SOUTH BAY UNION SCHOOL DISTRICT 2010-2011 Insurance Benefits The Open Enrollment period begins October 27, 2010 through November 10, 2010 The new plan year begins January 1, 2011 You are invited to the Health Fair & Flu Clinic at Burress Auditorium on Wednesday, October 27th, from 2:00 p.m – 5:00 p.m. Your Insurance Benefits South Bay Union School District is a member of VEBA, the Voluntary Employees Benefit Association, for medical health plans, Keenan & Associates for dental and vision plans, and the San Diego County Office of Education’s Fringe Benefit Consortium for other programs. To comply with VEBA’s plan year, our medical plans have a January 1, 2011 start date. In this brochure we outline the cost of benefits to employees. There are rows that refer to what the District pays and what the eligible employee pays and both are based on negotiations settlements. Eligible employees are provided a comprehensive package of benefits described in this brochure. Currently, the one- year agreement has the District paying up to the 2010 premium for Kaiser, and the full 2010 cost of dental, vision and group life insurance. Beginning January 1, 2011, the District’s contribution to health (including dental, vision, and group life insurance) benefits will revert back to the 2009 premium rates (health at the Kaiser rate). The following pages are provided as a summary of each plan and contain information about the general provisions of each of your insurance benefits. Several voluntary programs are available as outlined on page 4 of this brochure. You are urged to become familiar with these benefits so that you and your family can take maximum advantage of the benefits. Beginning January 1, 2011, any qualified adult child up to age 26, regardless of employment, student status or residency, will be allowed to be added as a dependent. They must not have or be eligible for health insurance elsewhere. Grandchildren are NOT eligible dependents without court approved legal guardianship. The new Performance HMO will be replacing the current Pacificare plan. We will now be offering Pacificare under tiered rates. The premiums due will be based on the amount of employees and dependents insured. Also, the Pacificare POS plan will no longer be available. All Pacificare HMO and POS subscribers will need to enroll in the new Pacificare Performance HMO plan or change to Kaiser. You may be able to waive medical insurance if you have other health insurance. You will be required to sign a waiver and submit proof of other coverage. All employees will have to log on to the VEBA website for online enrollment. All employees, even if you are not changing plans will need to enroll online. You will need to verify if all the information is correct. If you have any questions, please contact Margie Cordero in the Human Resources office at extension 81698. Carol A. Parish, Ed.D, District Superintendent Board of Trustees Elvia Aguilar - Chris Brown - Nick Inzunza - Althea F. Jones - David Lopez HEALTH PLAN COMPARISON VEBA Plans Phone Number 619-278-0021/Web Site www.vebaonline.com PacifiCare Performance HMO Kaiser $10/$10 Carrier Phone 1-800-624-8822 1-800-464-4000 Numbers/Web Sites www.pacificare.com www.kaiserpermanente.org Co-Pay Network 1- $10 copay $10 Office visits Class/Cert/Mgmt Network 2 - $20 copay $10 Medication Class/Cert/Mgmt Network 3- $40 copay Certificated Certificated –Single Certificated -Two Party Certificated - Family Premiums Tenthly- Super composite Tenthly Premium Network 1 - $594.68 Network 1 - $1,173.24 Classified (10 mos) $1,048.81 Tiered Rates Network 2 - $1,242.92 Network 1 - $1,652.72 Network 2 - $629.83 Network 2 - $1,750.37 Cert (10 mos) $1,114.32 Network 3 - $1,253.34 Network 3 - $634.60 Network 3 - $1,764.25 Mgmt (10 mos) $1,098.65 Certificated Certificated - Single Certificated- Two Party Certificated - Family District Pays - Super composite District Pays Network 1 - $594.68 Network 1 - $887.51 Network 1 - $887.51 Classified (10 mos) $928.68 Tenthly Network 2 - $629.83 Network 2 - $887.51 Network 2 - $887.51 Cert (10 mos) $887.51 Network 3 - $634.60 Network 3 - $887.51 Network 3 - $887.51 Mgmt (10 mos) $887.51 Certificated Certificated – Single Certificated – Two party Certificated – Family Employee Pays - Super composite Employee Pays Network 1 - $0 Network 1- $285.73 Network 1- $765.21 Classified (10mos) $120.13 Tenthly Network 2 - $0 Network 2- $355.41 Network 2 - $862.86 Certificated (10mos) $226.81 Network 3 - $0 Network 3- $365.83 Network 3 - $876.74 Mgmt (10mos) $211.14 Classified Classified – Single Classified – Two party Classified – Family Tenthly Premium Network 1 - $594.68 Network 1 - $1,173.24 Network 1 - $1,652.72 Tiered Rates Network 2 - $629.83 Network 2 - $1,242.92 Network 2 - $1,750.37 Network 3 - $634.60 Network 3 - $1,253.34 Network 3 - $1,764.25 Classified Classified – Single Classified – Two party Classified – Family District Pays Network 1 - $594.68 Network 1 - $ 928.68 Network 1 - $928.68 Tenthly Network 2 - $629.83 Network 2 - $ 928.68 Network 2 - $928.68 Network 3 - $634.60 Network 3 - $928.68 Network 3 - $928.68 Classified Classified – Single Classified – Two party Classified – Family Employee Pays Network 1 - $0 Network 1 - $244.56 Network 1 - $724.04 All Chiropractic services provided through American Specialty Health Tenthly Network 2 - $0 Network 2 - $314.24 Network 2 - $821.69 $10 copay/30 visits per calendar yr Network 3 - $0 Network 3 - $324.66 Network 3 - $835.57 800-678-9133 Management Mgmt – Single Mgmt – Two Party Mgmt - Family Tenthly Premiums Network 1 – $594.68 Network 1 - $1,173.24 Network 1 - $1,652.72 Network 2 – $629.83 Network 2 - $1,242.92 Network 2 - $1,750.37 Tiered Rates Network 3 - $634.60 Network 3 - $1,253.34 Network 3 - $1,764.25 Management Mgmt – Single Mgmt – Two Party Mgmt – Family District Pays Network 1 - $594.68 Network 1 - $887.51 Network 1 - $887.51 Tenthly Network 2 - $629.83 Network 2 - $887.51 Network 2 - $887.51 Network 3 - $634.60 Network 3 - $887.51 Network 3 - $887.51 Management Mgmt - Single Mgmt – Two Party Mgmt - Family Employee Pays Network 1 – $0 Network 1 – $285.73 Network 1 - $765.21 Tenthly Network 2 – $0 Network 2 – $355.41 Network 2 - $862.86 Network 3 - $0 Network 3 - $365.83 Network 3 - $876.74 Hospital Benefits Paid in full Network 1/ $500 copay per admit Network 2/ 20% copayment Network 3 Hospital paid at 100% Emergency Room $100 copay Network 1/$200 copay Network 2/ $300 copay Network 3 (waived if Emergency Room copay $50.00 admitted) (waived if admitted) Maternity Care Paid in full Network 1/ $500 copay per admit Network 2/ 20% copayment Network 3 100% Prescriptions Retail (30 day supply) $3/$15/$30 Network 1 Prescriptions $10.00 copay $10/$25/$40 Network 2 up to a 100-day supply $10/$25/$40 Network 3 Mail Order (90 day supply) $6/$30/$60 Network 1 $20/$50/$80 Network 2 $20/$50/$80 Network 3 The outline and summary do not create nor confer any rights. It is a brief outline of the plans and is not to be accepted or construed as a substitute for the provisions of the Master Policy. Benefits are paid on eligible expenses. DISTRICT-PAID BENEFITS DENTAL VISION 800-942-0854 www.metlife.com/mybenefits Tenthly PPO Monthly Premiums Class/Mgmt $80.03 Cert $116.55 866-723-0513 www.eyemedvisioncare.com District pays Tenthly Class/Mgmt $80.03 Cert $113.07 Tenthly Monthly Premiums $10.81 Eligible Employee Pays Tenthly Class/Mgmt $0 Cert $3.48 District Pays Tenthly $10.81 DHMO Tenthly District Pays 100% All Empl Eligible Employee Pays $0 $37.79 Vision care benefits are provided thru Eye Med Select Plan Dental Benefits provided thru Met Life Dental PPO Deductible Your dental benefits include: $15 copay for exam in Network Classified/Mgmt/Certificated - Deductible $25 per year - In Network/ Up to $18 reimbursement for Out of Network $50 per year - Out of Network Class/Mgmt/Certificated - Annual Max $1,500 year one, $1,750 year Benefits two & $2,000 year three - In Network/ $1,000 max - Out of Network Vision exam every 12 months Class/Mgmt/Certificated – Orthodontia Lifetime Maximum: $1,000 - Lenses every 24 months In Network and $500 - Out of Network Frames every 24 months Class/Mgmt/Certificated - Cleanings, x-rays, and exams 100% PDP These services may be secured from any Eye Med Vision Care Fee - In Network/100% R & C Fee - Out of Network Select doctor or from a doctor of your choice. If the services Class/Mgmt/Certificated – Fillings, extractions, root canals, gum are provided by an In Network provider you will have a less treatments 80% PDP Fee – In Network/70% R&C Fee – Out of out of pocket expense. If you see an Out of Network provider Network you can submit for an Out of Network reimbursement. This Class/Mgmt/Certificated - Crowns, cast restorations, bridges, dentures 80% PDP Fee - In Network/40% R&C Fee - Out of Network benefit can be coordinated with your HMO for additional Class/Mgmt/Certificated – Orthodontia 50% PDP Fee - In Network/ savings. 40% R&C - Out of Network MASTECTOMY NOTICE Special Rights Following Mastectomy: A group health plan PDP refers to Participating Dentists/R&C refers to Reasonable & Customary generally must, under federal law, make certain benefits You will be eligible for Prosthodontic Benefits after you have been enrolled continuously under the contract for 12 months available to participants who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits Dental HMO (DHMO) The DHMO is a managed dental plan for: requiring you to select a Primary Dentist. The Primary Dentist will direct all y our dental care needs, including referrals to specialists. Reconstruction of the breast on which the mastectomy has been There is no annual plan maximum under the DHMO and some of performed: your out-of-pocket expenses may be lower than on the PPO. • Surgery and reconstruction of the other breast to produce a However, the DHMO has a much smaller network of dentist that the symmetrical appearance; PPO. • Prostheses; • Treatment of physical complications of mastectomy. GROUP TERM LIFE INSURANCE Term life insurance coverage is paid for by South Bay Union School Our Plan complies with these requirements. Benefits for these District during active employment, through age 75. Coverage is items generally are comparable to those provided under our $30,000 until age 70. At age 70, life insurance is reduced to Plan for similar types of medical services and supplies. Of $19,500. At age 75, life insurance is reduced to $15,000. Coverage course, the extent to which any of these items is appropriate is provided through Mutual of Omaha. following mastectomy is a matter determined by consultation You may change your life insurance beneficiary at any time between the attending physician and the patient. Our Plan throughout the year. neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending DUAL COVERAGE providers to provide care inconsistent with these requirements. If you and your spouse/ domestic partner each have the same dental or vision benefits, you may qualify for dual coverage. When BEHAVIORAL HEALTH CARE BENEFITS utilizing these benefits, have the provider submit a claim in each You get behavioral benefits through Optum Health as long as social security number and this could eliminate deductibles and co- you receive care from a Optum Health network provider. A pays. mental health provider can help you explore problems, understand the cause of the problems and learn self- SWTA Only: DISABILITY INSURANCE management techniques. Your conversations with your mental This benefit is for SWTA members only. health provider are always confidential. 24 hrs a day/7 days a The long-term disability plan provides income protection in case week for pre-authorization of services, call 888-625-4809 you become totally disabled due to illness or injury. Benefits begin Web: www.liveandworkwell.com Click Find a Mental Health after you have been totally disabled for 90 days. The maximum Clinician. You must call Optum Health for pre-authorization. monthly benefit is 2/3 of your monthly salary up to $5,000. You Your dependents are also eligible for behavioral health care must be a full-time employee at the time you are totally disabled to benefits. qualify for this benefit DISTRICT-SPONSORED VOLUNTARY BENEFIT Premiums paid through Payroll Deduction Tax Sheltered Accounts COBRA Coverage Participation is available to employees Fortify your retirement by You may be entitled to continue throughout the year. For a comparison contributing to tax sheltered/ your medical coverage at your quote, the District’s Liberty Mutual deferred compensation accounts expense under this program after number is: 619-370-6667 known as 403(b) and 457 plans. certain Qualifying Events. See representatives at the Open The Qualifying Events are: Hyatt Legal Plan Enrollment meetings. 1. The Primary Enrollee’s Coverage is provided through Hyatt termination of employment, Legal Plans, a Met Life Company. The Long-Term Care Insurance other than for gross employee premium is $23.10 tenthly. Long-term care is assistance for misconduct, or his/her people who are unable to care for reduction in work hours to less Coverage provides legal representation themselves independently because than the minimum required to for a variety of services including wills, of an accident, illness, or advancing be eligible under this program; trusts, estate planning, identity theft age. Care may be provided either 2. The Primary Enrollee’s death; defense, consumer protection matters, at home or in a licensed facility. 3. A divorce or legal separation real estate matters, debt collection from the Primary Enrollee; defense; as well as unlimited telephone Coverage is provided through 4. An enrolled dependent child’s advice for attorneys, office consultations, UNUM Life Insurance Company. loss of eligibility as a and document preparation. Once Voluntary long-term care insurance dependent; enrolled, you must stay in the plan and may also be purchased for your 5. The Primary Enrollee qualifies continue payroll deductions for the full spouse, parents, grandparents, and for Medicare benefits. plan year. your spouse’s parents and grandparents. Spouse coverage is Voluntary Term Life Insurance IRC Section 125 paid by payroll deduction. Other You may purchase additional life This IRS program is designed to help family members pay the provider insurance for yourself, your spouse, reduce the amount of taxes you pay. directly for their coverage. and your dependents. Coverage is provided through Mutual of There are three areas of Section 125: New employees are offered a Base Omaha. Premiums vary by type of 1. Pre-tax medical premiums if you Plan (Facility only benefit, $1,000 plan and amount of coverage. select one of the PacifiCare or Kaiser per month benefit, $24,000 plan Employee can elect amounts in options that has a copayment; maximum). $10,000 increments, up to 2. Flexible Spending Accounts $300,000 not to exceed 5 times a) Medical reimbursement accounts. Subscribers can elect buy-ups that salary. Spouse can elect amount in Maximum reimbursement is include simple inflation, Home $5,000 increments, up to $100,000, $2,400. Health Care Benefit, a longer not to exceed 50% of employee b) Dependent care reimbursement duration (4 years or unlimited) and amount. accounts. Maximum dependent a larger monthly benefit up to care is $5,000; $6,000. Liberty Mutual 3. Improve your benefit portfolio by Liberty Mutual Insurance Company adding certain voluntary insurance Premium costs vary by type of offers employees a program called plans provided through American plan/coverage and age. Coverage Group Savings Plus, which Fidelity. may be continued if you leave the provides discounts on auto and District. homeowners insurance. Coverage Strict IRS guidelines apply to this includes: program. Your selection cannot be Accidental Death & Dismem- * A group discount off Liberty revoked or changed during the plan year berment Insurance (AD&D) Mutual’s auto and homeowners except due to a change in family status. Coverage is provided through insurance rates Mutual of Omaha. Premiums vary * Additional savings based on your For more information, contact American by type of plan and amount of age, driving experience, and more Fidelity at 1-866-523-1857 to schedule an coverage. Subscribers may elect * Convenient payment plans, appointment. the Employee Only or Family Plan including payroll deduction Representative: Jason Czajkowski and amounts up to $300,000, in * Rates guaranteed for 12 months $10,000 increments. 24-Hour claims service and Emergency Roadside Assistance The information in this brochure covers important features of your benefits, but does not create nor confer any rights. This is not a replacement of the official plan documents which legally govern the plans. These documents are available upon request in the Human Resources Department.