered at 100%) Out-of-Network: Refer to
Plan Summary for details
All plans are detailed in BCBS 2019 Certificate of Coverage (COC). This is a brief summary only. For exact terms and conditions, please refer to your certificate.
Medical Insurance Plan
Options and Costs
BlueSelect Plus
Employee Cost Per Pay Period Costs are based on completed wellness requirements. If not completed add $20 per month to the listed cost.
Employee Only
Employee & Spouse
Employee & Child(ren)
Employee & Family
Special Family
Member Coinsurance 10% 30% 10% 40% 0% 20% 0% 30%
Out-of-Pocket
30% after deductible
Covered at 100%
Covered at 100%
Covered at 100%
and lab only)
(Copay waived if admitted to a hospital)
$200 copay then deductible then 10%
(Copay waived if admitted to a hospital)
0% after deductible 0% after deductible
Outpatient Surgery
Mail Order (90-day supply)
$15 / $40 / $60
covered at 100%) Out-of-Network: Refer to Plan Summary for details
$15 / $40 / $60
covered at 100%) Out-of-Network: Refer to Plan Summary for details
0% after
No benefit
All plans are detailed in BCBS 2019 Certificate of Coverage (COC). This is a brief summary only. For exact terms and conditions, please refer to your certificate.
Medical Insurance Plan
Options and Costs
WELLNESS
A Healthier You wellness program. Any
employee that earns a minimum of 4,200
points in A Healthier You program will have
$20 dollars waived from their premium and
will receive a $200 contribution from the
KCKPS District into either a Medical Flexible
Spending Account (FSA) or Health Savings
Account (HSA).
through MyBlueKC website.
9/1/2020
for participants to earn points and meet
the 4200 goal. Members can find the
detailed list of point earning
opportunities on the Wellness Program
webpage or by request from the
Wellness Coordinator.
PORTAL
Healthier You App.
*Use Google Chrome
time visitor, click REGISTER
your member ID card
from the “My Home” page.
4. First time users will be prompted to
complete the onboarding personalization
tax payroll deductions or deposit money to be
used to pay for current or future qualified medical
expenses for you and/or your dependents. Once
money goes into the account, it’s yours to keep—
the HSA is owned by you, just like a personal
checking or savings account.
OPPORTUNITY.
account can grow tax-free in an investment of your
choice (like an interest-bearing savings
account, a money market account, a wide
variety of mutual funds—or all three). Of
course, your funds are always available if
you need them for qualified health care
expenses.
GROW OVER TIME.
you leave the company, and unused funds
carry over from year to year. You never have to
worry about losing your money. That means if you
don’t use a lot of health care services now, your
HSA funds will be there if you need them in the
future—even after retirement.
You can use your HSA for your spouse and tax
dependents for their eligible expenses—even if
they’re not covered by your medical plan.
WHAT ARE THE RULES?
High Deductible Health plan (QHDHP) in
order to establish an HSA.
You cannot establish an HSA if you or your
spouse also have a medical FSA, unless it is a
Limited Purpose FSA.
or Tricare due to age or disability.
You cannot set up an HSA if you have
insurance coverage under another plan, for
example your spouse’s employer, unless that
secondary coverage is also a qualified high
deductible health plan.
under someone else’s tax return.
WHAT ELSE SHOULD I KNOW?
You can invest up to the IRS’s annual
contribution limit. Contributions are based
on a calendar year. The contribution limits for
2019 are $3,500 for Single and $7,000 for
Family coverage. If you’re age 55 or older,
you are allowed to make extra
contributions each year.
out tax-free as long as you utilize the funds
for approved services based on the IRS
Publication 502 (medical, dental, vision
expenses and over-the-counter medications
Your unused contributions roll over from year
to year and can be taken with you if you
leave your current job.
expenses, then the money becomes taxable
and subject to a 20% excise tax penalty.
There is no penalty for distributions following
death, disability (as defined in IRC 72), or
attainment of Medicare eligibility age, but
taxes would apply for non-qualified
distributions.
your HSA balance, you need to pay the
remaining cost another way, such as a credit
card or personal check. But save your
receipts in case you are ever audited! You
can request reimbursement later, after you
have accumulated more money in your
account.
coverage on the BlueSaver High Deductible plan,
the District will contribute towards a Health Savings
Account. It is important to note that you must
open an HSA through UMB Bank in order to receive
the District contribution. Additionally, it is your
responsibility to make sure that you are eligible to
contribute to an HSA.
YOU CAN USE HSA FUNDS FOR IRS-APPROVED
ITEMS SUCH AS:
Doctor's office visits
lenses and solution
medications (with a physician’s prescription)
Physical therapy, speech therapy, and
chiropractic expenses
additional details about the HSA, is available at
irs.gov.
Every time you use your HSA, save your receipt in
case the IRS asks you to prove your claim was for
a qualified expense. If you use HSA funds for a
non-qualified expense, you will pay tax and a
penalty on those funds.
As an HSA account holder, you will be required
to file a Form 8889 with the IRS each year. This
form identifies any contributions, distributions, or
earned interest associated with your account.
This may be the best plan option for you if any of
the following is true:
prescription medication expenses.
pay for Qualified Expenses permitted under
Federal Law.
FREQUENTLY ASKED QUESTIONS
the pharmacy with the
drug until you satisfy your calendar year
deductible in full.
You can access all of your EOB information, as
well as obtain other important information, by logging on to Blue Cross
Blue Shield of Kansas City website at www.mybluekc.com
What will I pay at the
physician’s office with the
HSA qualified plan?
You’ll provide your ID card at the time of the visit and the physician’s office will
submit the claim to Blue Cross Blue Shield of Kansas City. You will not owe anything at the time of the visit. Later
you’ll receive an Explanation of Benefits (EOB) from Blue Cross Blue Shield of
Kansas City that shows the discounted charges based on their contract with the physician. When you receive a bill
from the physician’s office, you pay the portion of the discounted cost
you are responsible for as shown on the EOB.
DISTRICT HSA CONTRIBUTION:
You are eligible for a $200 contribution if you earn
4200 points in” A Healthier You program”.
The points must be earned from 9/1/2019—9/1/2020.
When you have out-of-pocket expenses (such as
copayments and deductibles), you can either use your
FSA debit card to pay for these expenses at qualified
providers or submit an FSA claim form with your receipt to
CBIZ Payroll. Reimbursement is issued to you through
direct deposit into your bank account, or if you prefer, a
check can be issued to you.
2019 Maximum Contributions
Dependent Care Expense Account $5,000 max
HEALTH CARE FLEXIBLE SPENDING ACCOUNT
This account enables you to pay medical, dental,
vision, and prescription drug expenses that may or
may not be covered under your insurance program
(or your spouse’s) with pretax dollars. You can also
pay for dependent health care, even if you choose
single (vs. family) coverage. The total amount of
your annual election is available to you up front,
reducing the chance of having a large out-of-
pocket expense early in the plan year. Be aware—
any unused portion of the account at the end of the
plan year is forfeited.
Contraceptives Prescription drugs
Dermatologists Routine physical
Eyeglasses, includes exam fee
Hearing devices and batteries Surgical expenses
FSA ACCOUNTS
Dependent Care Expense Account
This account gives you the opportunity to redirect a portion
of your annual pay on a pre-tax basis to pay for
dependent care expenses. An eligible dependent is any
member of your household for whom you can claim
expenses on your Federal Income Tax Form 2441, “Credit
for Child and Dependent Care Expenses.” Children must
be under age 13. Care centers which qualify include
dependent care centers, preschool educational
institutions, and qualified individuals (as long as the
caregiver is not a family member and reports income for
tax purposes). Before deciding to use the Dependent
Care Expense Account, it would be wise to compare its tax
benefit to that of claiming a child care tax credit when
filing your tax return. You may want to check with your tax
advisor to determine which method is best for you and
your family. Any unused portion of your account balance
at the end of the plan year is forfeited.
CONTACT INFORMATION
Request a full statement of your accounts at any time by calling 800.815.3023 or logging on to www.myplans.cbiz.com to review your FSA or dependent care expense account balances. You can also fax claims to CBIZ Payroll at 800.584.4185
At www.myplans.cbiz.com you can:
File claims
LIMITED FLEXIBLE SPENDING ACCOUNT
For those who enroll in the in one of the BlueSaver
High Deductible Health Plan with an HSA, IRS rules
state you are not eligible to participate in the
medical flexible spending account. You are,
however, eligible to participate in the Limited
Flexible Account, allowing you to pay for dental and
vision care expenses, ONLY. All rules that apply to
the traditional Medical flexible spending account
also apply to the Limited FSA, i.e. once you make
your annual election your contributions will remain
unchanged unless you experience a qualifying
event; you can file claims for any amount up to your
total annual contribution at any time, even if you
have not yet had the amount withheld from your
pay and any unused amounts at the end of the plan
year and grace period are forfeited.
Contributions will be updated once the 2019 limits are released by the IRS.
DISTRICT FSA CONTRIBUTION:
You are eligible for a $200 contribution if you complete all
requirements of the Wellness Program by the deadline
(Biometric Health Screening, Health Risk Assessment & Earn
3200 points on the Blue KC A Healthier you portal).
For employees who elect employee only coverage on the
BlueSelect Plus $2500 PPO plan, the District will continue to
contribute towards a Flexible Spending Account. You will
receive $14.68 per pay period if enrolled.
REVIEW YOUR DENTAL PLAN 4
DENTAL INSURANCE
GUARDIAN IS THE DENTAL CARRIER FOR 2019.
The dental plans are both PPO plans that offer coverage both in and out-of-network. If you choose to go out-
of-network, you will be responsible for any cost exceeding Guardian’s negotiated fees, plus any deductible
and coinsurance associated with your procedure.
Dependent children are eligible until the end of the year in which they turn age 26.
PREDETERMINATION
A predetermination of benefits is simply a notification to you and your dentist as to whether the procedures
recommended are within the services covered by the Guardian contract. By obtaining a predetermination
from Guardian prior to receiving dental services, you have the security of knowing in advance the percentage
Guardian will pay, how much you will be responsible for out of pocket and whether the services
recommended by your dentist fall within the benefit maximums and procedure limitations. Guardian suggests
having a predetermination for all services that exceed $300. You or your dental provider can submit the
predetermination by sending Guardian an itemized bill or a completed claim form with the following
information:
ID #
DDS name and address
The predetermination can be submitted directly to the Guardian Dental Claims Department at:
Email: [email protected] , fax: (509) 465-3404. Once the services are completed, your dentist can fill in the dates of
service, sign the predetermination and submit it to Guardian for processing.
MAXIMUM ROLLOVER
Guardian will roll over a portion of each member’s unused annual maximum into your Maximum Rollover
Account (MRA). The MRA can be used in future years if a member reaches the plan’s annual maximum.
To qualify, you must submit a claim and not exceed the paid claims threshold during the benefit year. You and
each of your dependents maintain separate MRAs based on your own claim activity. Each member’s MRA
may not exceed the MRA limit.
Plan Annual
Maximum* Threshold
Maximum Rollover
$500 $250 $350 $1,000
*If a plan has a different annual maximum for PPO benefits vs. non-PPO benefits ($2,000 PPO/$1,000 non-PPO), the non-PPO maximum
determines the Maximum Rollover plan.
Employee Employee & Spouse Employee & Child(ren) Employee & Family
$12.91 $23.50 $27.87 $42.11
$17.11 $31.16 $37.03 $56.04
Low Plan High Plan
$25 / $75 Applied to Type B & C Services
Annual Maximum $1,000 $1,000 $2,000 $1,000 Applied to Type A, B & C Services
Preventive
X-Rays – four bitewings every twelve months;
Periodontal Maintenance Procedure – every six months
Emergency Palliative Treatment
Space Maintainers for Children (under age 16)
Topical Sealants for un-restored molar teeth – one treatment for children under age 16 in a three year period
Basic
Fillings – amalgam & anterior composites
Endodontic Services/Root Canal Therapy
Crowns – stainless steel
Injectable Antibiotics – for treatment of a dental condition only
Laboratory Test
Major
Oral Surgery
Dentures – full and partial
TMJ – annual limit of $200
Orthodontic Services 40% 40% 50% 40% Not subject to annual maximum rollover
Children under age 19 for Low Plan
Adult + Child for High Plan
Orthodontia Child(ren)
lifetime maximum
In-network Providers: Provider is reimbursed based on contracted fees and cannot
balance bill you.
Customary standards and balance billing is possible.
FIND A DENTIST To find a Guardian provider in
your area, visit the website at
www.guardiananytime.com
Enter your ZIP Code
Select the “PPO network”
Click “Submit” for a
DENTAL INSURANCE CONTINUED
This is intended to be a summary only. Please refer to your Summary Plan Description (SPD) for a more complete listing of services
including plan limitations and exclusions.
REVIEW YOUR VISION PLAN
SUPERIOR VISION IS THE VOLUNTARY VISION CARRIER FOR 2019.
The vision plan offers coverage both in-network and out-of-
network. It is to your advantage to utilize a network provider in
order to achieve the greatest cost savings. If you go out-of-
network, your benefit is based on a reimbursement schedule.
Also, if you are considering Lasik surgery,
there is a discount available with some
providers. To find a participating provider, go
to www.superiorvision.com .
of the year in which they turn age 26.
FIND A PROVIDER:
Under the Member Tab you can
quickly find a provider by
clicking on “Locate a Provider”
Enter your location information
and select the “Insurance
Through Your Employer” option
Pick the Superior National
network and choose your
OR, you can call 800.507.3800 to
speak with a Customer Service
representative
Superior Vision Employee Cost Per Pay Period
Employee Employee & Spouse Employee & Child(ren) Employee & Family
$5.15 $10.20 $10.00 $15.20
Up to $34 (Ophthalmologist)
Exam Lenses Frames Contact Lenses
Every 12 months Every 12 months Every 12 months Every 12 months
Every 12 months Every 12 months Every 12 months Every 12 months
Lenses
Covered in full Covered in full Covered in full
Up to $165 retail Covered in full (up to age 19)
Covered in full Covered in full
Reimbursement
Up to $29 Up to $43 Up to $53 Up to $53
Not Covered Not Covered Not Covered
Frames $25 copay; $125 allowance,
20% off balance at participating providers
Reimbursement Up to $65
$15 copay Not Covered
$0 copay; $130 allowance, 20% off balance at
participating providers
5
Rates per $10,000 of coverage
Guardian Age Employee Spouse* Child(ren)
Voluntary Life
<30 $0.49 $0.49 $0.57
30-34 $0.57 $0.57 $0.57
35-39 $0.57 $0.57 $0.57
40-44 $1.05 $1.05 $0.57
45-49 $1.86 $1.86 $0.57
50-54 $2.84 $2.84 $0.57
55-59 $4.70 $4.70 $0.57
60-64 $5.43 $5.43 $0.57
65-69+ $9.40 $9.40 $0.57
*Spouse rate is based on the employee’s age. Coverage for the spouse terminates at spouse’s age 70.
REVIEW YOUR
You have the ability to purchase additional life
insurance coverage for yourself, your spouse
and your dependent children. This plan is
offered by Guardian and includes a guarantee
issue level of coverage when you elect to
enroll in this plan during your initial enrollment
period. This means that you cannot be turned
down for coverage based on your medical
history.
to a maximum of $500,000. Guarantee issue
up to $200,000.
Guarantee issue up to $30,000.
Optional Dependent Life for children: $2,000
increments to a maximum of $10,000.
Guarantee issue up to $10,000.
If you don’t enroll in the Voluntary Life plan
during your initial enrollment period, you’ll be
required to complete an Evidence of
Insurability form and be approved by
Guardian before you’re able to get
coverage in the future.
18 Questions? Call us at 844.212.0479
Disability insurance provides income protection if
or when you can’t work because of an illness or
injury.
SHORT-TERM DISABILITY
Should a sickness or injury strike, your out-of-pocket expenses – not to mention lost time on the job –
can impact the financial well-being of you and your family. Guardian’s voluntary individual short-
term disability insurance can help replace a portion of your salary in the event of a covered
sickness or off-the job accident.
Secures up to 60% of your gross salary (not to exceed $1,200 weekly).
You choose how much coverage you want – between $250 and $1,200 weekly.
Benefits are payable after a 14-day elimination period and you can receive benefits for up to 6
months. (KPERS include a long-term disability benefit after a 6 month waiting period.)
PRE-EXISTING CONDITION LIMITATION
A pre-existing condition is defined in your policy as a condition for which symptoms existed that
would cause you to seek treatment from a physician, or took medicine within 3 months before
your coverage effective date. Benefits for a disability due to a pre-existing condition will not be
paid if that disability begins within 12 months of your coverage effective date. Pregnancy, at the
time coverage is effective, is considered a pre-existing condition. For more information about
pre-existing conditions, please email [email protected].
REVIEW YOUR DISABILITY COVERAGE
working?
emergency savings to cover six months or more of
their expenses.
Security Disability Insurance are denied.
LONG-TERM DISABILITY
you by Kansas City Kansas Public
Schools through KPERS. The benefit
coverage begins after a 180 day
waiting period and pays 60% of your
annual compensation, payable in
$5,000 maximum monthly benefit).
and emotional consequences of being
diagnosed with a critical illness, you can
prepare for the consequences such an illness
may have on your personal finances.
While major medical insurance may pay for a
good portion of the costs associated with the
illness, there are a lot of expenses that are just
not covered—from deductibles and copays to
living expenses.
Manhattan Life can help with the treatment
costs of covered critical illnesses—such as a
heart attack or stroke. More importantly, it can
help you focus on recuperation instead of the
distraction of out-of-pocket costs.
benefits directly (unless otherwise assigned)—
giving you the flexibility to help pay bills related
to treatment or to help with everyday living
expenses.
Benefit amounts are available at various levels. You
can choose:
maximum of $30,000.
benefit is equal to exactly half of the employee's
coverage
employee's coverage to a maximum of $5,000
COVERAGE FOR VASCULAR CONDITIONS
Heart attack (100%)
Stroke (100%)
coronary artery disease (25%)
Percent of benefit amount paid at initial diagnosis:
Transplant, other than heart (100%)
End-stage renal failure (100%)
Coma (100%)
Occupational HIV (100%)
If you’re like most people, you don’t budget for life’s
unexpected moments. One mishap can send you on
an unexpected trip to your local emergency room—
and leave you with a flurry of unexpected bills.
That’s where Accident Insurance jumps in.
In the event of a covered accident, the plan pays you
cash benefits fast to help you pay for the costs
associated with out-of-pocket expenses and bills—
expenses major medical may not take care of.
MANHATTAN LIFE ACCIDENT INSURANCE COVERS
THINGS LIKE THE FOLLOWING:
Emergency room visits
Surgery and anesthesia
Transportation and Lodging Benefits
A Rehabilitation Unit Benefit
and paralysis
qualify for coverage without having to answer health
questions)
otherwise)
dependent children
Coverage is portable (with certain stipulations). That
means you can take it with you if you change jobs or
retire
about four business days
855-448-6982
Focus less on finances and more on treatment and recovery!
For many, a cancer diagnosis is a devastating financial blow, even if they’re already covered
by major medical insurance. According to the American Society of Clinical Oncology, newly
approved cancer drugs cost an average of $10,000 per month, with some therapies topping
$30,000 per month.
Cancer insurance is available to help people cope with the high out-of-pocket costs associated with serious
illnesses — costs major medical insurance were never intended to cover. In the event of a cancer diagnosis,
policyholders enrolled in voluntary plans receive cash benefits that can be used as they see fit. Sometimes they
go toward daily living expenses, such as rent, gas, groceries, babysitting and other necessities. Other times,
they’re used to help pay co-payments and deductibles.
For these reasons and more, voluntary cancer insurance is becoming increasingly important in helping
Americans combat the high costs of cancer.
Plan Highlights Include:
Guarantee Issue, making it easier for you to obtain coverage
Benefits are paid directly to you, regardless of any other insurance
Coverage tiers for individual, single parent, or family and rates do not increase due to age
Portable coverage allowing you to continue the plan should you retire or leave the District
Annual Cancer Screening Benefit rider
A. Basic Benefit ($50 Per Calendar Year) If you have any of the covered annual screening tests you are eligible
to submit a claim for the expenses incurred but not to exceed $50 per calendar year per covered member.
Covered annual Cancer screening tests include but are not limited to mammogram, pap smear, breast
ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool
specimen, PSA (blood test for prostate cancer) CEA, (blood tests for colon cancer) CA125 (Blood test for
ovarian cancer) CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma)
B. Additional Benefit ($100 Per Calendar Year) If an invasive diagnostic procedure is required as the result of an
abnormal basic cancer screening test you are eligible to submit a claim for the expenses incurred but not to
exceed $100 per calendar year per covered member.
You work hard to provide for your family. So,
when an unexpected bout of pneumonia
lands you in the hospital for five days, your
first concern is how this would affect your
family’s finances. But with Hospital Indemnity
coverage, your family’s budget is protected.
The plan can cover you, your spouse, and your children. If
any covered person is admitted to the hospital you will
need to file a claim. Once you receive your check for the
covered amount it can be used however you want and
does not coordinate with medical insurance.
VOLUNTARY HOSPITAL INDEMNITY
VOLUNTARY CANCER
Hospital Indemnity coverage is a benefit paid directly to you to help with the unexpected – deductibles, copayments, and other out-of-pocket costs.
IDENTITY THEFT
victim of identity theft. If you haven’t had
your identity stolen, you probably know
someone who has. Identity theft occurs
when someone steals your personal
information and uses it without your
knowledge to commit fraud or other crimes.
It’s a growing problem, affecting 11.1 million
adults in the United States just last year,
according to a survey by Javelin Strategy &
Research.
the U.S. It has been listed as the #1
consumer complaint for 12 consecutive
years. The crime can be devastating, and is
often costly and time-consuming to resolve.
According to the Federal Trade
Commission:
$18 billion in 2013.
Consumer out-of-pocket costs averaged
suffering a loss of $2,294.
Total time spent to resolve cases
averaged more than 11 hours per victim.
Help prevent being a victim of Identity Theft
and learn how InfoArmor cannot only help
prevent but also restore your identity should
you join the growing number of victims
across the country!
fraud at its inception. We detect fraud in
the locations where thieves buy and sell
personal information including High Risk
Transactions, compromised accounts,
password resets*.
monitoring of your TransUnion credit file
for no additional charge. Activate these
credit services in your online portal.
SOCIALARMOR
Twitter, and Instagram profiles to give
actionable alerts of reputational
damage including racist, violent,
Let us keep tabs on your digital footprint so you
don’t have to.
Internet search finds out about a
subscriber, offers a Privacy Grade and
tips to better secure personal information.
WALLETARMOR
and easy. Using state-of-the-art
card monitoring of the Underground Internet.
are given the opportunity to enroll themselves and
dependents into our group health plans.
If you elect to decline coverage because you are
covered under an individual health plan or a group
health plan through your parent’s or spouse’s
employer, you may be able to enroll yourself and your
dependents in this plan if you and/or your dependents
lose eligibility for that other coverage. You must request
enrollment within 30 days after the other coverage
ends. In addition, if you have a new dependent as a
result of marriage, birth, adoption or placement for
adoption, you may enroll any new dependent within
30 days of the event. To request special enrollment or
obtain more information, contact Human Resources.
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
As a requirement of the Women’s Health and Cancer
Rights Act of 1998, your plan provides benefits for
mastectomy-related services including all stages of
reconstruction and surgery to achieve symmetry
between the breasts, prostheses and complications
resulting from a mastectomy, including lymphedema.
The benefits must be provided and are subject to the
health plan’s regular copays, deductibles and co-
insurance. Contact Blue Cross Blue Shield of Kansas
City at the phone number on the back of your ID card
for additional benefit information.
As an employer with 50 or more eligible employees, we
are required to provide 1095-C forms to all employees
who were eligible for coverage under our group health
plan in 2019. If you were eligible for coverage under
our group plan, you’ll receive a personalized 1095-C
form before March 31, 2019. We are also required to
send a copy of your 1095-C form to the IRS.
The information reported on Form 1095-C is used in
determining whether an employer owes a payment
under the employer shared responsibility provisions
under section 4980H. Form 1095-C is also used by you
and the IRS to determine eligibility for the premium tax
credit.
You’ll need 1095 form to complete your Federal tax
return.
right to request a copy of the Notice of Privacy
Practices by contacting Human Resources.
IMPORTANT NOTICES NOTICE REGARDING WELLNESS PROGRAM
The KCKPS Employee Wellness Program is a voluntary
wellness program available to all employees. The
program is administered according to federal rules
permitting employer-sponsored wellness programs
disease, including the Americans with Disabilities Act
of 1990, the Genetic Information Nondiscrimination
Act of 2008, and the Health Insurance Portability and
Accountability Act, as applicable, among others.
Employees who choose to participate in the wellness
program through Blue KC “A Healthier You Wellness
Program” and earn 4200 points will receive an
incentive of $240 additional premium waived from
their health premiums for the next insurance plan
year.
the program and earn 4200 points,
MEDICAID CHIP NOTICE
Children's Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). To see if any other states have added a premium assistance program since July 31, 2019, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/agencies/ebsa
www.cms.hhs.gov
COVERAGE
This notice has information about your current prescription drug coverage and about your options under Medicare’s prescription drug coverage. If you are eligible for Medicare, the following information can help you decide whether or not you want to join a Medicare drug plan. You should consider comparing your current coverage through our medical plan with the costs of plans offering Medicare prescription drug coverage in your area. Two important things you need to know about your current coverage and Medicare prescription drug coverage:
Medicare prescription drug coverage is available if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan.
All Medicare drug plans provide at least a standard level of coverage set by Medicare. More coverage may be offered at a higher premium.
Blue Cross Blue Shield of Kansas City has determined that the prescription drug coverage offered by Kansas City Kansas Public Schools is on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because this coverage is Creditable Coverage, you can keep it and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
If you lose your current creditable prescription drug coverage through no fault of your own, you will be eligible for a two-month Special Enrollment Period to join a Medicare drug plan.
If you decide to join a Medicare drug plan, your current coverage will not be affected. This plan will coordinate with Part D coverage. If you drop your current coverage, be aware that you and your dependents will be able to get this coverage back.
If you drop or lose your current coverage and don’t join a Medicare drug plan within 63 continuous days after your coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
This information is provided for the Medicare open enrollment period which begins on October 15. If you want more information about Medicare plans that offer prescription drug coverage, you will find it in the “Medicare & You” handbook or you can visit medicare.gov or call 800.MEDICARE (800.633.4227).
TTY users: 800.486.2048. If you have limited income and resources, visit Social Security at socialsecurity.gov, or call 800.772.1213 (TTY users call 800.325.0778).
Keep all Creditable Coverage notices. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of the notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Introduction
If you have recently gained coverage under a group health plan sponsored by Kansas City Kansas Public
Schools, this notice pertains to you. This notice has important information about your right to COBRA
continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains
COBRA continuation coverage, when it may become available to you and your family, and what you need to
do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for
other coverage options that may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a Federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other
members of your family when group health coverage would otherwise end. For more information about your
rights and obligations under the Plan and under Federal law, you should review the Certificate of Coverage
Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be
eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through
the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs.
Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which
you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a
life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a
qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified
beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if
coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who
elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your spouse dies; Your spouse’s hours of employment are reduced; Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because
of the following qualifying events: The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred.
The employer must notify the Plan Administrator of the following qualifying events: The end of employment or reduction of hours of employment; Death of the employee; or The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s
losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after
the qualifying event occurs. You must provide this notice to Crystal Primers at (913) 279-2200. Note, proof of
the qualifying event must be provided.
How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation cover-
age will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent
right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage
on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due
to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying
event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of
coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you
notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an ad-
ditional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to
have started at some time before the 60th day of COBRA continuation coverage and must last at least until
the end of the 18-month period of COBRA continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the
spouse and dependent children in your family can get up to 18 additional months of COBRA continuation cov-
erage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This exten-
sion may be available to the spouse and any dependent children getting COBRA continuation coverage if the
employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets
divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent
child. This extension is only available if the second qualifying event would have caused the spouse or depend-
ent child to lose coverage under the Plan had the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and
your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options
(such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost
less than COBRA continuation coverage. You can learn more about many of these options at
www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the con-
tact or contacts identified below. For more information about your rights under the COBRA law, the Patient
Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Region-
al or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your
area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are
available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family
members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Plan contact information: KCKPS USD #500, Crystal Primers, Senior Benefits Specialist, 2010 N. 59th Street, Kansas
City, KS 66104
MARKETPLACE COVERAGE OPTIONS PART A: General Information
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance:
the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice
provides some basic information about the new Marketplace and employment based health coverage
offered by your employer.
WHAT IS THE HEALTH INSURANCE MARKETPLACE?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The
Marketplace offers "onestop shopping" to find and compare private health insurance options. You may also
be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for
health insurance coverage through the Marketplace begins in October 2018 for coverage starting as early as
January 1, 2019.
CAN I SAVE MONEY ON MY HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer
coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're
eligible for depends on your household income.
DOES EMPLOYER HEALTH COVERAGE AFFECT ELIGIBILITY FOR PREMIUM SAVINGS THROUGH THE
MARKETPLACE?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be
eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan.
However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost
sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain
standards. If the cost of a plan from your employer that would cover you (and not any other members of your
family) is more than 9.5% of your household income for the year, or if the coverage your employer provides
does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax
credit. 1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered
by your employer, then you may lose the employer contribution (if any) to the employeroffered coverage.
Also, this employer contribution, as well as your employee contribution to employeroffered coverage is often
excluded from income for Federal and State income tax purposes. Your payments for coverage through the
Marketplace are made on an aftertax basis.
HOW CAN I GET MORE INFORMATION?
For more information about your coverage offered by your employer, please check your certificate of
coverage or contact Kansas City Kansas Public School District HR department.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage
through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online
application for health insurance coverage and contact information for a Health Insurance Marketplace in
your area.
MARKETPLACE COVERAGE OPTIONS CONTINUED PART B: Information About Health Coverage Offered By Your Employer
This section contains information about any health coverage offered by your employer. If you decide to
complete an application for coverage in the Marketplace, you will be asked to provide this information. This
information is numbered to correspond to the Marketplace application.
Here is some basic information about health coverage offered by this employer:
As your employer, we offer a health plan to:
All employees. Eligible employees are:
Full time employees, working a minimum 30 hours per week on a regular basis. Employees will be
effective the first day of the month, following date of hire.
Some employees. Eligible employees are:
With respect to dependents:
We do offer coverage. Eligible dependents are: a spouse, unmarried Children through the end of the
calendar year (December 31) in which they turn 26, Unmarried dependent children over age 26 who
are incapable of supporting themselves because of mental or physical handicaps (upon approval).
We do not offer coverage.
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is
intended to be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a
premium discount through the Marketplace. The Marketplace will use your household income, along with
other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages
vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are
newly employed midyear, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.
Here’s the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax
credit to lower your monthly premiums.
Employer Name:
Kansas City Kansas Public School District Employer Identification Number (EIN):
48-6031181
Employer Phone Number:
913.551.3200
Who can we contact about employee health coverage at this job? Crystal Primers
Phone Number: 913.279.2200 Email Address: [email protected]
X
X
X
Enroll at www.cbizesc.com/kckps 29
GLOSSARY OF MEDICAL TERMS
Coinsurance—The plan’s share of the cost of covered services which is calculated as a
percentage of the allowed amount. This percentage is applied after the deductible has been
met. You pay any remaining percentage of the cost until the out-of-pocket maximum is met.
Coinsurance percentages will be different between in-network and non-network services.
Copays—A fixed amount you pay for a covered health care service. Copays can apply to office
visits, urgent care or emergency room services. Copays will not satisfy any part of the deductible.
Copays should not apply to any preventive services.
Deductible—The amount of money you pay before services are covered. Services subject to the
deductible will not be covered until it has been fully met. It does not apply to any preventive
services, as required under the Affordable Care Act.
Emergency Room—Services you receive from a hospital for any serious condition requiring
immediate care.
Lifetime Benefit Maximum—All plans are required to have an unlimited lifetime maximum.
Medically Necessary—Health care services or supplies needed to prevent, diagnose or treat an
illness, injury, condition, disease or its symptoms, which meet accepted standards of medicine.
Network Provider—A provider who has a contract with your health insurer or plan to provide
services at set fees. These contracted fees are usually lower than the provider’s normal fees for
services.
Out-of-pocket Maximum—The most you will pay during a set period of time before your health
insurance begins to pay 100% of the allowed amount. The deductible, coinsurance and copays
are included in the out-of-pocket maximum.
Preauthorization—A process by your health insurer or plan to determine if any service, treatment
plan, prescription drug or durable medical equipment is medically necessary. This is sometimes
called prior authorization, prior approval or precertification.
Prescription Drugs—Each plan offers its own unique prescription drug program. Specific copays
apply to each tier and a medical plan can have one to five separate tiers. The retail pharmacy
benefit offers a 30-day supply. Mail order prescriptions provide up to a 90-day supply. Sometimes
the deductible must be satisfied before copays are applied.
Preventive Services—All services coded as Preventive must be covered 100% without a
deductible, coinsurance or copayments.
UCR (Usual, Customary and Reasonable)—The amount paid for medical services in a
geographic area based on what providers in the area usually charge for the same or similar
service.
Urgent Care—Care for an illness, injury or condition serious enough that a reasonable person
would seek immediate care, but not so severe to require emergency room care.
Notes
Notes
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 contracts, 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.

Documents

2019 EMPLOYEE BENEFITS GUIDE - KCKPS