your 2016 benefits enrollment & reference guide ope… · assistance related to the enrollment...

Your 2016 Benefits Enrollment & Reference Guide

Cape Girardeau

publiC SChoolS

Human Resources

Questions? Contact Human Resources at [email protected] * 573.335.1867 2

INFORMATIONAL MEETINGS ARE BEING HELD AT…

Date Meeting Location Time Monday, November 16th Alma Schrader Elementary – Cafeteria 3:30 pm

Tuesday, November 17th

Career & Technology Center – Multipurpose Room 2:50 pm

Wednesday, November 18th

Franklin Elementary – Cafeteria 3:30 pm

Thursday, November 19th

Blanchard Elementary – Cafeteria 3:30 pm

Friday, November 20th

Clippard Elementary – Library 3:30 pm

Monday, November 23rd Retirees’ Meeting – Central Administration Offices

9:00 am

Monday, November 23rd

Central Middle School – Cafeteria 3:30 pm

Monday, November 30th

Central Junior High School – Cafeteria 3:00 pm

Tuesday, December 1st

Jefferson Elementary – Cafeteria 4:00 pm

Wednesday, December 2nd

Cape Central High School – Commons 2:50 pm

Thursday, December 3rd

Central Academy/Central Administration Offices – Upstairs Board Room

2:30 pm

In addition, representatives from the following partners will be available to answer any questions you may have regarding your benefits on December 3rd (1:00 pm to 5:00 pm) and December 4th (9:00 am to 4:30 pm) at the Central Administration Office, Room 218:

Mutual Medical AFLAC Assurant HealthLink

Sonus Benefits

mailto:[email protected]


Cape Girardeau

publiC SChoolS

Human Resources

Dear Cape Girardeau Public Schools Colleagues, Our open enrollment period for 2016 is November 16 through December 4, 2015. This is the time of year when all benefit-eligible faculty and staff can re-evaluate their benefit needs and review current plan elections to ensure they continue to meet their needs and those of their families. Now is the time to make changes to all 2015 elections or enroll for the first time for the 2016 calendar year. Any new elections and all changes will become effective January 1, 2016, and continue through December 31, 2016. This guidebook includes helpful information for evaluating your benefits options. Also, this guidebook includes a summary comparison of medical coverage options and a Glossary of Health Coverage and Medical Terms. The comparison chart summarizes important information about all of your medical plan options to help you compare your choices before enrolling and understand your coverage after enrollment. The glossary defines some of the most common medical and insurance terms. I encourage you to carefully review and consider the information provided in the 2016 Benefits Enrollment & Reference Guide. Should you have questions on any of the plan options or need assistance related to the enrollment process, our benefit specialist, Katherine Elfrink and I are eager to assist you. We can be reached Monday through Friday from 8:30 am to 4:30 pm by phone at 573.335.1867 or email at [email protected]. I look forward to seeing you at the Informational Meetings at your building! Cynthia Y. Paul Human Resource Coordinator Cape Girardeau Public Schools



Your 2016 Benefits Guide Contents Page Topic

5 What’s New for 2016

6 7

What Do I Need To Do? Important Dates

8

Health & Wellness • Medical Plan Comparison Chart • Prescription Drug Plan • Dental Plan • Vision Plan

14 15

Health Savings Account Flexible Spending Accounts

17 Life Insurance Products

18 18 19 19 23

Contact Information Lab Services Maternity Benefits Annual Notices Glossary of Health Care Terms

If you have any questions after reading this Benefits Open Enrollment Guide, please visit our website, call the Human Resources Department at 573.335.1867 or email [email protected].



What’s New for 2016 Lower Premiums and Deductibles! Last year, Cape Girardeau Public Schools implemented a self-funded medical plan, which is having a positive impact on our overall experience. For 2016 both the district’s contribution toward employees’ medical coverage and employee rates will decrease. In addition, individual deductibles have decreased by $500; family deductibles decreased by $1,000.

Medical Premiums

Coverage Tiers Major Medical Plan (PPO) Health Savings Account Plan 2015 2016 2015 2016 Employee (Board Paid) $564.44 $500.00 $516.30 $451.86 Spouse $677.34 $612.90 $619.56 $555.12 Child(ren) $536.22 $471.78 $490.50 $426.06 Family $1,044.22 $979.78 $955.16 $890.72

Medical Deductibles

Plan Individual Family 2015 2016 2015 2016 Major Medical Plan (PPO) Deductibles $2,500 $2,000 $5,000 $4,000 HSA Plan Deductibles $3,000 $2,500 $6,000 $5,000

New Vision Care Plan Design! All benefit eligible employees have access to vision care benefits through EyeMed. Effective January 1, 2016, these benefits will include a $130 allowance toward the purchase price of eyeglasses/contacts. Plan participants also receive coverage for one eye examination every 12 months with a $10 copay and discounts on the purchase of eyeglasses and contact lenses. All participants will receive a new vision ID card for 2016. Increased Family HSA Maximum The IRS raised the maximum allowable contribution to a health savings account by $100 in 2016; but only for families.

For 2016 HSA Contribution Limit (employer + employee) Individual: $3,350 Family: $6,750



What Do I Need to Do? Open enrollment is an opportunity for you to review your current health plan elections to ensure they continue to meet your needs and those of your family.

No changes to your current elections? If you do not want to make any changes to your current medical, dental, supplemental life, dependent life, long-term disability, you do not need to do anything. Your 2015 elections for these benefit plans will automatically continue for calendar year 2016. Simply, check the “I do not wish to change” box on your benefits election form. Then, return the letter to Human Resources by December 7th.

What benefits require re-election? If you want to participate in the health savings account (HSA), flexible spending account (FSA) or the vision plan during calendar year 2016, you must complete a new enrollment form. Even if you participated in these plans during calendar year 2015, your deductions will default to $0 for 2016 unless you re-enroll. What if I want to change my current elections or enroll for the first time? If you want to change your elections or enroll for the first time in the medical, dental, vision, supplemental life, dependent life, long-term disability, you must complete and return an enrollment form by December 7th. Once you have submitted your enrollment form, it is important that you review your confirmation statement for deduction accuracy. Any changes you make during open enrollment will take effect on January 1, 2016. Decisions made during open enrollment are binding through December 31, 2016, unless you have a qualified life event, such as a marriage or birth of a child. What if I experience a qualified life event in 2016? Dependents who become eligible during the year can be added to your coverage within 31 days of the qualified life event. Eligible dependents are your legal spouse and children. Adopted, foster, and stepchildren are also eligible for coverage. Documentation will be required when you add a dependent. Contact the Benefits Specialist at 573.335.1867 within 31 days of the qualified life event to enroll.



Current ID Cards Please do not discard your current Mutual Medical ID card. You will only receive a new card when you move from the Medical Reimbursement Plan (MRP). Affordable Care Act (ACA) and the Individual Mandate The ACA includes penalties for individuals who are not enrolled in health coverage that meets minimum standards. (Each of the district’s plan options meets the minimum standards.) Employers are now required to report individual health plan enrollment to the IRS. Employees enrolled in the health plan will receive a tax form in January 2016, documenting each month the employee and any family members were covered under the health plan. The tax forms require a social security number (or tax identification number for those who do not have an SSN) for each covered dependent. Human Resources will contact you if we do not have a number on file for your dependents.

Important Dates Open Enrollment for 2016 Plan Year begins

November 16th - November 23rd and November 30th - December 4th Please refer back to page 2

Return your benefits election form and any new enrollment forms by

December 7th

The choices you make during open enrollment will apply for the entire 2016 Plan Year, January 1st – December 31st. Unless you have a qualifying event, your next opportunity to make benefit choices will not be until the 2017 Open Enrollment period.



Health & Wellness Medical Plans Your medical-related needs and considerations are unique, and so are your family’s. That’s why the district offers you the opportunity to select the plan option that works best for you. Use the comparison chart on pages 9 and 10 to determine which of the following plans best suits your medical needs. Major Medical Plan (PPO) Health Savings Account Plan (HSA) Medical Reimbursement Plan (MRP) Maxi Plan and Maxi II Plan (Maxi) The Affordable Care Plan (ACP)

You must turn in an enrollment form if: You want to change your benefit plan option for 2016 You want to enroll in a Flexible Spending Account or Health Savings Account

The Choice Is Yours Find the medical plan that is right for you by answering a few questions about your medical needs. Call Mutual Medical Monday through Friday from 8:30 am to 4:30 pm by phone at 800.448.4689 or email [email protected].

Remember, it’s up to all of us to help control costs by using benefits wisely—so that the Plan can continue to share the savings through low employee contributions and deductibles.



Summary Comparison of Medical Coverage Options

Benefits Major Medical Plan (PPO)

HSA Plan

Medical Reimbursement Plan (MRP)

Description

No lifetime limits.

The Cape Girardeau Public Schools Health Care Plan is administered by Mutual Medical Plans.

The PPO network is HealthLink OAIII. Hospital charges in Cape Girardeau county are only payable at Southeast Missouri Hospital.

No lifetime limits.

The Cape Girardeau Public Schools Health Care Plan is administered by Mutual Medical Plans.

The PPO network is HealthLink OAIII. Hospital charges in Cape Girardeau county are only payable at Southeast Missouri Hospital.

No lifetime limits.

Options/Benefits

Cost Share

Annual Plan Deductible • $2,000 individual • $4,000 family Out of Pocket Maximum* *includes the deductible In Network • $4,500 individual • $9,000 family Out of Network • No Limit

Preventative care services covered at 100%, in network.

Office Visit Copays: $25 ER Copay: $250

In Network 80%/20% cost share after deductible

Out of Network 50%/50% cost share after deductible

Retail Rx Copays: $10/$30/$50/25% max $150

Mail Order Rx Copay: $25/$75/$125

Annual Plan Deductible • $2,500 individual • $5,000 family Out of Pocket Maximum* *includes the deductible In Network • $2,500 individual • $5,000 family Out of Network • No Limit

Preventative care services covered at 100%, in network.

All other services subject to the deductible.

0% cost share after deductible.

Annual Plan Deductible • $0 Out of Pocket Maximum In Network • $0

Preventative care services & Chiropractic services are covered at 100%, in network, when not covered at all by your other insurance.

The MRP reimburses covered members for 100% of their deductibles, coinsurance and plan co-payments incurred on their other insurance.

Employee must submit copies of their other Plan’s Explanation of Benefits to Mutual Medical Plans.

Eligibility

Full Time (30 or more hours per week)

Full Time (30 or more hours per week)

Full Time (30 or more hours per week) who have other coverage through a spouse, Tricare or other insurance policy.

How to Change Coverage

Within 31 days of an IRS qualifying change in family status, is required.



Eligibility Family Members: Your lawful spouse who resides with you in common residence and your under age 26 natural child, adopted child, child placed with you for adoption, or stepchild that you or your spouse have legal guardianship or legal custody or had such guardianship or custody when the child turned age 18, without regard to residence, financial support, or marriage. A disabled dependent age 26 or older who was covered under the program this Plan replaced may be covered through calendar year 2016.



Summary Comparison of Medical Coverage Options

Benefits Maxi/Maxi II Plan

Affordable Care Plan (ACP)

Description

No lifetime limits.

No lifetime limits.

Options/Benefits Cost Share


0% cost share. Maxi/Maxi II pays all covered outpatient services in full. Maxi Pays $1,500 on inpatient bills. Maxi II pays zero on all facility charges. Medicare/Medicaid will pay the balance of the inpatient bill or facility charge. Member will zero out-of-pocket.

Retail Rx Copays: $10/$30/$50/25% max: $150 The Maxi Plan will reimburse you for all of your RX copayments.

Mail Order Rx Copay: $25/$75/$125. The Maxi Plan will reimburse you for all of your RX copayments. Maxi II does not cover RX but will reimburse all RX copays on Medicaid.


Preventative care services covered and ER visits covered 100%, in network.

ACP pays 100% of Exchange policy premiums PLUS all deductibles, coinsurance and copayment incurred on the Exchange policy.

Eligibility

Full Time (30 or more hours per week) who also have Medicare (Maxi) or Medicaid (Maxi II)

Full Time (30 or more hours per week) who are expected to have claims exceeding $50,000 in a year.

How to Change Coverage


Changes can be made at any time to the employee’s contribution portion.

The benefits available through CGPS are an important part of your total compensation. This is a good time to review all of your benefit options.



Prescription Drug Plan (Only available with the Major and Maxi Plan) This Prescription Drug program is a comprehensive benefits that provides coverage for prescription drugs when prescribed by a licensed, practicing physician. Plan Benefits Insulin, insulin syringes, and most other prescription only drugs may be obtained at retail pharmacies - up to a 30 day supply, for co-payments of $10 generic, $30 preferred brand, $50 non-preferred brand. Mail co-pays are double the above for up to a 90 day supply. Generic oral contraceptives are covered in full with no co-payment. If you purchase a brand name drug when the generic is available, you pay the brand co-pay plus the difference in ingredient cost.

The co-pays and the deductible are not covered under the Major Medical Benefits and does not count towards the Major Medical Plan deductible or out-of-pocket expense limit, but are covered under the Maxi Plan. Specialty drugs or injectable drugs, other than insulin, not receiving special authorization from the Claim Administrator will not be covered providing that any drug that cost over $12,000 per year will not be covered or authorized, but you may call Mutual Medical if you need assistance with a manufacturer’s subsidy or for possible Affordable Care Plan (ACP) enrollment. Drugs not approved by the FDA for the condition being treated, infertility, weight loss, hair growth, cosmetic purposes, Retin-A for individuals over 26 years old, contraceptive devices, and any drug determined to be abused or otherwise misused by you are not covered under this prescription drug benefit. Formulary drug lists are available at www.express-scripts.com or call Express Scripts 800.282.2881. The calendar year out-of-pocket limit on covered prescription drugs is $1,500 per person ($3,000 family). Note that a few generic drugs are covered in full as required by the Affordable Care Act (ACA).

Only the first 3 refills at retail pharmacies are covered by this Plan. If you require more than 3 refills please use the mail order program. Certain non-preferred brand name drugs are only covered if the preferred brand name drug has been used unsuccessfully as determined by your physician and Express Scripts.



Dental Benefits Regular visits to the dentist may do more than just brighten your smile – they can be important to your overall health. This plan will pay reasonable and customary fees of licensed dentists up to a maximum of $1,000 per person for expenses incurred in a calendar year.

Dental Benefits Copay Diagnostic and Preventive Services

• Oral exams and cleanings up to twice per calendar year • Bite-wing x-rays once per calendar year • Sealants to age 19 • Fluoride treatment once per calendar year to age 19 • Full mouth x-rays once in a consecutive 24 month period

100% No Deductible

Major Services

• Denture repair and relining • Recementing of inlays, onlays, and crowns • Extractions, dental tests, oral surgery and related anesthesia

except for general anesthesia for 3 or less simple extractions • Fillings consisting of amalgam, silicate and plastic restorations • Space maintainers, periodontics (diseases of the gum),

endodontics, and apicoectomy • Emergency treatment including prescriptions

70% (Deductible $75 per person per

calendar year)

• Implants, gold foil restorations, inlays and onlays, and crowns or crown build-ups

• Dentures, full or partial • Bridges, fixed or removable

50% (Deductible $75 per person per

calendar year)

Orthodontics are not covered. The placement of dentures, bridges or crowns is limited to once in a consecutive five year period for the same tooth or teeth. The date an appliance is placed shall be the date the claim is incurred. General limitations and exclusions of the plan apply.



Vision Benefits EyeMed Vision Care offers a network of contracting providers to choose from when vision care is needed. When a contracting provider is used, the care is considered “in-network,” out-of-pocket costs will be less, and the highest level of benefits is received. If a provider outside the network is used, the care is considered “out-of-network” and coverage is still provided, but the out-of-pocket costs will be significantly higher. For a complete list of providers near you, visit the Provider Locator at www.eyemedvisioncare.com or call 866.804.0982. You pay the full cost for your vision coverage. Your cost is based on the coverage level you choose.

Vision Benefits Copay Exam $10

Eye Exam Frequency 12 Months Eye Exam Benefit $10 Up to $50 Materials In Network Out of Network

Lenses Frequency 12 Months Single Vision $20 Up to $50 Bifocals $20 Up to $70 Trifocals $20 Up to $90 Contacts Frequency 12 Months

Necessary Covered in full Up to $210

Elective Conventional: $130 allowance + 15% off any balance Disposable: $130 allowance Up to $130

Frames Frequency 24 Months

Frames $130 allowance + 20% off any balance Up to $97.50

Need Assistance?

Visit EyeMed’s Help & Resources pages

Call EyeMed Vision Care at 866.804.0982 Monday – Saturday: 7:30 am to 11:00 pm (ET) Sunday: 11:00 am to 8:00 pm (ET)


http://www.eyemedvisioncare.com/

https://www.eyemedvisioncare.com/member/public/faqs.emvc


Health Savings Account (HSA) The HSA Medical Plan will include a health savings account (HSA) administered by US Bank. For calendar year 2016, the school district will contribute $577.68 ($48.14/per month) to the HSA for those employees enrolled in the HSA Medical Plan. You have the option to contribute additional funds through pre-tax payroll deductions, but contributions are not mandatory.

For 2016, you can contribute up to an additional $2,772.32 if you are enrolled as an individual or $6,172.32 if you are enrolled with a spouse and/or children through payroll deduction on a pre-tax basis. If you are age 55 or older, you can contribute an additional $1,000 regardless of your coverage tier. You can contribute by check/money order or transfer/rollover funds directly to US Bank.

You can use this account to pay for qualified health expenses, including deductibles, coinsurance, dental, vision, and prescription drug expenses. Since the HSA is a bank account that you own, you will be issued a debit card. As the account holder, you will be responsible for all banking fees such as replacement of a debit card or ordering check. You can use your debit card or check to directly pay for your eligible out-of-pocket health expenses to providers.

Eligibility:

IRS rules state that participants cannot be covered in any other traditional health plan, health care reimbursement account, health care flexible spending account, Tricare, and/or VA benefits.

You cannot be claimed as a dependent on another person’s tax return (excluding your spouse’s).



Flexible Spending Accounts The district offers flexible spending accounts (FSA) from which the payment for certain health and dependent care expenses are paid with tax-free dollars. Health Care Reimbursement Account The Health Care Reimbursement account offers you the opportunity to pay for certain care expenses for yourself and your dependents as long as these expenses are not paid by your medical, dental, or vision plan. Eligible health care expenses include:

• Medical, dental, and vision deductibles, coinsurances, and office visit copay • Prescription medication • Certain over-the-counter drug expenses • Unreimbursed vision expenses

Dependent Care Reimbursement Account The Dependent Care Reimbursement account offers you the opportunity to pay for certain eligible dependent care expenses incurred while you and your spouse (if married) work.

An eligible dependent care expense includes:

• Before and after school care • Extended day programs • Day care, preschool, or nursery school • Summer day camp • Elder day care

IRS regulations require re-enrollment into the FSAs each year. If you are enrolled in a health and/or dependent care FSA during calendar year 2015, your elections will not automatically be continued for calendar year 2016.



How the Accounts Work You elect an annual contribution, which will be deducted on a pre-tax basis from each of your paychecks in equal amounts. As a pre-tax contribution, the amount will be deducted from your salary before federal income tax, Social Security, and, in most cases, state and local taxes. Maximum contributions:

Health Care Reimbursement Account: $2,550 Dependent Care Reimbursement Account: $5,000

Your health and/or dependent care FSA contribution elections for 2016 must remain in effect through December 31, 2016. IRS regulations do not allow you to increase, decrease, or stop your contributions during a plan year unless you have a qualified life event, such as marriage, divorce, birth, or death. And the FSA contribution changes you make must be consistent with the type of life event. Proof of the life event is required and must be submitted within 31 days of the change effective date. You may not be enrolled in both the Health Care Reimbursement and a Health Savings Account at the same. Carryover You are allowed to carry over a portion of the medical FSA unused balance. The maximum allowed carryover is $500. Any unused medical FSA funds exceeding this carryover maximum are forfeited to your employer. Carryover funds are automatically moved into the new Plan Year after the Plan Run-out End Date.

For FSA Plan Year 2016, subject to eligibility to participate in the FSA Program

Plan Year Jan 1, 2016 – Dec 31, 2016

Pre-tax payroll contributions made during the plan year, which is a 12-month period. Use the funds in your FSA(s) for incurred eligible expenses during the plan year.

Reimbursement Period Jan 1, 2016 – Mar 30, 2017 Request reimbursement for 2016 eligible expenses during the reimbursement period, which is a 15-month period.

Reimbursement Filing Deadline Mar 30, 2017 All requests for 2016 reimbursement must be received

by TASC no later than March 30, 2017

Plan carefully. All TASC Card transactions and services must occur within the Plan Year. Any expenses not submitted by March 30, 2017, will be forfeited.



Other Benefits Basic Life Insurance The district pays the premiums for Basic Life Insurance. The coverage is mandatory for benefit-eligible employees. Beneficiary designations continue in effect from year to year unless a subsequent beneficiary form is completed. Beneficiary changes can be made at any time. You may enroll in other benefit plans at this time: Accidental Death and Dismemberment - AD&D provides benefits in the

event of a covered accident 24 hours a day, both on and off the job. If you enroll within 31 days of becoming eligible, you can purchase coverage without providing proof of good health, up to the Guarantee Issue amount. Select coverage for yourself or for you and your eligible family members.

Voluntary Life Insurance (proof of good health is required) – If you cover

yourself, you can also purchase Voluntary Life Insurance for your eligible family members. You can change your current elections during open enrollment, or, if you experience a qualifying event (birth, marriage, death, etc). Changes must be made within 30 days of the qualifying event.

Long Term Disability Insurance – This coverage provides an income

replacement in the event your income ceases because you are unable to work as a result of an eligible disability. Coverage is available to employees only.

Do you know who is listed as your beneficiary on your life insurance, retirement plans, and any other plans that provide a death benefit? It’s not just a smart practice to review your beneficiaries—it is essential if you experience a major change in your life such as marriage, divorce or birth of a child or grandchild. Updating your beneficiaries can save your loved ones from unnecessary grief during a difficult time. You can check and update your beneficiaries for life insurance by contacting Human Resources. Review and update your retirement plan beneficiary designations by logging in to your account with PSRS/PEERS at www.psrs-peers.org.



Carrier Contact Information

Members Services Telephone Number

Participant Website

Mutual Medical 800.448.4689

Medical Ask for Debbie Norris Network Provider: www.healthlink.com Outside of Missouri: www.phcs.com

Dental Ask for Monica No Network

Prescription Drugs Ask for Kathy Mathews

Express Script 800.818.0093 www.Express-Scripts.com

Sonus Benefits 573.803.3303

Life 800.451.4531 www.assurantemployeebenefits.com

Vision 866.804.0982 www.eyemedvisioncare.com

Flexible Spending Account 800.422.4661 www.mytasconline.com

Just a Reminder Lab Services Preventive and non-preventative labs when completed by Southeast Health, the Cape County Health Department, or by a Southeast Health PPO physicians and the lab test is on the list of required Affordable Care Act preventives services are covered at 100%. Preventive labs performed at Labcorp, Quest or other in-network labs and the lab test is on the list of required ACA preventives services are covered at 100%. Non-preventative labs performed at Labcorp, Quest or other in-network labs will apply to deductibles and coinsurance. Beware of lab schemes where the provider ordering the lab work has a financial tie-in with a lab and thousands of dollars are billed out for general diagnoses such as fatigue. Such lab charges will not be paid by the Plan, and you may or may not be balance billed.


http://www.healthlink.com/

http://www.phcs.com/

http://www.express-scripts.com/

http://www.assurantemployeebenefits.com/

http://www.eyemedvisioncare.com/

http://www.mytasconline/


Maternity Benefits A newborn baby is not automatically covered under the mother’s insurance for the hospital stay. While in the hospital, your baby will incur both delivery and nursery charges along with individual charges. What to do if you have an individual health policy for your newborn: If you have an individual health policy on the baby, it will pay primary for delivery, nursery and individual charges. Our plan will be considered secondary. What to do if you do not have an individual policy for your newborn: If you do not have an individual health policy on the baby, please contact the Benefits Specialist to complete a new enrollment card. This must be completed within 30 days from the date of delivery. The monthly child premium will be required at the time of the enrollment change. Our self-funded plan will process your claim as follows: If a newborn is discharged with the mother and is considered a “well-baby” the delivery and nursery charges will be included as part of the mother’s hospital bill and is covered under her insurance. Sick babies and individual charges including, but not limited to pediatrician visits, labs, circumcision, etc. will be processed under the baby’s insurance. These charges are subject to the individual deductible and coinsurance for the child.

Annual Notices Notice of Special Enrollment Rights If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. To request special enrollment or obtain more information, contact Katherine Elfrink at 573.335.1867 or email at [email protected].



Health Insurance Marketplace Coverage Options Individuals have an option to purchase private health insurance through the public Health Insurance Marketplace that was established in connection with health care reform. For more information on coverage options available through the Health Insurance Marketplace, please visit www.healthcare.gov. For comparison purposes, information on your health plan options through Cape Girardeau Public Schools is contained in this Benefits Enrollment & Reference Guide, as well as on the Human Resources/Benefits website at http://www.capetigers.com. Women’s Health and Cancer Rights Act (WHCRA) of 1998 If you have had or going to have a covered 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 consultations with the attending physician and the patient, for: All states of reconstruction of the breast on which the mastectomy was

performed Surgery and reconstruction of the other breast to produce a symmetrical

appearance; Prosthesis, and; Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same exclusions, deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) The Children’s Health Insurance Program Reauthorization Act of 2009 is a premium assistance program for employees who are eligible for health coverage from their employer, but are unable to afford the premiums. 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 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. You can also call 1-877-KIDS NOW or visit www.insurekidsnow.gov to find out how to apply.


http://www.capetigers.com/

http://www.insurekidsnow.gov/


Medicare Part D - Creditable Coverage Disclosure Notice If you are Medicare-eligible, there are two important things you need to know about your current coverage and Medicare’s prescription drug coverage. First, 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. Second, the Cape Girardeau Public Schools determined that the prescription drug coverage offered by Express Scripts 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. If you are considering joining Medicare’s prescription drug coverage, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. For more information about Medicare’s prescription drug coverage please visit: www.medicare.gov. Newborns’ and Mothers’ Health Protection Act of 1996 Under federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital lengths of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain pre-certification.


http://www.medicare.gov/


HIPAA Privacy Notice The School Board of Cape Girardeau County is concerned about your privacy, and maintains a strict privacy policy. Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the School Board has implemented procedures to ensure full compliance with all federal privacy protection laws and regulations. For more information about our privacy practices, contact the Human Resources Department. If you have a complaint, please contact: Cape Girardeau Public Schools Dr. Neil Glass, Compliance Officer 301 N. Clark Cape Girardeau, MO 63701 You may also contact the Compliance Officer by: Email: [email protected] Telephone: 573.335.1867 Complaints If you are concerned that we violated your privacy rights or you disagree with a decision we made about access to your records, you 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 information.

More information: If you would like more information about these Annual Notices, please review the information posted on the Benefits page at www.capetigers.com or contact Katherine Elfrink at 573.335.1867 or email at [email protected].



http://www.hhs.gov/ocr




Glossary of Health Care Terms Types of Plans Fully insured Plans: In a fully insured plan, the employer pays a per-member premium to an insurance company, and the insurance company assumes the risk of providing health coverage for insured events. Self-insured Plans: In a self-insured plan, instead of purchasing health insurance from an insurance company and paying the insurer a per-member premium, the employer acts as its own insurer. In the simplest form, the employer uses the money that it would have paid the insurance company to instead directly pay health care claims to providers. Self-insured plans often contract with an insurance company or other third party to administer the plan, but the employer bears the risk associated with offering health benefits. Providers Preferred Provider Network: Providers (such as hospitals and physicians) who agree to charge a pre-negotiated rate for everyone on a particular health plan. Participating Provider Network: Providers (such as hospitals and physicians) who have agreed to provide services to patients at rates pre-negotiated by the patient’s health plan. Non-Network Providers: Providers (such as hospitals and physicians) who are not part of a particular HealthLink provider network. Some health plans cover non-network providers, but your costs will be higher. Member Costs Copay: A fixed dollar amount the member pays the provider when they receive a medical service. Deductible: A fixed, annual dollar amount per calendar year that a member pays for medical services before the plan begins paying for covered medical services. Coinsurance: The percentage a member pays toward the total negotiated charges for medical services.



Out-of-Pocket Maximum: A maximum amount you’ll be responsible for paying toward your covered medical expenses in a calendar year. This amount varies by plan, and includes the deductible, coinsurance, and co-pays. After you have reached your out-of-pocket maximum, the plan pays 100% of remaining covered medical expenses in a calendar year. Prescription Coverage Generic Drugs: Prescription medications that have the exact same active ingredients and strength as brand-name medications. Generics, as they’re often called, are equal in therapeutic power to their brand-name counterparts. Health plans often encourage use of generics because they are usually much less expensive. Formulary: A list of prescription medications covered by a health plan. Formularies can be open, meaning you may get some coverage for medications not on the list, or closed, meaning only medications on the list are covered. Formularies are also called “Preferred Medication Lists.” Non Formulary: Prescription medications that are not on the list of prescriptions covered by a health plan. Medications not on the list are covered but at a higher cost to members. Closed Formulary: When formularies are closed, only medications on the formulary list are covered. Medications not on the list are not covered. Understanding the Deductible… The deductible is the amount you need to pay each year before your insurance begins paying coinsurance. Certain benefit design options make you responsible for a percentage of your medical costs after you’ve reached your “deductible” for the year. Remember:

• Some network benefits have an office visit co-pay while other benefits will be subject to the deductible.

• If there is a copay, meeting the deductible is not required. • The deductible will apply to all major services such as inpatient hospitalization,

outpatient surgery, and outpatient diagnostic therapeutic services. • The in-network and out-of-network deductible and coinsurance are completely

separate. • Deductible and coinsurance accumulate separately by calendar year from

January 1st to December 31st.



This booklet provides an overview of your Cape Girardeau Public Schools’ benefits plans. It is for informational purposes only. It is neither intended to be an agreement for continued employment, nor is it a legal plan document. This booklet is not intended to be and should not be treated as tax advice. If there is a discrepancy between this booklet and the plan documents, the plan documents will govern. In addition, the plans described in this booklet are subject to change without notice. Continuation of benefits is at the school district’s discretion.

Cape Girardeau

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Human Resources 301 N. Clark Cape Girardeau, Missouri 63701 Hours: 8:00 am - 5:00 pm (M-F) Phone: 573.335.1867 Fax: 573.335.1820 Email: [email protected] Web: www.capetigers.com




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