RETIREE Benefit Newsletter€¦ · School District of Clayton 2019 Annual Enrollment Page 5 Cigna our DHMO Dental Carrier Log on to: Find a Dentist Check Claim Status Order New Id

RETIREE

Benefit Newsletter

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Table of Contents

SUBJECT PAGE MEDICAL Base Plan. . . . . . . . . . . . . 2 Buy-Up Plan. . . . . . . . . . . 2 QHDHP……... . . . . . . . . . 3 DENTAL PPO - Delta Dental . . . . . . 4 DHMO - Cigna . . . . . . . . . 5 VISION.—EyeMed . . . . . . . . 6 ADDITIONAL INFORMATION Medicare & H.S.A. . . . . . . 7 Medicaid/CHIP Notice . . . 8 OPEN ENROLLMENT Access Information. . . . . . 9 Enrollment Dates . . . . . . . 9 Non-Discrimination Disclosure. . . . . . . . . . . . . 10 How to Enroll. . . . . . . . . . . . 11

2019 OPEN ENROLLMENT The School District of Clayton is getting ready for the 2019 benefit year which begins on January 1, 2019. The District’s benefit package will continue to offer Medical, Dental, and Vision benefit plans, Anthem Blue Cross Blue Shield will continue to be our medical carrier for the upcoming year. The benefits offered to you contain three medical plan options. These include a Base, Buy-Up, and a Qualified High Deductible Health Plan. The Qualified High Deductible Health Plan allows those who are not enrolled in Medicare to enroll in a Health Savings Account. You will once again have the choice between two dental plans, a PPO and a DHMO. The PPO plan will be provided by Delta Dental and allows you to move freely between In-Network and Non-Network providers. The DHMO plan is again offered through CIGNA. This type of plan offers a greater benefit, however, it is more restrictive as you must choose a network provider for your dental care. You will receive all services from that provider and be referred to a specialist for any specialty dental procedures. The vision plan will be administered through EyeMed. A brief summary of all our benefit plans along with rates based upon the coverage you select are provided in this newsletter. Open enrollment begins on October 22 and ends on October 29. Mary Jo Gruber Chief Financial Officer PLEASE NOTE: IF YOU DO NOT WANT TO MAKE ANY CHANGES THIS YEAR TO YOUR BENEFITS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH OUR 2019 CARRIERS. IF YOU WANT TO MAKE CHANGES TO YOUR BENEFITS, YOU WILL NEED TO LOG INTO THE PORTAL AND MAKE THE NECESSARY CHANGES . YOU CAN ALSO CALL EXPLAIN MY BENEFITS AT 1-888-734-6937 Option 3 AND THEY WILL ASSIST WITH YOUR ELECTIONS AND/OR CHANGES.

Type of Coverage

Monthly Cost

Employee Only $660.00

Employee & Spouse $1,265.00

Employee & Children $1,040.00

Employee & Family $1,640.00

Benefit/Service In Network Non-Network

YOU PAY YOU PAY

Deductible $750 / Individual $1,500 / Family

$1,500 / Individual $3,000 / Family

Coinsurance 10% 40%

Out-of-Pocket Maximum



Office Visit $30 Primary Care

$60 Specialist 40%

After Deductible

Preventive Care 100% Covered 40%

After Deductible

Inpatient Hospital

10% After Deductible


Outpatient Hospital



Urgent Care $50 Co-Pay 40%

After Deductible

Emergency Room

$300 Co-Pay $300 Co-Pay

Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3

$10 Co-Pay $40 Co-Pay $70 Co-Pay


$140 Co-Pay

Not Covered

Not Covered

BASE PLAN


YOU PAY YOU PAY

Deductible $250 / Individual $500 / Family

$500/ Individual $1,000 / Family

Coinsurance 0% 30%




Office Visit $25 Primary Care

$50 Specialist 30%

After Deductible


After Deductible

Inpatient Hospital

0% 30%

After Deductible

Outpatient Hospital

0% 30%

After Deductible

Urgent Care $50 Co-Pay 30%

After Deductible

Emergency Room


Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3

$10 Co-Pay $40 Co-Pay $70 Co-Pay


$140 Co-Pay

Not Covered

Not Covered

BUY UP PLAN - MONTHLY COST BASE PLAN - MONTHLY COST

Retiree Cost

The deductible, co-pays, and prescription drug co-pays count towards the out-of-pocket maximum.

This option offers the lowest out-of-pocket maximum . The co-pays, and prescription drug co-pays count towards the out-of-pocket maximum.

Traditional PPO Medical Plans BUY-UP PLAN

Type of Coverage

Monthly Cost

Employee Only $795.00

Employee & Spouse $1,560.00

Employee & Children $1,290.00


Retire Cost

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School District of Clayton 2019 Annual Enrollment


YOU PAY YOU PAY

Deductible $3,000/ Individual $6,000 / Family


Coinsurance 10% 30%




Office Visit Deductible 30%

After Deductible


After Deductible

Inpatient Hospital 10%

After Deductible 30%

After Deductible

Outpatient Hospital 10%


After Deductible

Urgent Care 10%


After Deductible

Emergency Room 10%


After Deductible

Prescription Retail & Mail Order

Deductible then

10%

Not Covered

If you elect the Qualified High Deductible Health Plan (QHDHP) you can also participate in a Health Savings Account (HSA) if you are not enrolled in, or eligible for, Medicare. You cannot be covered elsewhere under a non-qualified plan.

All expenses count towards the deductible, which has to be satisfied first before you receive benefits under this plan.

The single deductible applies to the family deductible. Once the single deductible has been satisfied, benefits for that member are payable subject to coinsurance. Once the family deductible has been satisfied, benefits for the family will be payable subject to coinsurance.


Qualified High Deductible Health Plan (HSA Qualified)

Type of Coverage Monthly

Cost

Employee $535.00

Employee & Spouse/ $915.00

Employee & Child(ren) $755.00


QUALIFIED HIGH DEDUCTIBLE PLAN

Retiree Cost

ANTHEM BLUE CROSS BLUE SHIELD

To find helpful medical benefit information and tools, log on to

anthem.com Log on to: My Online Services

Find Doctors and Hospitals

Check Claim Status

Order New ID Cards

Print Temporary ID Cards

View Benefits

Refill Mail Order Prescriptions

Access Anthem’s Drug List

Member Services: 1-800-490-6145

Policy No. 00252877

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The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA.

Employees age 55 and over may contribute an additional $1,000 annually to their HSA.

You cannot be enrolled in another health plan that is not a QHDHP.

If you are enrolled in Medicare you cannot participate in the Health Savings Account.

You or your spouse cannot participate in a Medical Flexible Spending Account.

You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP.

IRS rules dictate calendar year maximum deposits into Health Savings Accounts. You cannot exceed these set maximums. Maximum allowed deposits for the calendar year 2019 are:

Individual Accounts: $3,500 Family Accounts: $7,000

http://www.anthem.com

You have two dental plan options. One option is a PPO plan with Delta Dental. This option offers you more freedom to choose any dentist. The second option is a Dental Health Maintenance Organization (DHMO) with Cigna (Shown on Page 5) .

Benefits PPO PREMIER NON-

NETWORK

You Pay You Pay You Pay

Deductible Individual Family

$50 $150

$50 $150

$50 $150

Coinsurance

Diagnostic/Preventive

Basic Services

Major Services

Orthodontia (child)

0%

Deductible is Waived

10%

Deductible Applies

40%

Deductible Applies

50% Deductible Does

Not Apply

0%

Deductible is Waived

20% Deductible Applies

50%

Deductible Applies

50% Deductible Does

Not Apply

0% Deductible is Waived



50% Deductible Does

Not Apply

90%

Percentile

Annual Maximum Benefit

$1,500/person

Ortho Lifetime Max. $1,000/child

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Dental - PPO


Met Life our PPO dental carrier.

Log on to: www.deltadentalmo.com

Find a Dentist

Check Claim Status

Order New ID Cards

Member Services: 800-335-8266

Customer Service: [email protected]

Policy Number: 01190301


Cost

Employee $41.08

Employee & Spouse $82.17


Employee & Family $135.42

Retiree Cost - PPO

Plan Highlights

If you believe your dental procedure will exceed $300, have your dentist contact Met Life for an estimate.

Is your dentist a non-network dentist? Benefits will be paid at the 90th percentile, which means what 9 out of 10 dentists charge in area where your dentist is lo-cated. This could cause you to have higher out-of-pocket expenses.

Dental - DHMO

The CIGNA DHMO patient charge schedule is not changing for 2019. Following is a sample schedule:

CODE PROCEDURE PATIENT PAYS

D1110 Adult Cleaning No Charge

D0270 Bitewings No Charge

D0330 Panoramic X-Ray No Charge

D2330 Composite - Surface No Charge

D2140 Amalgam - 1 surface No Charge

D2752 Crown - Porcelain $425

D6794 Crown - Titanium $460

D3310 Root Canal - Anterior $210

D3320 Root Canal - Bicuspid $245

D3330 Root Canal - Molar $335

D4210 Gingivectomy 4 per Quad $180

D5110 Full Upper Denture $625

D5120 Full Lower Denture $625

D6065 Implant supported porcelain/ceramic crown

$790

Ortho 24-Month Treatment Fee $2,040


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Cigna our DHMO Dental Carrier Log on to: www.cigna.com

Find a Dentist

Check Claim Status

Order New Id Cards

Member Services: 1-800-244-6224


Plan Highlights

You are responsible for a $5 Office Visit Fee per patient, per office visit.

You have to be on the dentist’s roster in order to receive treatment.

Check the Patient Charge Schedule K1-V9 before receiving services to know what your responsibility is.

The Patient Charge Schedule K1-V9 is located in Custom Solutions or you can contact Barb Daves in the Business Office for a copy.

If a procedure is not shown in the schedule, it is not covered.


Cost

Employee $26.67

Employee & Spouse/SSDP $46.74



Retiree Cost - DHMO

http://www.cigna.com/

Benefit/Service In Network Non-

Network

You Pay Reimbursement

Exam Co-pay 0% $35

Frequency Exam Lenses Frames

Every 12 months Every 12 months Every 24 months

Lenses Single Bifocal Trifocal

$5 Co-pay then

0% 0% 0%

$35 $45 $60

Frames

0%

$50 Wholesale $125 to $150

Retail

$35

Contacts Medically Necessary Cosmetic

UCR* $130 Allowance

$250 $130 Allowance

* UCR refers to Usual Customary and Reasonable charges. To determine the UCR, EyeMed takes the procedural charge of area providers and calculates an average. Charges above this average become your responsibility.

Vision Plan


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Cost

Employee $4.40

Employee & Spouse $8.36

Employee & Children $8.80


Retiree Cost

PLAN HIGHLIGHTS If you visit one of EyeMed’s providers you

do not have to obtain a voucher. Your vi-sion provider can receive your benefits electronically.

Non-Network benefits are based on a reimbursement schedule.

You are eligible for savings on Lasik vision services. Savings range from 40% to 50% off the national average price of traditional Lasik.

Contact lens allowance is for lenses. In network providers are contracted to charge no more than $40 for the standard contact lens fit and follow up exam.

EyeMed is our vision carrier Log on to: www.eyemed.com

To find a provider

Member Services: 866-939-3633


Additional Information


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How Your Medical Plan Works with Medicare

THIS IS IMPORTANT IF YOU ARE A RETIREE AGE 65 OR OLDER...

If you are a retiree of The School District of Clayton who elects to be covered under the medical plan and you are age 65 or older, you MUST enroll in Medicare Part A and Part B. The reason: The medical plan provided to you through your retirement from The School District of Clayton is offered as secondary or supplemental coverage to Medicare.

Failure to enroll in Medicare Part A and Part B will cause you to have more out of pocket expenses because Medicare pays first under Medicare Secondary Payer rules established by the Center for Medicare Services. Anthem will consider the claim after Medicare payment has been determined.

If you do not have Medicare Part A and Part B coverage, Anthem will pay the claim as if Medicare paid and consider only the remaining amount if allowable under Clayton’s benefit plan leaving you to pay what Medicare would have paid and your deductible.

If you are not currently signed up for Medicare Part A and Part B, please contact the Department of Social Security for details.

Additional HSA Information

The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA.

Employees age 55 and over may contribute an additional $1,000 annually to their HSA.

You cannot be enrolled in another health plan that is not a QHDHP.

If you are enrolled in Medicare you cannot participate in the Health Savings Account.

If you are a retiree and not participating in Medicare, you are allowed to set up a Health Savings Account at your selected financial institution. If you retire and are currently participating in the HSA with Anthem, you will be required to pay the associated fees.

If you enroll any family member, you must satisfy the family deductible before benefits are paid.

You or your spouse cannot participate in a Medical Flexible Spending Account. You can participate in a Dependent Care Flexible Spending Account.

You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP.

Save your receipts. The IRS is notified of all distributions.

Want To Know What Medicare Covers?

Here is how you do it… 1. Go to www.medicare.gov 2. Go to the top of the page, on the tool bar go to

“What Medicare Covers”. 3. Under “What Medicare Covers” click on “Your

Medicare Coverage”. 4. In the dialog box, enter what medical care you are

needing to determine if covered. 5. Click on “Go” after you have entered the

information. 6. View results.

OR You may call Medicare with your questions: Phone: 1-800-633-4227

Open Enrollment

Our benefit plan year is from January 1 through December 31. You are asked to make your elections for the 2019 plan year through the online enrollment process which is October 22 through October 29. When your en-rollment period is closed, you will not be able to make any changes to your elected coverage until the next open en-rollment period or you experience a qualifying life change event. A life change event includes death, marriage, di-vorce, birth or adoption of a child, or if your spouse loses

or gains coverage through his or her employer.

Medicaid Children’s Health Insurance Program (CHIP)

Offer Free Or Low-Cost Health Coverage To Children And Families

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. CBIZ Custom Solutions provides a copy of the form listing the states that offer assistance. Please access www.cbizesc.com/Clayton and locate forms or contact the Business Office. You can also contact: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565

Important Notice


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Additional Information - Continued

http://www.dol.gov/ebsa

http://www.cms.hhs.gov/


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On Line Enrollment

Enroll in the Online system

School District of Clayton provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible

Retirees the ability to make group insurance benefit elections and changes online during the annual open enrollment and qualifying

events.

Enrollment has never been easier. Accessible 24 hours a day, information about all of your benefit election options, including

premiums and carrier contact information are available to help you make informed decisions.

You can also log into the Explain My Benefits portal at anytime or download the Mobile App, to review your benefits, access carrier

links, update your personal information for yourself and your dependents, and process qualifying life events.

Self-Service Visit explainmybenefits.com/clayton on any computer, click on the blue “Log into Your Benefit System” button and move through the enrollment system at your own pace. Or, download the new Mobile App on your phone or tablet and move through the enrollment at your own pace.

Be sure to click “submit” at the end of the process and make note of your confirmation number. If you do not receive a confirmation number, you have not completed your enrollment and you will not be enrolled in your benefits.

Return to the system anytime and click your confirmation number to view your confirmation statement.

For assistance, please call Customer Service at 1-888-734-6937; Option 3

PLEASE REMEMBER — IF YOU ARE NOT MAKING ANY CHANGES TO YOUR CURRENT BENEFIT ELECTIONS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH THE 2019 CARRIERS.

Review Your Benefits

Visit our benefits portal to review your benefit guide, Important documents and watch

benefit education videos.

ExplainMyBenefits.com/clayton

http://www.explainmybenefits.com/clayton

http://www.ExplainMyBenefits.com/clayton


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Non-Discrimination Disclosure

It is the policy of the School District of Clayton not to discriminate on the basis of race. color, religion, gender, national origin, age, or disability in its programs or employment practices as required by Title VI and VII of the Civil Rights Act of 1964. Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Dis-crimination Act of 1975 and Title II of the Americans with Disabilities Act of 1990. Behavior that is not unlawful or does not rise to the level of illegal discrimination or harassment might be unacceptable for the workplace or the educational environment. Demeaning or otherwise harmful actions are prohibited, particularly if directed at personal characteristics. Accordingly, the District prohibits discrimination or harassment on the basis of sexual orientation, perceived sexual orientation or gender identity. Inquires related to the District’s employment practices should be directed to Dr. Tim Dilg, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri 63015 or by phone at (314) 854-6032. Inquiries related to the District’s student programs should be directed to Kashina Bell, Assistant Superintendent of Student Services, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri 63015 or by phone at (314) 854-6013. Inquiries or concerns regarding civil rights compliance by school districts should be directed to the local school district Title IX/non-discrimination coordinator. Inquiries and complaints may also be directed to the Kansas City Office, Of-fice for Civil Rights, US Department of Education, 8930 Ward Parkway, Suite 2037, Kansas City, MO 64114; (816) 268-0550; TDD (877) 521-2172.

School District of Clayton #2 Mark Twain Circle

Clayton, Missouri 63015 (314) 854-6000

About This Bulletin

The purpose of this booklet is to describe the highlights of your benefit program. Your specific rights to benefits under the Plans are governed solely, and in every respect, by the official Plan documents and insurance con-tracts, and not by this booklet. If there is any discrepancy between the description of the Plans as described in this material and official Plan documents, the language of the documents shall govern.

Documents

RETIREE Benefit Newsletter€¦ · School District of Clayton 2019 Annual Enrollment Page 5 Cigna our DHMO Dental Carrier Log on to: Find a Dentist Check Claim Status Order New Id