2021 Employee

Benefit Guide

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Welcome

Welcome Chesapeake Public Schools (CPS) is excited to offer you and your family comprehensive benefits options designed to help you grow personally, financially, and professionally.

This benefits guide contains an overview of the benefits package available to you through CPS. You will find helpful information herein to assist you in understanding all benefits offered. Please read your materials carefully to choose the options that best meet the needs of you and your family.

As you prepare to enroll for benefits or make changes to your coverage, consider the needs of you and your family throughout the entire year. Keep this guide as reference to use throughout the year. If you have any questions, contact Employee Benefits and Risk Management or carrier directly.

Availabil ity of Summary Health Plan Information As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.

Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.

Disclaimer 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 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.

Medicare Part D — Prescription Drug Information: If you are covered by Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please s ee page 22 for more details.

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Table of Contents

Contents

Benefits Glossary........................................................................................................................ 3

Eligibility..................................................................................................................................... 4

Enrollment ................................................................................................................................. 5

Health and Wellness ................................................................................................................... 6

Medical............................................................................................................................. .......... 8

Telehealth ................................................................................................................................ 11

Flexible Spending Accounts ....................................................................................................... 12

Health Savings Account ............................................................................................................ 13

Dental Plan ............................................................................................................................. .. 14

Long Term Care......................................................................................................................... 15

Life and AD&D Insurance .......................................................................................................... 16

Voluntary Life Benefit Term Insurance ...................................................................................... 17

Whole Life ................................................................................................................................ 17

Short Term Disability . ................................................................................................................ 18

Critical Illness ............................................................................................................................ 18

Accident.................................................................................................................................... 19

Hospital Indemnity .................................................................................................................. 20

Legal Plan and Identity Protection Plans................................................................................... 21

Creditable Coverage Notice ................................................................................................... 22

Legal Notices .......................................................................................................................... 23

Resources ............................................................................................................................…. 26

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Co-insurance – A percentage of a health care cost—such as 20 percent—that the covered member pays after meeting the deductible.

Co-payment – The fixed dollar amount—such as $25 for each doctor visit—that the covered member pays for medical services or prescriptions.

Deductible – A fixed dollar amount that the covered member must pay out-of-pocket each calendar year before the plan

will begin to pay. There is typically an Individual and a Family deductible. An “embedded” deductible means that a single member of a family does not have to meet the full family deductible for after-deductible benefits to take effect. Instead, the member’s after-deductible benefits will take effect as soon as he/she has met the individual deductible. Non-embedded deductible plans are different because after-deductible benefits do not begin to pay for medical expenses until the entire family deductible has been met.

Formulary – A list of prescription drugs covered by the health plan, often structured in tiers that subsidize low-cost

generics at a higher percentage than more expensive brand-name or specialty drugs.

Flexible Spending Accoun ts (FSA) – FSAs let you set aside money from your paycheck on a pre-tax basis to use

for eligible out-of-pocket expenses. Employees must elect to participate in these plans annually. There are three types of FSAs :

Health Care FSA – You can use this account to pay for eligible medical, dental, vision, hearing and prescription drug expensesfor you, your spouse and your eligible tax dependents.

Dependent Care FSA – You can use this account to pay for eligible child and adult care expenses like day care, before andafter school care, nursery school, preschool, and summer day camp.

Limited Purpose FSA – You can only elect this account if you have a Health Savings Account (HSA) and use it to pay foreligible dental and vision expenses.

Health savings accoun t (HSA) – HSAs may be opened by employees who enroll in a high-deductible health plan. Employees can put money in an HSA up to an annual limit set by the government (for 2021, the limit is $3,600 for employee-only coverage and $7,200 for family coverage), using pre-tax dollars. HSA funds may be used to pay for medical expens es before or after the deductible has been met, and no tax is owed on funds withdrawn from an HSA to pay for eligible medical expenses. HSAs are individually owned and the account remains with an employee after employment ends.

High-deductible health plan (HDHP) – An HDHP features higher annual deductibles ($1,500 Individual and $3,000 for family coverage in 2021) than traditional health plans, such as a preferred provider organization (PPO) or health maintenance organization (HMO) plan. With the exception of preventive care, covered members must meet the annual deductible before the plan pays benefits. HDHPs, however, typically have lower premiums than a PPO or HMO plan.

In-network – Doctors, clinics, hospitals and other providers with whom the health plan has an agreement to care for its members. Health plans cover a greater share of the cost for in-network health providers than for providers who are out-of-network.

Out-of-network – A health plan will cover treatment for doctors, clinics, hospitals and other providers who are out-of-network, but covered employees will pay more out-of-pocket to use out-of-network providers than for in-network providers.

Out-of-pocket limit – The most a member could pay during a coverage period (usually one year) for his/her share of the

costs of covered services, including co-payments and co-insurance.

Premium – The amount that must be paid for a health insurance plan by covered employees and their employer,

shared by both. A covered employee’s share of the annual premium is generally paid per pay period and deducted from his/her paycheck.

Preventive care – Preventive care includes screenings and other services for adults and children. (Examples include: certain immunizations, screenings for high blood pressure, cholesterol, Type 2 diabetes, and certain types of cancer.) Preventive care services are covered with no deductible, copayments, or coinsurance when you use an in-network provider. Please note: certain benefits for members who have current symptoms or a diagnosed health problem may be covered under the “Diagnostic Tests” benefit, instead of preventive services.

Benefits Glossary

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All full-time employees are eligible to enroll for benefits described in this guide. Benefits for all newly-hired employees begin on the first of the month following date of hire.

Coverage for Dependent s A dependent is your:

Legal Spouse Natural born child or stepchild Legally adopted child

You may cover a dependent child on the Chesapeake Public Schools health plans as follows: Medical and Dental Plans: Through the last day of the year in which the child reaches age 26.*

*A dependent child who is either mentally or physically handicapped and incapable of self-support may continue to be covered regardless of age if the condition exists and coverage is in effect when the child reaches age 26.

Required Documentation to Add Dependents to Medical and/or Dental Coverage 1. A copy of your city/court certified marriage register certificate (not the one from the clergyman)2. A copy of the front page of last year’s federal 1040 tax return showing either married filing joint or

married filing separately (return must list your spouse’s name and SS#) and One (1) financial document from a financial institution, dated within the last 60 days, which must list your name and your spouse’s name, the date, and the CPS employee’s mailing address. Examples: checking, savings, credit card, personal loan or mortgage statements only.

Newborn children only1. A copy of the proof of birth letter from the hospital within 31 calendar days of the baby ’s birthdate for a

temporary enrollment. 2. A copy of the state certified birth certificate and Social Security number within 45 calendar days of the

baby’s birthdate to complete the enrollment

Children and Disabled Children:1. A copy of the child’s birth certificate or adoption certificate naming you or your spouse as the child ’s birth/

adoptive parent. (If CPS employee is not the named birth/adoptive parent, all the above documentation for aspouse is also required.) or

2. A copy of the court order naming you or your spouse as the child ’s legal guardian (your tax return showingdependent is claimed is required if dependent is over age 18 AND if CPS employee is not the guardian, all the above documentation for a spouse is also required).

3. Disabled children over 26 years old must also have an Anthem Handicapped Dependent Certification completedby a physician and submitted with enrollment paperwork.

Eligibility

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Open Enrollment Open Enrollment is your once-a-year opportunity to make changes to your benefit el ections, and choose the plans and coverage levels that are right for you and your family.

You can change plans as well as add or drop coverage provided to you and/or your dependent(s) that meet the eligibility requirements. Any changes made during Open Enrollment must remain in effect until the following Open Enrollment period, unless you experience a qualifying life event. We encourage you to research your options, evaluate the level of coverage you truly need, and ultimately make choices that best meet your needs.

Qualifying Events For Medical, Dental and Flexible Benefits, you may only make changes to your elections during the year if you experience a qualifying life event. Qualifying life events include:

Marriage, divorce; Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage, or

reaching the dependent child age limit; Changes in your spouse’s employment affecting benefit eligibility; Changes in your spouse’s benefit coverage with another employer that affects benefit eligibility; Changes in employee work status.

The change to your benefit elections must be consistent with the qualifying life event. You have 31 calendar days from the date of the event to submit appropriate forms to the Department of Employee Benefits and Risk Management. Specific documentation is required to add dependents. You will receive confirmation of when your changes will become effective.

If you attempt to make benefit elections beyond the 31 calendar day from the event, you must wait until the next Open Enrollment to make any changes to your coverage.

For more information: Department of Employee Benefits and Risk Management cpsbenefts@cpschools.com 757-547-1343

Enrollment

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CPS Health Centers Locations

Knells Ridge

817 Botetourt Ct,

Chesapeake, VA 23320

757 -389 -7300

Washington Shoppes 838 Old George Washington Hwy, Chesapeake, VA 23323

757-389-7631

Hours Mon-Fri 7 am – 5:30 pm Sat 9 am – 2 pm

Sun Closed

To Schedule Appointments Please call the

location directly or schedule online at asthma and diabetes. My.Marathon-Health.com.

Chesapeake Public Schools (CPS) is committed to helping you lead a healthier life by providing you the tools and resources to make healthier choices! To help accomplish this, CPS joined forces with Marathon Health, one of the leading providers of onsite healthcare, to operate a employee Health Centers. The Health Centers offer convenient and free healthcare services to employees covered by the CPS health plan. In addition to the acute care employees can receive for common illnesses, Marathon Health also offers health coaching to address lifestyle health risks such as stress, unhealthy eating, inadequate sleep, and physical inactivity. Coaching for chronic conditions such as diabetes, asthma heart problems, or high blood pressure.

Health Coaching Health coaching is an innovative way to help you manage your health. You can evaluate your health — where you are and where you want to be. The health coach will help you set goals and will provide you the resources and support you need in order to achieve them. A health coach is available to employees, after completing a Health History and Risk Assessment (HHRA) and a fasting Biometric Health Screening. Health coaching is available to spouses and dependent children (age 6 and older) for chronic conditions including asthma and diabetes.

Condition Care Programs for Asthm a and Diabetes Employees, spouses, and dependents (age 6 and older) with diabetes and/or asthma, covered by a CPS health insurance plan, are encouraged to enroll in our Condition Care Program. Enrollment begins at the Health Center with the completion of a HHRA, Biometric Health Screening, and a Comprehensive Health Review (CHR). Participants are assigned to a Health Coach that works with their physician to offer additional support in managing their condition. As an incentive for meeting with a Health Coach on a regular basis, copays for medications and supplies used to treat diabetes will be covered 100%. To enroll, please contact one of our CPS Health Centers.

Your Privacy is Important All care received from Marathon Health is completely confidential. The rules that protect the privacy of your health information at your local medical office also protect your health information at a Marathon Health practice. For more information on the Marathon Health Privacy Policy, visit Marathon-Health.com/Privacy or call (802) 857-0400 and ask to speak with the Marathon Health privacy office.

Health and Wellness

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Mental & Emotional Health Care Counseling is now available at the Washington Shoppes Health Center for employees covered by a CPS health plan. There is no cost for these services. For more details, please call (757) 389-7631.

Wellness Credits Employees will receive a $20 per pay period reduction in their health insurance premium if the employee completes both a biometric screening and an online questionnaire concerning their personal health history (HHRA). Participation is voluntary and not required.

The following two (2) steps must be completed each year. You must complete both steps each year for a premium reduction in the following year.

Step 1: Complete an online Health History and Risk Assess ment (HHRA)

Login to My.Marathon-Health.com and complete the HHRA found under the “Questionnaires”tab.

I f you completed a HHRA before, simply complete the Health Risk Assessment Annual Update. Need help logging on? Call Marathon Health at 1-888-490-6077

Step 2: Complete a Fasting Biometric Health Screening There are two ways you can complete this step:

1. Schedule a screening at the Health Center2. Schedule a screening with your Primary Care Doctor (PCP) and complete the Physician

Screening Form, found at cpschools.com/wellness/credits.

For more information: www.cpschools.com/wellness/

Health and Wellness

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Medical Plan Summary

To meet the diverse needs of Chesapeake Public Schools employees and their families, we offer a robust medical plan through Anthem. All plans allow you to receive care from participating and non-participating providers; however, you will be covered at a higher level when using in-network providers.

Option 1: Health Keepers HMO Open Ac cess Plan The HMO plan offers affordable health care for you and your family through a network of health care providers. Most network services will have a copay that will go towards your out-of-pocket maximum. For the services that don’t have copays you will pay full cost of the services until you reach your deductible, and then coinsurance will apply. Once you reach your out-of-pocket maximum (includes copays, deductibles, and coinsurance) all eligible services will be covered at 100%. Preventive care services are covered at 100% in-network.

Option 2: Keycare PPO Plan (Closed Plan) This plan is closed to any new enrollment. If you are not currently enrolled in this plan, you are not eligible for this plan. The PPO plan allows you to visit any provider whether they are in-network or out-of-network; however, you will be covered at a higher level when using in-network providers. You have an annual deductible that you must meet before coinsurance applies. There are also copays for certain services that will apply to your out-of-pocket maximum. Once the out-of-pocket maximum is met, all eligible services will be covered at 100%. Preventive care services are covered at 100% in-network.

Option 3: Keycare HDHP with HSA The Keycare HDHP plan does not have any medical copays, meaning you pay the full cost of all services until your deductible is met. Once the deductible is met coinsurance will apply. Just like the other plans, once the out-of-pocket-maximum is met, services will be covered at 100%. Preventive care services are covered at 100% in-network. The HDHP plan is also paired with a Health Savings Account (HSA), that will help offset a portion of your deductible. Please s ee page 13 for more information on the HSA.

Prescription Drug Plans You will have two options when filling prescriptions: the first is the Retail and Home Delivery Pharmacy through Anthem, and the other is the CPS Wellness Center Pharmacy. As an employee, you and your family are encouraged to use the CPS Pharmacy whenever possible as it reduces your co-pays and deductibles. An important note on the Retail and Home Delivery Pharmacy: A pharmacy deductible will apply to the HMO and PPO plans on all Tier 2,3, and 4 drugs. If you are enrolled in the HSA plan, you will need to pay 100% of the cost of your prescriptions until your meet your plan deductible. After the plan deductible is met, you will be responsible for plan co-pays based on the drug tier.

Potential Financial Responsibility When Using Out-of-Network Providers The amount the plan pays for covered services provided by non-network providers is based on a maximum allowable amount for the specific service rendered. Although your plan stipulates an out-of-pocket maximum for out-of-network services, please note the maximum allowed amount for an eligible procedure may not be equal to the amount charged by your out-of-network provider. Your out-of-network provider may bill you for the difference between the amount charged and the maximum allowed amount. This is called balance billing and the amount billed to you can be substantial. The out-of-pocket maximum outlined in your policy will not include amounts in excess of the allowable charge and other non-covered expens es as defined by your plan. The maximum reimbursable amount for non-network providers can be based on a number of schedules such as a percentage of reasonable and customary or a percentage of Medicare. The plan document or carrier’s master policy is the controlling document, and this Benefit Highlight does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual plan language. Contact your claims payer or insurer for more information.

For more information: Anthem www.anthem.com 1-833-630-6742

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Medical Plans

Plan Features Healt h Keepers HMO

In Network

KeyCare PPO In Net work (Closed to New

Enrollment s) KeyCare HDHP with HSA

Calendar Ye ar Deductible $200 Individual

$400 Family $200 Individual

$400 Family $1,500 Individual

$3,000 Family

Out of Pocket Maximum $3,500 Individual

$7,000 Family $3,500 Individual

$7,000 Family $5,000 Individual $10,000 Family

Coverage

Preventive Care Visit No charge No charge No charge

Doctor Visit s $25 per visit to your PCP

$50 per visit to a specialist $25 per visit to a PCP

$50 per visit to a specialist

After deductible; 20% of the amount the

health care professionals in the network have agreed to

accept for their services

Online Visits $15 per visit $15 per visit $49 per visit

L abs, Diagnostic X-rays and Other Outpatient Diagnostic Tests

$25 per visit to your PCP $50 per visit to a specialist

20% of the amount the health care professionals in our network have agreed to

accept for their services

After deductible; 20% of the amount the

health care professionals in the network have agreed to

accept for their services

Out patient Services in a Hospital or Facility

$250 per visit

$200 plus 20% of the amount the health care

professionals in our network have agreed to

accept for their services*

After deductible; 20% of the amount the

health care professionals in the network have agreed to

accept for their services

Inpatient Stays in a Hospit al or Facilit y

$300 per day (not to exceed $1,500) for an admission*

$400 plus 20% of the amount the health care

professionals in the network have agreed to accept for

their services*

After deductible; 20% of the amount the

health care professionals in the network have agreed to

accept for their services

Routine Vision $15 for each visit $15 for each visit $15 for each visit

Emergency Care Visit s In or Out of the Service Area *Waived if admitted directly to thehospital.

$200 per visit to an emergency room*

$200 plus 20% of the amount the health care

professionals in the network have agreed to accept for

their services*

After deductible; 20% of the amount the

health care professionals in the network have agreed to

accept for their services *Waived if a dmitted directly to the hospital.

Employee Cost Per Pay Per iod (20 pay pe r iods)

Health Keepers HMO Open Acce ss

KeyCare PPO (Closed to New

Enrollment s) HDHP with HSA

Employe e Only $25.00 $102.00 $21.00

Employee + Child(ren) $85.00 $181.00 $21.00

Employe e + Spouse $153.00 $259.00 $81.00

Employe e + Family $213.00 $329.00 $139.00

Double Employee $42.00 $148.00 Not eligible

Double Employe e + Family $102.00 $218.00 Not eligible

For more information: Anthem www.anthem.com 1-833-630-6742

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Prescription Plans

Prescription Plan FeaturesRet ail Pharmacy/Home

Delivery PharmacyCP S Wellness Center

Tier 1Ret ail (30 day supply)Home Delivery (90 day supply)

$20 copay$40 copay

$2 copay$4 copay

Tier 2 Ret ail (30 day supply) ($100 deductible)

Home Delivery (90 day supply)

$50 copay after$100 deductible

$100 copay after $100 deductible

$20 copay

$40 copay

Tier 3 Retail (30 day supply) ($100 deductible)

Home Delivery (90 day supply)

$100 copay after $100 deductible

$200 copay after $100 deductible

$40 copay

$80 copay

Tier 4Ret ail (30 day supply) ($100 deductible)

Specialty Drugs

Home Delivery (90 day supply)

10% coinsurance after$100 deductible;

$200 per prescription maximum

10% coinsurance after$100 deductible;

$400 per prescription maximum

10% coinsurance; $200 per prescription maximum

10% coinsurance; $400 per prescription maximum

C P S Wellness C e n ter P ha rm a cy The centers include full-service pharmacies operated by On-Site Rx, Inc., a company specializing in employer-sponsored pharmacies. These pharmacies will save you and your family significant money on co-pays. Furthermore, the pharmacy has staff dedicated to your well-being. They exclusively serve Chesapeake Public Schools (CPS) employees, retirees, and dependents on a CPS health insurance plan.

L ocat ions Knells Ridge 817 Botetourt Ct, Chesa peake, VA 23320 Phone (757) 410-2775 Fax (757) 410-2790

Washington Shoppes 838 Old George Washington Hwy, Chesapeake, VA 23323 Phone (757) 606-1956 Fax (757) 606-1970

With LiveHealth Online, you can access a doctor from your home, office, or on the go 24/7/365. Board certified doctors can visit with you by secure video to help treat many non-emergency medical conditions. LiveHealth Online’s doctors can diagnose your symptoms, prescribe medication and send prescriptions to your pharmacy of choice.

When Should You Use LiveHealth? Instead of going to the ER or an urgent care center for a non-emergency issue During or after normal business hours, nights, weekends and even holidays I f your primary care doctor is not available To request prescription refills (when appropriate) I f traveling and in need of medical care

Who is Eligible? I f you are enrolled in any of the medical plans, then you and your dependents are elig ible for this service. Pediatricians are on call 24/7/365. A parent or guardian must be present on each call for children 18 years of age or younger.

Common Conditions Treated

Allergies Asthma Bronchitis Cold & Flu Diarrhea Ear Aches Fever Headache Infections

Insect Bites

Joint Aches

Rashes

Respiratory Infections

Sinus Infections

Skin Infections

Sore Throat

Urinary Tract Infections

And More!

Pediatric Conditions:

Cold & Flu

Constipation

Ear Aches

Nausea

Pink Eye

And More!

How Much Does it Cost?

Signing up is free, you only pay per visit. You will pay $15 per visit for the HMO and PPO plans, and you will pay $49 per visit for the HDHP plan.

How to Sign Up

You can easily sign up or activate your account by using one of the following methods:

1. Go online and visit : livehealthonline.com/

2. Call our toll free number: 1-888-548-3432

3. Download the LiveHealth Online App

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Telehealth

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Flexible Spending Account (FSA) The Flexible Spending Account (FSA) plans, administered by Flexible Benefit Administrators, allow you to set aside pre-tax dollars to pay for your eligible out-of-pocket health care and dependent care expenses.

Elections made to either plan cannot be changed unless you have a qualifying life event. You must contact the Department of Employee Benefits and Risk Management within 31 calendar days of your qualifying event in order to make a change to your FSA contribution.

There are three types of FSA accounts:

Health Care FSA - Covers qualified health care expenses for you and your eligible family members that are not reimbursedby any medical, dental or vision care plan that you or your dependents have. You may contribute up to $2,750 for the 2021 plan year.

Limited Purpose Health Care FSA - This account is for those who enrolled in the High Deductible Health Plan. Under aLimited Purpose FSA, eligible expenses are limited to qualifying dental and vision expenses for you, your spouse, and youreligible dependents.

Dependent Care FSA - Reimburses your eligible expenses for child care and/or elder care. You may contribute up to $5,000 per family per plan year ($2,500 if married and file separate on tax returns).

Important Notes About the FSA • Enrollment for the FSA plans is required each year. You do not need to be enrolled in a Medical Plan to participate in the

FSA Plan.• The IRS sets an annual maximum on each FSA plan. The annual maximum for both health care FSAs is $2,750 for 2021. The

dependent care FSA maximum is $5,000 ($2,500 if you are married but fling separately).• The FSA plan year runs from January 1 - December 31. • Active employees have until March 30 of the following plan year to submit claims for expenses incurred in the current plan

year.• Upon termination, you have 30 days following your termination (or retirement) date to submit claims or funds will be

forfeited.• Unused FSA funds will be forfeited. This is known as the “use it or lose it” rule. Please plan your expenses carefully to avoid

over-contributing to the FSA. Set aside only enough money to cover the expenses you are reasonably certain you will incur.• If your employment ends, you only have 30 days from your termination date to submit claims incurred prior to your last

day.

For more information: Flexible Benefit Administrators www.flex-admin.com

757-340-4567

Flexible Spending Account (FSA)

If you enroll in the High Deductible Health Plan (HDHP) you will have the option to open a Health Savings Account (HSA).

What To Know About The HSA A Health Savings Account is a tax-advantaged savings account used to pay for eligible medical expenses as well

as deductibles, coinsurance, prescriptions, vision, and dental care incurred by employees and dependents. Contributions are made pre-tax from your paycheck reducing your federal income taxes. Assets in your HSA account grow tax-free. Funds can be withdrawn without IRS taxation if you use them for qualified medical expenses. Account holders will be issued a debit card to pay for eligible expenses. Your tax dependents are also eligible to use HSA funds. Once enrolled in Medicare, you are no longer eligible to contribute to an HSA. However, you can continue to use

the funds in your account. There is NO “use it or lose it penalty.” Your account is portable and will remain yours if you leave Chesapeake

Public Schools. Additional retirement savings: Age 65+, HSA funds can be withdrawn for any purpose without penalty. Calendar Year Maximum contributions amounts are regulated by the IRS.

To p arti cip ate in t he HS A, yo u mus t Be enrolled in the HDHP. Not be covered by any other plan, such as a spouse’s medical plan or a Medical Flexible Spending Account. Not be enrolled in Medicare, TRICARE or TRICARE for Life. Not be claimed as a dependent on someone else’s tax return.

Ho w the HSA Works Money Goes In You can contribute pre -tax dollars through payroll deductions as long as you do not exceed the IRS maximums for 2021: $3,600 for single coverage $7,200 if you enroll your spouse and/or children $1,000 catch-up contributions at age 55+

Money C omes Out When you have an eligible expense, you decide whether to use your tax -free HSA or pay for care with other resources.

You pay the full cost of non-preventive care, including non-preventive prescription drugs, until you meet the deductible. Remember, you receive discounted rates in -network.

Money Left Over, Ro lls Over Any money left in your account is yours to pay for eligible health care expenses in the future — tax-free.

If y ou leave C PS o r retire, y ou t ake the m oney wi th y ou. For auditing purposes, it is important to keep all of your receipts. Using your HSA funds for anything other than qualified medical expenses before age 65, could result in taxation on those amounts, plus a 20% IRS penalty.

A complete list of qualified HSA expenses can be found in the IRS Publication 502: Medical and Dental Expenses, available by visiting www.irs.gov.

For more information: Anthe m www.a nthe m.c om 1-833-630-6742

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Health Savings Account (HSA)

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Dental Plan

Plan Features In Network Out of Network

Annual B e ne fit Maximum $1,250 $1,250

Plan Year Deductible Individual Family

$50

$100

$50

$100

Annual Deductible – (Calendar Year) Per insured person Family maximum

$50

2x single member deductible

$50

2x single member deductible

Coverage Anthem Pays Anthem Pays

Diagnostic & Preventive Care Periodic oral exam Teeth cleaning (prophylaxis) Bitewing X-rays: 2x a year Intraoral X-rays

100% coinsurance 100% coinsurance

Basic Dental Care Fillings Root Canal Scaling and Root Planning

80% coinsurance 80% coinsurance

Major Dental Care Crowns Dentures Bridges Implants Prosthetic Repairs/Adjustments

50% coinsurance 50% coinsurance

Orthodontic Services Not covered Not covered

Employe e Cost Per Pay Period (10 mont hs)

Employee Only $0.00

Employee + Family $15.61

For more information: Anthem www.anthem.com 1-833-630-6742

The caregiving needs of an aging loved one can take an emotional and financial toll on a family. Long Term Care insurance is one way to help reduce the impact on family and loved ones.

Most medical plans do not cover long term care services such as nursing home care or at -home care toassist with activities of daily living, such as bathing, eating, etc.

Anyone at any age may need these services, the cost of which can quickly deplete savings or retirementincome. Under this program, coverage to help pay for long term care may be more affordable than youthink.

VRS has contracted with Genworth Life Insurance Co. as the insurer for the program. This coverage isemployee-paid and provides a monthly benefit allowance for covered long term care expenses

For More Information:

Genworth

www.genworth.com/COV

1-866-859-6060

Long Term Care

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Long Term Care

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Life and AD&D Insurance

This plan is offered through Anthem Life Insurance Company and is available for employees only. You must enroll in this plan if you enroll in medical and/or dental insurance. It is also available if you are not enrolled in medical and/or dental insurance. You will receive $10,000 of Basic Life and AD&D insurance at $0.96 per pay period.

Anthem Life Resource Advisor Chesapeake Public Schools employees enrolled in the Anthem 10K Basic Life insurance policy have access to a resource advisor with Anthem. Counselors are available to speak with you on various topics like money matters, legal issues such as wills, identity theft, emotional problems, travel assistance, and more. Please contact the Employee Benefits Department for informational fliers. For assistance, contact a Resource Advisor at 888-209-7840.

Employee and Family Voluntary AD&D Insurance You have the option of choosing Accidental Death & Dismemberment insurance for yourself, your spouse, and/or your child(ren). This plan, also offered through Anthem Life Insurance Company, provides 24-hour coverage against any covered accident. Coverage is shown below:

*Dependent children up to age 24Employees who are married to another Chesapeake Public Schools employee cannot be covered as a dependentunder a spouse’s plan. Only one employee can carry family coverage.

For more information: Anthem www.anthem.com 1-888-209-7840

10K Basic Term Life:

Employee only $0.96

EMPLOYEE COST PER PAYDAY OVER 10 MONTHS

AD&D Insurance:

Employee only coverage

$50,000 $0.36

$100,000 $0.72

$150,000 $1.08

$200,000 $1.44

$250,000 $1.80

Employee/Family coverage

$50,000 $0.66

$100,000 $1.32

$150,000 $1.98

$200,000 $2.64

$250,000 $3.30

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Aflac Group Voluntary Benefits

Aflac group term life insurance helps take care of your loved ones’ immediate and future needs if you should pass away. Immediate needs can include burial/funeral expenses, uninsured medical costs and current bills and debts. Future needs could include income replacement, education plans, ongoing family obligations, emergency funds, and retirement expenses.

It’s Insurance for Daily Living Aflac pays cash benefits directly to you, unless you choose otherwise. This means that your family will have added financial resources to help with ongoing living expenses. Aflac group term life insurance plans* are designed to provide you with cash benefits such as the following:

Up to $100,000 of Term Life coverage Waiver of premium Accidental death

*This is a brief product overview only. Products and benefits vary by state and may not be available in some states.Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions that mayaffect benefits payable. Refer to the plan for complete details, limitations, and exclusions

Whole Life Insurance Aflac group whole life insurance helps take care of your loved ones’ immediate and future needs if you should pass away. Immediate needs can include burial/funeral expenses, uninsured medical costs and current bills and debts. Future needs could include income replacement, education plans, ongoing family obligations, emergency funds, and retirement expenses. This plan also builds cash value.

It’s Insurance for Daily Living Aflac pays cash benefits directly to you, unless otherwise assigned. This means that your family will have added financial resources to help with ongoing living expenses. Aflac group whole life insurance plans* are designed to provide you with cash benefits such as the following:

Up to $300,000 of Whole Life coverage Waiver of premium Accidental death

*This is a brief product overview only. Products and benefits vary by state and may not be available in some states.Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions that mayaffect benefits payable. Refer to the plan for complete details, limitations, and exclusions.

For more information: www.aflacgroupinsurance.com 1-800-433-3036 Group Policy #24644

Voluntary Term Life

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Aflac Group Voluntary Benefits

Short Term Disability No one plans on becoming disabled. It not something we typically think about and yet, it is something that can happen to anyone. If you get sick or hurt and could not work, how would you pay the mortgage? Buy groceries? Make your car payment? And all of the other bills that won’t go away, just because your paycheck is gone?

This is where the A flac group short -term disability insurance plan* can help make the difference. The difference that means you will have a portion of your income to help take care of your bills while you’re taking care of yourself.

It’s Insurance for Daily Living Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses. A flac group disability insurance plans* can help with everyday living expenses, like your rent or mortgage, utility bills, groceries, and more by providing benefits, such as the following:

Total disability Partial disability Waiver of premium

*This is a brief product overview only. Products and benefits vary by state and may not be available in some states.Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions thatmay affect benefits payable. Refer to the plan for complete details, limitations, and exclusions.

Critical Illness Chances are you know someone who has been diagnosed with a critical illness such as cancer, a heart attack (myocardial infarction), or stroke. You cannot help but notice the strain it ’s placed on the person’s life, both physically and emotionally. What’s not so obvious is the impact on that person’s personal finances. While the person is busy getting well, the bills may continue to pile up.

Would You Have The Money to Cover the Out-of-Pocket Expenses, such as? Transportation to a distant medical facility. Specialized treatment costs. Living expenses like rent, mortgage, and utility bills

It’s Insurance for Daily Living Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses. Aflac group critical illness insurance plans* are designed to provide you with cash benefits, such as the following:

Pays a lump sum benefit for a covered critical illness: cancer, heart attack, and stroke.

*This is a brief product overview only. Products and benefits vary by state and may not be available in some states.Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions thatmay affect benefits payable. Refer to the plan for complete details, limitations, and exclusions.

For more information: www.aflacgroupinsurance.com 1-800-433-3036 Group Policy #24644

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Aflac Group Voluntary Benefits

Accident Accidents can happen in an instant affecting you or a loved one. A flac is designed to help families plan for the health care bumps ahead and take some of the uncertainty and financial insecurity out of getting better.

Protection for the unexpected, that’s the be nefi t of the A flac Group Accident Plan. After an accident, you may have expenses you’ve never thought about. Can your finances handle them? It’s reassuring to know that an accident insurance plan can be there for you in your time of need to help cover expenses such as:

Ambulance rides Emergency room visits Surgery and anesthesia Prescriptions Major Diagnostic Testing Burns

Plan Features Benefits are paid direct ly to you, unless otherwise assigned. Coverage is guaranteed-issue (which means you may qualify for coverage without having to answer

health questions). Benefits are paid regardless of any other medical insurance.

What you need, when you need it. Group accident insurance pays cash benefits that you can use any way you see it.

For more information: www.aflacgroupinsurance.com 1-800-433-3036 Group Policy #24644

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Aflac Group Voluntary Benefits

Hospital Indemnity The average cost per inpatient day for a hospital stay is $2,157.1

As health care costs continue to rise, you are responsible for paying more and more out -of-pocket costs with every accident and illness. A flac is designed to help families plan for the health care bumps ahead and take some of the uncertainty and financial insecurity out of getting better.

How will you help protect your savings when you have a covered accident or sickness?

If you are confined to the hospital, major medical insurance will help with many medical expenses, but you could be left with out-of-pocket expenses. You could also lose pay while you’re out of work and you can be sure that the bills will keep coming. Aflac is here to help.

It’s Insurance for Daily Living Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses. A flac group hospital indemnity insurance plans2 are designed to provide you with cash benefits to help with the following:

Hospital Confinement Benefit Hospital Admission Benefit Hospital Intensive Care Benefit Intermediate Intensive Care Step-Down Unit Everyday living expenses, like your rent or mortgage, utility bills, groceries, and more It even provides coverage for newborn children for 60 days from the date of birth3

1State Health Facts, Kaiser Family Foundation, 2015. http://www.statehealthfacts.org. 2 This is a brief product overview only. Products and benefits vary by state and may not be available in some states. Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions that may affect benefits payable. Refer to the plan for complete details, limitations, and exclusions. 3 Applies to newly adopted children as well. Refer to the plan for complete details.

For more information: www.aflacgroupinsurance.com 1-800-433-3036 Group Policy #24644

Legal Resources Legal Plan covers 100% of the attorney fees for fully covered legal matters. Whether your legal matter is for an everyday legal need or a result of an unexpected life event, you and your family will have immediate and ongoing access to a network of top-rated law firms in your area. Don’t see your legal need listed below? Don’t worry, the Legal Plan offers a 25% discount on less common services such as: Immigration, Tax Law, Small Business Matters, Bankruptcy, Felonies, and more. Your cost is only $10.20 per pay period and covers you, your spouse and qualified dependent children up to age 26. Member and spouse’s parents are covered at a 25% discount, as well. The plan may be used as often as needed.

General Advice and Consultation Prep and Review of Routine Legal Documents

Family Law Domestic adoption, uncontested Divorce, uncontested

Real Estate Purchase, sale, or refinance of primary residence Tenant-landlord matters Cr iminal Matters

Defense of misdemeanor Misdemeanor defense of juvenile

Wills and Est at e Matters, Elder L aw Will preparation and periodic updates Financial powers of attorney Contingent trust for minor children Power of attorneys for membersparents Estate Advice

Consume r Relations and Credit Prote ction Warranty and billing disputes

Civil Actions Representation as a defendant or plaintiff Insurance matters Small claims court advice

Traffic Violations Speeding and reckless driving Driving under the influenc e (1st offense)

This summary of coverage is intended to provide a broad overview of plan coverage. For sp eci fic coverage questions call Member Services at 800.728.5768. Members are responsible for all non-attorney costs such as fling fees, court cost, f ines, etc. Th e plan may not be used against the administrator of the plan.

Identity Protection Plan and Insurance

Employee Cost Per Payday over 10 Mont hs

ID Theft ONLY Gold Employee Only ID Theft ONLY Gold Employee/Spouse ID Theft ONLY Platinum Employee Only ID Theft ONLY Platinum Employee/Spouse

$ 5.97 $10.77 $10.17 $18.57

Legal Resources Identity Theft Protection Plans (IDP) safeguard your personal identity, credit, and financial well-being. Identity theft is the fastest growing crime in the U.S., with more than 16.7 million victims last year alone. The need for identity theft protection and insurance is rising and will continue to grow as we further integrate our lives electronically.

The Identity protection plans monitor and control your personal information and include:• 24/7 fully managed, do-it-for-you resolution, by Certified Identity Restoration Specialists• $1 Million of identity theft insurance• Real-time, advanced identity monitoring• Instant alerts• Monthly credit reports and scores• Lost wallet assistance• Emergency cash and travel services• Online data protection tools and software• Personal and secure Dashboard with unlimited account monitoring

For more information: Legal Resources www.legalresources.com 1-800-728-5768 or 757-498-1220

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Legal Plan

Important Information from Anthem Blue Cross and Blue Shield about Your Prescription Drug Benefit Plan and Medicare

Employers must provide information regarding creditable coverage to allow Medicare-eligible members to make informed decisions regarding Medicare Part D coverage. Anthem Blue Cross and Blue Shield has determined that the following prescription drug coverage plan is creditable for the 2017 Medicare Part D standard prescription drug benefit:

Your Prescription Drug Plan

Retail Pharmacy CPS Wellness Center

Tier 1 $20 $2

Tier 2 $50 copay after $100 deductible $20

Tier 3 $100 copay after $100 deductible $40

Tier 4 10% after $100 deductible (max. $200) 10% (max. $200)

Why is creditable coverage important? Most employers that provide prescription drug coverage to Medicare-eligible members – including active employees, retirees and their dependents – must disclose to those members whether that coverage is creditable or not creditable toward the Medicare Part D prescription drug benefit. Beneficiaries who are not covered under a creditable prescription drug plan and who choose not to enroll during the annual open enrollment period for Part D will pay a late enrollment penalty if they subsequently do choose to enroll in Medicare Part D.

What do I need to do? Notice to beneficiaries must occur at the following times:

Prior to the Annual Coordinated Enrollment Period (ACEP) each year, which begins Jan. 1 Prior to the effective date of the person’s enrollment in the plan At the time of any change in the creditable coverage status of the prescription drug plan Upon request from the beneficiary

Notice to the Centers for Medicare & Medicaid Services (CMS) whether coverage is creditable or non -creditable must occur at the following times:

Within 60 days after the beginning date of the plan year Within 30 days after the termination of the prescription drug plan Within 30 days after any change in the creditable coverage status of the prescription drug plan

To learn more about Medicare Part D, creditable coverage, and your responsibilities as a plan sponsor, please visit CMS on the World Wide Web at http://www.cms.hhs.gov/ EmplUnionPlanSponsorInfo.

Date: January 1, 2021 Name of Entity/Sender: Chesapeake Public Schools Contact Position/Office: Employee Benefits/Risk Management Address: 312 Cedar Road, Chesapeake, VA 23322 Phone Number: (757) 547-1343

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Creditable Coverage Notice

The Women’s Health and Cancer Rights Act The Women’s Health and Cancer Right Act requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for this year.

These services include: Reconstruction of the breast upon which the mastectomy has been performed; Surgery/reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment for physical complications during all stages of mastectomy, including lymphedemas.

In Addition, The Plan May Not: Interfere with a participant’s rights under the plan to avoid these requirement; or Offer inducements to the healthcare provider, or assess penalties against the provider, in an attempt to

interfere with the requirements of the law.

However, the plan may apply deductibles, coinsurance, and co-pays consistent with other coverage provided by the Plan. If you have any questions about the current plan coverage, please contact Employee Benefits and Risk Management at 757-547-1343.

Know Your Cobra Notification Responsibilities It is your responsibility to notify Financial Service and Risk Management when a dependent becomes eligible or ceases to be eligible for coverage under our benefit plans. All eligibility changes should be reported within 31 days of the event. Failure to report changes in a timely manner can impact your ability to add newly eligible dependents or discontinue pre-tax premium contributions on ineligible dependents.

In addition, failure to report a loss of eligibility due to legal separation or divorce or a dependent that has otherwise ceased to be eligible, such as a child reaching the maximum dependent child age limit, can impact your dependent ’s rights for group health plan coverage under the federal law known as COBRA. If you fail to report the loss of eligibility within 31 days of the event, your dependents may be left with no continuation coverage under our plan. Please see your COBRA notice or your group health plan summary plan description for additional information.

Protecting Your Health Information Privacy Rights Chesapeake Public Schools is committed to the privacy of your health information. The administrators of the Chesapeake Public Schools Health Care Plan (the “Plan”) use strict privacy standards to protect your health information from unauthorized use or disclosure. The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. You may receive a copy of the Notice of Privacy Practices by contacting Employee Benefits and Risk Management.

Notice of Your HIPPA Special Enrollment Rights Loss of Other Coverage - If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. To be eligible for this special enrollment opportunity you must request enrollment within 31 days after your other coverage ends or after the employer stops contributing towards the other coverage.

23

Legal Notices

New Dependent as a Result of Marriage, Birth, Adoption or P lacement for Adoption - If you have a new dependent a s a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 31 days after the marriage, birth, adoption or placement for adoption.

Medicaid Covera ge - The Chesapeake Public Schools group health plan will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occur: Termination of Medicaid or CHIP Coverage - If the employee or dependent is covered under a Medicaid plan or under

a State child health plan (SCHIP) and coverage of the employee or dependent under such a plan is terminated as aresult of loss of eligibility.

Eligibility for Premium Assistance Under Medicaid or CHIP - If the employee or dependent becomes eligible forpremium assistance under Medicaid or SCHIP, including under any waiver or demonstration project conducted underor in relation to such a plan. This is usually a program where the state assists employed individuals with premiumpayment assistance for their employer ’s group health plan rather than direct enrollment in a state Medicaidprogram.

To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 31 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP or the date you or your dependent’s Medicaid or state-sponsored CHIP coverage ends.

To request special enrollment or obtain more information, please contact Employee Benefits and Risk Management at 757-547-1343.

Premium Assistance Under Medicaid and the 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 yo u 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 b e 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).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2020. Contact your State for more information on eligibility –

24

Legal Notices

VIRGINIA – Medicaid and CHIP

Website: https://www.coverva.org/hipp/

Medicaid Phone: 1-800-432-5924

CHI P Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administration

www.dol.gov/agencies/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, Menu Option 4, Ext. 61565

25

Legal Notices

Benefit Carrier Phone Website

Medical Anthem 1-833-630-6742 www.anthem.com

Telehealth LiveHealth Online 1-888-548-3432 www.livehealthonline.com

F SA Flexible Benefit Administrators 1-757-340-4567 www.flex-admin.com

HSA Anthem 1-833-630-6742 www.anthem.com

Dental Anthem 1-833-630-6742 www.anthem.com

Life and AD&D Anthem 1-888-209-7840 www.anthem.com

Short Term Disability Group Term Life Whole Life Accident Critical I llness Hospital Indemnity

Aflac 1-800-433-3036 www.aflacgroupinsurance.com

Legal & Identity Theft Legal Resources 1-800-728-5768 www.legalresources.com

Department of Employee B enefits and Risk Management

1-757-547-1343

cpsbenefts@cpschools.com www.cpschools.com/

employee-benefits-risk-management/

Retirement Plans Virginia Retirement System (VRS) 1-888-827-3847 www.varetire.org

Long Term Care (LTC) Genworth 1-866-859-6060www.varetire.org/members/

benefts/ long -term-care/ voluntary-long -term-care/index.asp

26

Resources

The information contained in this guide should in no way be construed as a promise or guarantee of employment or benefits. The company reserves the right to modify, amend, suspend, or terminate any plan at any time for any reason. If there is a conflict between the information in this presentation and the actual plan documents or policies, the documents or policies will always govern. Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from the Department of Employee Benefits.

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