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2011 Employee Benefits Booklet

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2011 Employee Benefits Booklet Powered By Docstoc
					  Medical

   Dental

    Vision
                 Summary of Employee Benefits
  Disability     Plans Effective January 1– December 31, 2011

     Life

     EAP

  Accident

   Cancer

   Hospital

Intensive Care

  Personal
  Sickness

  Specified
   Health

     FSA



                                                                Prepared by:
                                            John Burnham Insurance Services
                                                        CA License 0619252
                                                             Issued 05.04.11
Our employees are our
most valuable asset.
That’s why at Grossmont-Cuyamaca Community College District (GCCCD) we are
committed to a comprehensive employee benefit program that helps our employees stay
healthy, feel secure, and maintain a work/life balance.

               Stay Healthy…
                  • Medical
                  • Dental
                  • Vision
                  • Flexible Spending Accounts (FSA)
               Feeling Secure…
                  • Disability Insurance
                  • Life and Accidental Death & Dismemberment (AD&D)
                  • Employee Assistance Program (EAP)
                  • Personal Coverage (AFLAC)

Who is Eligible and When…
Employees become eligible to participate in the various insurance plans on the first of the
month following their contract hire date provided they work at least 20 hours per week (for
most plans). If an employee enrolls, they have the option of covering their spouse or
domestic partner and/or children (up to the age of 26) for most coverages. Furthermore,
employees who retire from GCCCD are covered until they become eligible for Medicare.
Contents and Contact Information
Refer to this list when you need to contact one of your benefit vendors. For general information,
eligibility, forms, status changes, etc. please contact District Services.

MEDICAL & PRESCRIPTION DRUGS                                                                       page 1
KAISER HMO
Member Services and Prescription Drug Pharmacy Management: 1-800-499-3001
Online Member Services and Provider Finder: www.kp.org
DIRECT HEALTH PLAN
Dedicated Member Services: 1-877-427-5105 | Prescription Drug Pharmacy Management: 1-800-460-8988
Online Provider Finder: www.gcccd.edu/benefits then click on HealthPlans and choose either the Sharp or
the Anthem/Blue Cross link.
First Health Online Provider Finder (outside California): www.firsthealth.coventryhealthcare.com

DENTAL                                                                                             page 2
DELTA DENTAL
DHMO Member Services: 1-800-422-4234 | PPO Member Services: 1-800-866-3001
Online Member Services and Provider Finder: www.deltadentalins.com

VISION                                                                                             page 3
KAISER MEMBERS
Available through your Kaiser facilities. Online Member Services and Provider Finder: www.kp.org
DIRECT HEALTH MEMBERS/VSP
Member Services: 1-800-877-7195 | Online Member Services/Provider Finder: www.vsp.com

EMPLOYEE ASSISTANCE PROGRAM (EAP)                                                                   page 4
HORIZON HEALTH 1-800-342-8111
Online Services: www.horizoncarelink.com (contact District Services to obtain the login and password)

LONG TERM DISABILITY/LIFE/ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)                                  page 5
MUTUAL OF OMAHA
Member Services: 1-800-948-9478 | Online Member Services/Claims: www.mutualofomaha.com
Life Claims Phone: 1-800-775-8805 | Disability Claims Phone: 1-800-877-5176

ACCIDENT/CANCER/DISABILITY/HOSPITAL/INTENSIVE CARE/PERSONAL SICKNESS/SPECIFIED HEALTH              page 6
AFLAC
Member Services: 1-800-992-3522 | Online Member Services/Claims: www.aflac.com
Claims Phone: 1-800-992-3522 | Claims Fax: 1-877-442-3522

FLEXIBLE SPENDING ACCOUNTS (FSA)                                                                   page 7
AFLAC
Member Services: 1-800-322-5391 | Account Information: 1-877-353-9487 | Claims Fax: 1-877-353-9256

BENEFIT ELECTIONS                                                                                  page 8
Contact District Services

REQUIRED NOTICES                                                                                   page 9

BB&T – BENEFITS ADVOCATE CALL CENTER                                                          800-914-5096
                                                                                  Medical Insurance

GCCCD offers employees two medical plans to choose from.
Option 1: Kaiser HMO (Health Maintenance Organization) offers members access to medical care through
Kaiser Permanente physicians and hospitals.
Option 2: Direct Health Plan, a 3-tier PPO (Preferred Provider Organization) allowing members the freedom to
choose any provider or hospital – without the necessity of a designated primary care physician. However,
there are significant provider and benefit differences between the 3 tiers of benefits. Members utilizing the
Sharp network will receive many cost advantages, but ONLY claims for members utilizing a Sharp provider or
hospital will be paid at the Tier 1 level. If a member is referred to any provider outside of the Sharp network,
claims will be paid Tier 2 or 3 and will be subject to the $750 deductible. Please note this includes referrals made
by Sharp physicians (other than Lab and X-Ray services). If the provider or facility is not in either the Sharp,
Anthem or First Health networks, claims will be reimbursed at the Usual, Customary and Reasonable (UCR)
charge for that geographic location.
The chart below gives a side-by-                                                             Direct Health Plan
side look at some of the copays/                OPTION 1                                        OPTION 2
coinsurance members pay under                                                                        Anthem
                                                 Kaiser HMO                   Sharp                                          Non-Network
 each plan and benefit tier.                                                                  (First Health o utside CA )

                  Network Access Level         PCP Directed                   Tier 1                   Tier 2                     Tier 3

                         Lifetime Benefits        Unlimited                                         Unlimited

                                              Member Pays…               Member Pays…          Member Pays…                 Member Pays…

       Annual Out-of-Pocket Maximum          $1,500 (2x family)         $1,500 (2x family)    $1,500 (2x family)            $6,000 (3x family)

                      Annual Deductible              None                     None             $750 (3x family)             $750 (3x family)

               Primary Care Office Visits        $10 copay                 $15 copay              $30 copay*                 40% of the bill*

                 Specialists Office Visits       $10 copay                 $25 copay              $50 copay*                 40% of the bill*

      Routine GYN and Well Child Visits          $10 copay                 $15 copay              $30 copay*                 40% of the bill*

                   Adult Physical Exams          $10 copay                 $15 copay              $30 copay*                 40% of the bill*

                       Urgent Care Visits        $10 copay              $15 or $25 copay      $30 or $50 copay*              40% of the bill*

             Emergency Room Services             $35 copay                 $35 copay               $35 Copay                   $35 Copay

                 Diagnostic Lab & X-Ray          No charge                 No charge               No charge                 40% of the bill*

               Inpatient Hospitalization         No charge                 No charge               No charge                 40% of the bill*

                     Outpatient Surgery          No charge                 No charge              $50 copay*                 40% of the bill*

       Physical/Occupational Therapy             $10 copay                 $15 copay              $30 copay*                 40% of the bill*

              Outpatient Mental Health           $10 copay                 $15 copay              $30 copay*                 40% of the bill*

                   Chiropractic Services         $10 copay                 $15 copay              $15 copay*                 40% of the bill*

                   Generic Prescriptions         $10 copay                 $10 copay               $10 copay                  Not cov ered

              Brand Name Prescriptions           $20 copay                 $25 copay               $25 copay

            Non-Preferred Prescriptions               n/a                  $50 copay               $50 copay

                               Mail Order           00
                                             up to 1 days at co unter   2x copay = 90 days 2x copay = 90 days                      n/a

                                                                         * Benefit s apply AFTER t he annual deduct ible has been met .
      The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
    provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
    limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
1
 Dental Insurance

GCCCD offers employees two dental plans.
Option 1: DeltaCare® USA DHMO (Dental Health Maintenance Organization)
Services are coordinated though a designated primary care dental group chosen from the list of contracted
dental offices. This program is designed to encourage regular dental visits to maintain dental health. Many
services are covered at no cost, while others have set copayments. There is no deductible or annual limit on
dental benefits under the DeltaCare® USA plan.
Option 2: Delta Dental Premier® Incentive Plan
A traditional PPO, “Non-Referral” based dental plan that allows members the freedom to choose any
recognized dentist, in or out of network. A PPO Dental Plan offers significant cost advantages to members
utilizing "in network" PPO providers. This plan is designed to reward members who maintain enrollment, as the
benefits increase with years of membership beginning in year 1 through year 4.
The chart below gives a side-by-side summary of the two options.


                                                                                                  ®
                                                                                      PREMIER INCENTIVE PLAN
                                                 OPTION 1                                       OPTION 2
                                                     DHMO                                              PPO

                                             Primary Care Group              Year 1         Year 2             Year 3    Year 4+

            Annual Maximum Benefits                Unlimited                                          $2,000

                                               Member Pays…                                   Member Pays…

            Calendar Year Deductible                 None                                             None

                            Office Visits         No Charge                30% of bill    20% of bill     10% of bill   No charge

               Oral Exams and X-Rays              No Charge                30% of bill    20% of bill     10% of bill   No charge

                        Teeth Cleaning            No Charge                30% of bill    20% of bill     10% of bill   No charge

                    Fluoride Treatment            No Charge                30% of bill    20% of bill     10% of bill   No charge

                    Space Maintainers             No Charge                30% of bill    20% of bill     10% of bill   No charge

                      Amalgam Fillings            No Charge                30% of bill    20% of bill     10% of bill   No charge

                     Composite Fillings           No Charge                30% of bill    20% of bill     10% of bill   No charge

              Extrations & Oral Surgery           No Charge                30% of bill    20% of bill     10% of bill   No charge

                        Gingevectomy              No Charge                30% of bill    20% of bill     10% of bill   No charge

         Periodontal Scaling & Planing            No Charge                30% of bill    20% of bill     10% of bill   No charge

                                 Crowns           No Charge                30% of bill    20% of bill     10% of bill   No charge

                            Root Canals           No Charge                30% of bill    20% of bill     10% of bill   No charge

                Installation of Dentures          No Charge                50% of bill    50% of bill     50% of bill   50% of bill

                    Adult Orthodontics            $500 copay

                    Child Orthodontics            $500 copay                                   Not Cov ered

      Lifetime Orthodontics Maximum                  None

    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          2
                                                                                          Vision Insurance

For those members who are enrolled in Kaiser, the vision services are covered at medical offices or optical sales
offices when prescribed by your Kaiser physician or a optometrist.
The chart below provides a brief description of the benefits of this plan:

                                                                                                     Kaiser Plan

                                                                Schedule of Benefits               Kaiser Provider

                                                                    Well Vision Exam              Ev ery 12 months

                                                                 Prescription Lenses              Ev ery 12 months

                                                                              Fram es             Ev ery 24 months

                                                                      Contact Lens       Every 12 months (in lieu of glasses)

                                                                                                  Member Pays…

                                                                    Well Vision Exam                 $10 copay

                                                                            Materials        Member pays any amount
                                                                                           over the $125 allowance for
                                                                                             frames/lenses or contacts.


For those members who are enrolled in the Direct Health Plan, GCCCD includes this comprehensive vision plan
through VSP. This is a traditional PPO vision plan or “Non-Referral” based benefit. Members have the freedom
to choose any recognized provider.

                                         PPO Plan                       This "open access" allows members to see a provider
                                                                        of choice. VSP has a very broad network of
    Schedule of Benefits    PPO Provider            Non-PPO             contracted providers. VSP physicians offer
       Well Vision Exam              Ev ery 12 months                   personalized care that focuses on keeping eyes
                                                                        healthy year after year. Plus, when a VSP doctor is
    Prescription Lenses              Ev ery 12 months                   utilized, there are lower out-of-pocket costs and
                Frames               Ev ery 24 months
                                                                        satisfaction is guaranteed. After a comprehensive
                                                                        exam, members choose the eyewear that meets
         Contact Lens      Every 12 months (in lieu of glasses)         their needs and their budget. From classic styles to
                                                                        the latest designer frames, members are sure to find
                                     Member Pays…
                                                                        the eyewear that is right for them. The chart to the
       Well Vision Exam       $10 copay        amount over $34          left gives a side-by-side look at the benefits of a PPO
                                                 amount over            or Non-PPO provider.
              Materials       $25 copay
                                                   allowance            Additional discounts are available when utilizing a
    Single Vision Lenses      No charge        amount over $34          VSP Provider. An average of 20 to 25% savings
                                                                        on all non-covered lens options, 20% off additional
          Bifocal Lenses      No charge        amount over $51          glasses and sunglasses, including lens options, 15%
         Trifocal Lenses      No charge        amount over $68          off cost of contact lens exam (fitting and
                                                                        evaluation), and an average
          Contact Lens amount over $100 amount over $100                15% off the regular price or 5%
                Frames amount over $75         amount over $40          off the promotional price of
                                                                        Laser Vision Correction.


      The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
    provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
    limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
3
 Employee Assistance
 Program (EAP)
We all experience times when we need a little help with life’s challenges. GCCCD understands this and is
providing the Horizon Health EAP (employee assistance program) to offer support, guidance and resources to
help you and your family resolve personal issues.
What can the Horizon Health EAP programs do for me?
A master’s level Member Advocate from Horizon Health EAP services will
confidentially consult with you over the telephone and help you find solutions
and resources to meet life’s challenges. The Member Advocate will provide you
with consultation, resources, an action plan and information to help you address your issue. Your program also
includes 8 face-to-face assessment and counseling sessions per issue, per year. Horizon will work with you to
schedule appointments according to your needs. You may also receive referrals to support groups, community
resources, a Horizon network counselor or your health plan. Horizon Health EAP services can help with the
following issues, among others:
             •    Child care and elder care                                      •     Depression
             •    Alcohol and drug abuse                                         •     Emotional well-being
             •    Life improvement                                               •     Financial and legal concerns
             •    Difficulties in relationships                                  •     Grief and loss
             •    Stress and anxiety with work or family                         •     Identity theft and fraud resolution

                                                                                  Is it confidential?
                                                                                  Your calls and all counseling services are
                                                                                  completely confidential. Information will be
                                                                                  released only with your permission or as
                                                                                  required by law.
                                                                  When is it available?
Telephone consultation and online access to EAP services are always available. Simply call the toll-free
number 1-800-342-8111 or log on to www.horizoncarelink.com. In emergency situations, you may call the toll-
free number to speak with a licensed staff counselor who can also connect you to emergency services.

HorizonCareLinkSM
A broad range of educational materials and guide books on dependent care
topics are available online, but in addition, HorizonCareLinkSM online services
can save you countless hours by researching and providing referrals for
important issues such as
    •     Child care or elder care services            •     Healthy lifestyle guidance
    •     Pet care and veterinarians                   •     Self Assessment
    •     Adoption resources                           •     Videos and articles on topics like understanding depression,
    •     Health clubs and fitness centers                   nutrition advice and preparing for childbirth
Legal/Financial Services
Services include legal/financial consultation, guidance, and advice from qualified legal and financial
professionals. Each member receives an initial 30-minute telephonic consultation for each separate legal or
financial matter. Virtually all types of legal matters are eligible for these services, excluding work/employer-
related issues. Typical financial matters include credit counseling, debt and budgeting assistance, tax
planning, and retirement and college planning. Members also receive a 25% discount when retaining attorney
services, free online will program, complicated wills and trust preparation, identity theft consultation, mediation
services, and telephonic tax consultation.

    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          4
                                                                 Long Term Disability and
                                                                    Life/AD&D Insurance

GCCCD provides Long Term Disability (LTD) income benefits though Mutual of Omaha. In the event you
become disabled from an injury or sickness for more than 90 days, disability income benefits will be provided to
you in the amount of 66 2/3% of your pre-disability earnings up to a maximum benefit of $7,000 per month. If
you remain disabled, this plan will continue to pay until you would have otherwise reached 70 years of age (65
for those employees with less than 5 years of service). Other features of this plan include a vocational
rehabilitation services, accidental dismemberment or loss of sight benefits, survivorship benefit and individual
policy conversion.
                          Life/Accidental Death & Dismemberment (AD&D) insurance provides valuable financial
                          protection when death or injury occurs. That’s why GCCCD provides each employee
                          with a basic Life/AD&D benefit insured by Mutual of Omaha in the amount $50,000. Life
                          insurance benefits are payable if you die. . In addition, if you die as the result of an
                          accident, the AD&D benefit pays your beneficiary. Other features of this plan include a
                          seatbelt benefit, living benefit should you become diagnosed with a terminal
                          condition, continuation of coverage during a layoff or leave of absence, and
                          individual policy conversion.

The unexpected death of a family member is devastating for survivors. Too frequently, the hardships are
compounded by financial losses that could have been avoided with adequate life insurance. The right amount
of life insurance can protect loved ones against the financial hardships caused by death by giving them the
means to manage certain expenses. Voluntary Term Life insurance is available now to you and your family at
coverage levels that meet your family’s financial needs. This insurance is voluntary because, as an employee
you pay 100% of the premium through a convenient deduction from your paycheck. If you sign up for the
voluntary term life during your enrollment period, you’ll receive a guaranteed dollar amount of coverage of 5
times your annual salary up to $50,000. By signing up for even the minimum amount of coverage initially, you
protect the ability to buy additional coverage in the future under this plan, should your needs change. You
can also purchase spouse coverage up to 50% of your benefit, not to exceed $150,000. Coverage for your
unmarried children up to the age of 21 (25 if full-time student) is also available in the amount of $10,000.

Additional Voluntary AD&D insurance is also available to you. This plan offers protection on a worldwide basis,
24 hours a day, 365 days a year against any covered accident in the course of business or pleasure, including
accidents on or off the job, in or away from the home, commuting, traveling by train, airplane, automobile or
other private and public conveyances. You can purchase increments of $10,000 up to $300,000. Under a full
family plan your spouse’s principal sum is 50% of yours and each child’s principal sum is 10% of yours. If there are
no children covered, your spouse’s benefit increases to 60% of yours. If there is no spouse covered, each
child’s benefit increases to 20% of yours. NOTE: Spouse and/or all children coverage cannot be purchased on
a “standalone” basis, i.e., Employee participation is also required.




      The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
    provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
    limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
5
 Accident, Cancer, Disability
 Hospital, Personal Sickness
 and Specified Health
The Accident Plan is a way to stay ahead of the medical and out-of-pocket expenses
that add up so quickly after an accidental injury – not just for emergency treatment,
hospital stays and medical exams, but for other expenses you may face, such as
transportation and lodging needs. When you have a covered accident, AFLAC will send cash benefits directly
to you and you decide the best way to spend them. It's as simple as that. You'll receive cash benefits for
expenses that may not be fully covered by your major medical insurance including broken teeth, concussions,
intensive care unit confinement, ground and air ambulance, emergency room visits and lacerations.

                 The lump sum Cancer insurance policy provides you with a pre-established amount if you or
                 another covered person is diagnosed with cancer. You can use the money to help pay the
                 expenses that you'll have at the time, from medical costs to everyday bills. These benefits can
                 be used to help pay for the expenses associated with cancer that may not be fully covered by
                 your major medical insurance, including transportation to and from medical facilities, including
                 parking, out-of-network specialists, experimental treatments, rehabilitation, extended hospital
                 stays and daily living expenses.

The Short Term Disability insurance plan pays benefits for a period of time while you are disabled.
You select the right amount of disability insurance benefits for your needs, as well as the length
of time they are payable. You should choose a level of disability coverage that best meets your
needs for the price you feel you can afford, income requirements, the amount of monthly benefits
 you'll want, the period of time you want benefits to last, the number of days before coverage kicks
in and any optional riders.

                 No matter how good your medical insurance is, when you're hospitalized for an injury or illness
                 there will probably be medical expenses and out of pocket costs that aren’t covered. The
                 Hospital Confinement Indemnity insurance policy provides cash benefits to use as you see fit.
                 The benefits are predetermined and paid regardless of any other insurance you have, and you
                 have a choice of applying for basic to extensive hospital coverage.

The Hospital Intensive Care insurance policy provides cash benefits for accidents or illnesses that result in an
admission to a hospital intensive care unit. These cash benefits are paid directly to you, unless you instruct
AFLAC to direct them elsewhere, no matter what other insurance you have. The hospital intensive care
insurance policy has a straightforward benefit design that complements your major medical, limited benefit or
short-term health insurance plans. Additional advantages include Initial cash benefit for first seven days in the
ICU, with an increased benefit for the next eight days, progressive benefits that build over time, ambulance
benefit, and major human organ transplant benefit.

The Personal Sickness Indemnity insurance policies help ease the financial burden of hospital stays due to illness
by providing you with cash benefits. While the primary benefits of the policy pay for hospital care, there's also a
physician visit feature for those times when you're sick, have an accident, or just need a routine exam. Some of
the policy benefits include hospital confinement, major diagnostic exams, surgery, and ambulance
transportation. There are different levels of coverage to suit your needs and budget.

A serious health event such as heart attack, end-stage renal failure or third-degree burns is not
only a life-altering physical event, but a devastating financial one as well. Specified Health
Event Protection insurance may make all the difference by providing cash benefits as you
concentrate on your recovery. Some other covered health events also include stroke, paralysis,
coronary artery bypass surgery, persistent vegetative state, major human organ transplant, and
coma. This policy helps with the medical expenses related to a covered life-threatening health event.


    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          6
                                                                                      Flexible Spending
                                                                                         Accounts (FSA)
GCCCD offers you the opportunity to participate in tax-savings accounts through payroll deduction. With these
plans, money is taken out of your paycheck before taxes and set aside—so you don’t pay taxes on the
contributions. Then, the money is used to reimburse you for your eligible health care and dependent care
expenses. However, health insurance premiums that are automatically deducted by your
employer from your paycheck are not eligible for reimbursement. Under the FSA plan,
deductions of your medical, dental and vision insurance premiums are also made
before taxes. This plan is also administered by AFLAC.

Here are three ways you can save with an FSA:

                                               1. Pre-tax Health Care Premiums. If you have health care premiums
        CHANGES AFECTING
        CHANGES AFECTING                          (including dental and vision) that you pay for, GCCCD can deduct
         YOUR FSA PLAN:
          YOUR FSA PLAN:                          those premiums pre-tax.
     Effective January 1, 2011,
     Effective January 1, 2011,                2. Health Care Account. If you know how much you’ll spend on health
         all over-the-counter
          all over-the-counter                    care, you can set aside that money in an FSA health care account.
     medicines and drugs will
      medicines and drugs will                    Eligible expenses include copayments, deductibles, coinsurance, and
        require a physician‘s
         require a physician‘s                    some services your medical, dental and vision plans may not cover.
     prescription to be eligible
     prescription to be eligible                  You can set aside up to $5,000 per year on a pre-tax basis
     for reimbursement under
      for reimbursement under
        the flexible spending
         the flexible spending                 3. Dependent Care Account. If you pay someone (a licensed
                account.
                account.                          professional) to watch your dependents while you work, you can set
                                                  aside up to $5,000 per year on a pre-tax basis.

Some samples of the most popular qualified health related expenses are:

                        •   Medical & Dental plan copays                                •    Prescription eyewear
                        •   Medical & Dental plan deductibles                           •    Hearing aids
                        •   Dentistry & Orthodontics                                    •    Lamaze classes
                        •   Diabetic supplies                                           •    Physical therapy
                        •   Counseling visits                                           •    Occupational therapy


    Sample:
     Sample:                                            Without FSA
                                                        Without FSA             With FSA
                                                                                With FSA
    Gross Pay
     Gross Pay                                            $50,000
                                                           $50,000              $50,000
                                                                                 $50,000
    FSA Health Care Contributions
     FSA Health Care Contributions                            $0
                                                               $0                -$2,000
                                                                                  -$2,000
    FSA Dependent Care Contributions
     FSA Dependent Care Contributions                         $0
                                                               $0                -$5,000
                                                                                  -$5,000
    Salary You're Taxed On
     Salary You're Taxed On                               $50,000
                                                           $50,000               $43,000
                                                                                  $43,000
    Less Federal Income Tax (est. 15%)
     Less Federal Income Tax (est. 15%)                   -$7,500
                                                           -$7,500               -$6,450
                                                                                  -$6,450
    Less Social Security (est. 7.65%)
     Less Social Security (est. 7.65%)                     -$3,825
                                                            -$3,825              -$3,290
                                                                                  -$3,290
    Less After-Tax Health Care Expenses
     Less After-Tax Health Care Expenses                   -$2,000
                                                            -$2,000                 $0
                                                                                     $0
    Less After-Tax Dependent Care Expenses
     Less After-Tax Dependent Care Expenses               -$5,000
                                                           -$5,000                  $0
                                                                                     $0
    Your Take-Home Pay
     Your Take-Home Pay                                   $31,675
                                                           $31,675               $33,261
                                                                                  $33,261
             You'd save $1,586 in taxes by using these tax-free benefits!
              You'd save $1,586 in taxes by using these tax-free benefits!


       The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
     provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
     limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
7
 Benefit Elections and
 Making Changes

Benefit Elections…
GCCCD provides, eligible employees, with a comprehensive employee benefit package that is 100% paid for
by your EMPLOYER. The EMPLOYER-paid plans for employee and family coverage are as follows:

 •    Medical: Kaiser HMO and Direct Health Plan
 •    Dental: DeltaCare USA DHMO and Delta
      Premier Incentive Plan
 •    Vision: VSP PPO (if enrolled in Direct Health Plan)
 •    Long Term Disability: Mutual of Omaha
 •    Life: Mutual of Omaha Basic Term Life/AD&D
 •    EAP: Horizon Health

Employees can also choose to “buy-up” for:

 •    Voluntary Life/AD&D: Mutual of Omaha
 •    Accident: AFLAC
 •    Cancer: AFLAC
 •    Short Term Disability: AFLAC
 •    Hospital Confinement: AFLAC
 •    Intensive Care: AFLAC
 •    Personal Sickness Indemnity: AFLAC
 •    Specified Health Event: AFLAC
 •    Health and Dependent Care FSA: AFLAC


Making Changes…
Each year, during GCCCD’S annual Open Enrollment, which occurs prior to the first day of each plan year
(January 1), you will be offered the opportunity to change your benefit elections for the upcoming plan year.
The coverage(s) you elect during Open Enrollment cannot be changed during the plan year unless you have a
qualifying life event as recognized under IRS regulations such as:

                                            •   Loss or gain of coverage through your spouse
                                            •   Loss of eligibility of a covered dependent
                                            •   Birth or adoption of a child
                                            •   Marriage, divorce, or legal separation
                                            •   Switch from part-time to full-time

Any change due to a qualifying life event must be made within 30 days of the event. Employees are
responsible for notifying District Services of all changes to their benefit status, including over-age dependents.

    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          8
       Patient Protection and Affordable Care Act
               (PPACA) Mandatory Notices

    Opportunity to enroll or re-enroll dependents under the age of 26
    If you have a dependent whose coverage ended, or who was denied coverage (or was not eligible for
    coverage), because coverage for dependent children under the plan previously ended before they were
    age 26, they are eligible to enroll or reenroll in our medical plan. You may request enrollment for such
    children who are under age 26 for 30 days from the date this notice is received. Enrollment will be effective
    as of the first day of our first plan year beginning on or after September 23, 2010, even if that results in
    retroactive enrollment. For more information contact District Services or call the medical carrier at the
    telephone number on your insurance identification card.


    Lifetime limit not applicable and enrollment opportunity
    The lifetime limit on the dollar value of benefits under our medical plan no longer applies. Individuals whose
    coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan.
    Individuals have 30 days from the date of this notice to request enrollment. For more information contact
    District Services or call the medical insurance carrier at the telephone number on your identification card.


    Notice on Patient Protections
    The medical HMO plan generally allows the designation of a primary care provider. You have the right to
    designate any primary care provider who participates in the network and who is available to accept you or
    your family members. Until you make this designation, the medical carrier designates one for you. For
    information on how to select a primary care provider, and for a list of the participating primary care providers,
    contact the medical insurance carrier at the number listed on your identification card.

    For children, you may designate a pediatrician as the primary care provider. You do not need prior
    authorization from the medical insurance carrier or from any other person (including a primary care provider)
    in order to obtain access to obstetrical or gynecological care from a health care professional in the network
    who specializes in obstetrics or gynecology. The health care professional, however, may be required to
    comply with certain procedures, including obtaining prior authorization for certain services, following a pre-
    approved treatment plan, or procedures for making referrals. For a list of participating health care
    professionals who specialize in obstetrics or gynecology, contact the medical insurance carrier at the number
    listed on your identification card.


    2011 Changes to OTC Drug Reimbursements for FSAs/HSAs
    Under the new Health Care Reform law (PPACA), the cost of an over-the-counter medicine or drug cannot
    be reimbursed from the account unless a prescription is obtained. The change does not affect insulin, even if
    purchased without a prescription, or other health care expenses such as medical devices, eyeglasses,
    contact lenses, co-pays and deductibles. The new standard applies only to purchases made on or after
    January 1, 2011, so claims for medicines or drugs purchased without a prescription in 2010 can still be
    reimbursed in 2011.

    A similar rule goes into effect on January 1 for Health Savings Accounts (HSAs).

    The IRS has also posted a questions and answers section on its website
    http://www.irs.gov/newsroom/article/0,,id=227308,00.html concerning these provisions.



        The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
      provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
      limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
9
                            Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Pledge to You
This notice is intended to inform you of the privacy practices followed by the Grossmont-Cuyamaca
Community College District (GCCCD) Employee Benefit Plan (the Plan) and the Plan’s legal obligations
regarding your protected health information under the Health Insurance Portability and Accountability Act of
1996 (HIPAA). The notice also explains the privacy rights you and your family members have as participants of
the Plan. It is effective on April 14, 2011.

The Plan often needs access to your protected health information in order to provide payment for health
services and perform plan administrative functions. We want to assure the plan participants covered under
the Plan that we comply with federal privacy laws and respect your right to privacy. GCCCD requires all
members of our workforce and third parties that are provided access to protected health information to
comply with the privacy practices outlined below.

Protected Health Information
Your protected health information is protected by the HIPAA Privacy Rule. Generally, protected health
information is information that identifies an individual created or received by a health care provider, health
plan or an employer on behalf of a group health plan that relates to physical or mental health conditions,
provision of health care, or payment for health care, whether past, present or future.

How We May Use Your Protected Health Information
Under the HIPAA Privacy Rule, we may use or disclose your protected health information for certain purposes
without your permission. This section describes the ways we can use and disclose your protected health
information.

    n   Payment. We use or disclose your protected health information without your written authorization in
        order to determine eligibility for benefits, seek reimbursement from a third party, or coordinate benefits
        with another health plan under which you are covered. For example, a health care provider that
        provided treatment to you will provide us with your health information. We use that information in order
        to determine whether those services are eligible for payment under our group health plan.

    n   Health Care Operations. We use and disclose your protected health information in order to perform
        plan administration functions such as quality assurance activities, resolution of internal grievances, and
        evaluating plan performance. For example, we review claims experience in order to understand
        participant utilization and to make plan design changes that are intended to control health care costs.

    n   Treatment. Although the law allows use and disclosure of your protected health information for
        purposes of treatment, as a health plan we generally do not need to disclose your information for
        treatment purposes. Your physician or health care provider is required to provide you with an
        explanation of how they use and share your health information for purposes of treatment, payment,
        and health care operations.

    n    As permitted or required by law. We may also use or disclose your protected health information without
         your written authorization for other reasons as permitted by law. We are permitted by law to share
         information, subject to certain requirements, in order to communicate information on health-related
         benefits or services that may be of interest to you, respond to a court order, or provide information to
         further public health activities (e.g., preventing the spread of disease) without your written
         authorization. We are also permitted to share protected health information during a corporate
         restructuring such as a merger, be a or acquisition. We will also disclose health information documents
    The information provided herein intended tosale, summary of benefits only and in no way supersedes the actual planabout you
         when required by law, for example, in order to prevent serious harm to you or others.
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                        10
                               Notice of Privacy Practices

           n     Pursuant to your Authorization. When required by law, we will ask for your written authorization
                 before using or disclosing your protected health information. If you choose to sign an authorization
                 to disclose information, you can later revoke that authorization to prevent any future uses or
                 disclosures.

           n     To Business Associates. We may enter into contracts with entities known as Business Associates that
                 provide services to or perform functions on behalf of the Plan. We may disclose protected health
                 information to Business Associates once they have agreed in writing to safeguard the protected
                 health information. For example, we may disclose your protected health information to a Business
                 Associate to administer claims. Business Associates are also required by law to protect protected
                 health information.

           n     To the Plan Sponsor. We may disclose protected health information to certain employees of
                 GCCCD for the purpose of administering the Plan. These employees will use or disclose the
                 protected health information only as necessary to perform plan administration functions or as
                 otherwise required by HIPAA, unless you have authorized additional disclosures. Your protected
                 health information cannot be used for employment purposes without your specific authorization.


 Your Rights

           n     Right to Inspect and Copy. In most cases, you have the right to inspect and copy the protected
                 health information we maintain about you. If you request copies, we will charge you a reasonable
                 fee to cover the costs of copying, mailing, or other expenses associated with your request. Your
                 request to inspect or review your health information must be submitted in writing to the person
                 listed below. In some circumstances, we may deny your request to inspect and copy your health
                 information. To the extent your information is held in an electronic health record, you may be able
                 to receive the information in an electronic format.

           n     Right to Amend. If you believe that information within your records is incorrect or if important
                 information is missing, you have the right to request that we correct the existing information or add
                 the missing information. Your request to amend your health information must be submitted in
                 writing to the person listed below. In some circumstances, we may deny your request to amend
                 your health information. If we deny your request, you may file a statement of disagreement with us
                 for inclusion in any future disclosures of the disputed information.

           n     Right to an Accounting of Disclosures. You have the right to receive an accounting of certain
                 disclosures of your protected health information. The accounting will not include disclosures that
                 were made (1) for purposes of treatment, payment or health care operations; (2) to you; (3)
                 pursuant to your authorization; (4) to your friends or family in your presence or because of an
                 emergency; (5) for national security purposes; or (6) incidental to otherwise permissible disclosures.

                 Your request to for an accounting must be submitted in writing to the person listed below. You may
                 request an accounting of disclosures made within the last six years. You may request one
                 accounting free of charge within a 12-month period.

           n    Right to Request Restrictions. You have the right to request that we not use or disclose information
                for treatment, payment, or other administrative purposes except when specifically authorized by
                you, when required by law, or in emergency circumstances. You also have the right to request that
                we limit the protected health information that we disclose to someone involved in your care or the
                payment for your care, such as a family member or and in no
      The information provided herein intended to be a summary of benefits only friend. way supersedes the actual plan documents
     provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
                  Your request for restrictions must be submitted in writing to the person listed the carriers/administrators.
     limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by below. We will consider
11
                            Notice of Privacy Practices

              your request, but in most cases are not legally obligated to agree to those restrictions. However,
              we will comply with any restriction request if the disclosure is to a health plan for purposes of
              payment or health care operations (not for treatment) and the protected health information
              pertains solely to a health care item or service that has been paid for out-of-pocket and in full.

        n     Right to Request Confidential Communications. You have the right to receive confidential
              communications containing your health information. Your request for restrictions must be submitted
              in writing to the person listed below. We are required to accommodate reasonable requests. For
              example, you may ask that we contact you at your place of employment or send
              communications regarding treatment to an alternate address.

        n     Right to be Notified of a Breach. You have the right to be notified in the event that we (or one of
              our Business Associates) discover a breach of your unsecured protected health information. Notice
              of any such breach will be made in accordance with federal requirements.

        n     Right to Receive a Paper Copy of this Notice. If you have agreed to accept this notice
              electronically, you also have a right to obtain a paper copy of this notice from us upon request. To
              obtain a paper copy of this notice, please contact the person listed below.

Our Legal Responsibilities
We are required by law to protect the privacy of your protected health information, provide you with certain
rights with respect to your protected health information, provide you with this notice about our privacy
practices, and follow the information practices that are described in this notice.

We may change our policies at any time. In the event that we make a significant change in our policies, we
will provide you with a revised copy of this notice. You can also request a copy of our notice at any time. For
more information about our privacy practices, contact the person listed below. If you have any questions or
complaints, please contact:

Amber Herrmann, Director, Employment Services
Grossmont-Cuyamaca Community College District
8800 Grossmont College Drive, El Cajon, CA 92020
Phone: 619-644-7631
Email: Amber.Herrmann@gcccd.edu

Complaints
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made
about access to your records, you may contact the person listed above. You also may send a written
complaint to the U.S. Department of Health and Human Services — Office of Civil Rights. The person listed
above can provide you with the appropriate address upon request or you may visit www.hhs.gov/ocr for
further information. You will not be penalized or retaliated against for filing a complaint with the Office of Civil
Rights or with us.




    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          12
    Medicare Part D Creditable Coverage Notice

 There are two important things you need to know about your current coverage and Medicare’s prescription
 drug coverage:
   1.    Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can
         get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like
         an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a
         standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher
         monthly premium.
   2.    The current prescription drug coverage offered is, on average for all plan participants, expected to pay
         out as much as standard Medicare prescription drug coverage pays and is therefore considered
         Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this
         coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

 You can join a Medicare drug plan when you first become eligible for Medicare and each year from
 November 15th through December 31st. However, if you lose your current creditable prescription drug
 coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period
 (SEP) to join a Medicare drug plan.

 If you decide to join a Medicare drug plan, your current coverage will not be affected. Your current coverage
 pays for other health expenses in addition to prescription drug. If you enroll in a Medicare prescription drug
 plan, you and your eligible dependents will still be eligible to receive all your current health and prescription
 drug benefits.

 If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your
 dependents will be able to enroll back into the current benefit plan during the annual open enrollment period.
 You should also know that if you drop or lose your current coverage and don’t join a Medicare drug plan within
 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a
 Medicare drug plan later.

 If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium
 may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did
 not have that coverage. For example, if you go nineteen months without creditable coverage, your premium
 may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay
 this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you
 may have to wait until the following November to join.

 For more information about this notice or your current prescription drug coverage, contact District Services.
 NOTE: You will receive this notice each year, before the next period you can join a Medicare drug plan, and if
 the current coverage changes. You also may request a copy of this notice at any time.

 More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare &
 You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be
 contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage
 visit www.medicare.gov, call your State Health Insurance Assistance Program (see the inside back cover of your
 copy of the “Medicare & You” handbook for their telephone number) for personalized help or call 1-800-
 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

 If you have limited income and resources, extra help paying for Medicare prescription drug coverage is
 available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or
 call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you
 decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you
       The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
                  whether or not you have maintained detailed information pertaining therefore, whether or not you are
 join to show the insurance carriers/administrators. For more creditable coverage and,to your employee benefit plans, including
    provided by
     limitations pay a higher premium (a penalty).
 required toand exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
13
 Other Mandatory Notices

Women’s Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the
Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related
benefits, coverage will be provided in a manner determined in consultation with the attending physician and
the patient, for:

    •   All stages of reconstruction of the breast on which the mastectomy was performed;
    •   Surgery and reconstruction of the other breast to produce a symmetrical appearance;
    •   Prostheses; and
    •   Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other
medical and surgical benefits provided under this plan.
If you would like more information on WHCRA benefits, call your plan administrator.

CHIP-Children's Health Insurance Program (CHIP) Reauthorization Act of 2009
Medicaid and the 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.

If you or your dependents are already enrolled in Medicaid or CHIP, you can contact your state Medicaid or
CHIP office to find out if premium assistance is available. For a list of the contacts in each State, go to
www.dol.gov/ebsa/chipmodelnotice.doc.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these programs, you can 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, you can then
contact the State to find out if it has a program that might help you pay the premiums for an employer-
sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or
CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as
long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a
“special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible
for premium assistance.




    The information provided herein intended to be a summary of benefits only and in no way supersedes the actual plan documents
  provided by the insurance carriers/administrators. For more detailed information pertaining to your employee benefit plans, including
  limitations and exclusions, please refer to the plan documents and/or evidence of coverage provided by the carriers/administrators.
                                                                                                                                          14
                                                Prepared by:




The information in this Benefits Summary is presented for illustrative purposes and is based on information
provided by the employer. The text contained in this Summary was taken from various summary plan
descriptions and benefit information. While every effort was taken to accurately report your benefits,
discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the
actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the
Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary,
contact District Services.