2016 open enrollment packet 091015 - amazon web...

Health-(Medical, Dental, and Vision)

The Open Enrollment Period allows employees to enroll, change health plans, or add eligible depend-ents who were not previously enrolled into their insurance. The effective date for all changes made during Open Enrollment is January 1, 2016. Employees who are not making any changes will continue with their existing insurance into the new plan year (no action is needed).

2016 Open Enrollment THE WEST COVINA UNIFIED SCHOOL DISTRICT IS DEDICATED TO UNCOMPROMISING EXCELLENCE IN EDUCATION AND CITIZENSHIP.

West Covina USD Health Benefits All monthly Certificated employees and Classified employees who work at least 20 hours per week qualify for health benefits at West Covina Unified School District. The District contributes a maximum of $8,500.00 towards employee health benefits, pro-rated for part-time employees. Employee health benefits consist of medical, dental, vision, and life insurance. Supplemental insurances are also offered at the employee’s own expense.

Initial Enrollments and Qualifying Events

Eligible newly hired employees may enroll eligible dependents to their medical, dental, and vision insurance during the initial enrollment period when first employed, within 30 days. Subsequent to the initial enrollment period, employees may add dependents to their existing health plan if they experience a qualifying event* such as the birth of a child, a recent marriage, or a loss of coverage. Dependents may be added within 30 days of the qualifying event. Dependents may be dropped at any time, unless prohibited by law. Dependents who are added or deleted from your plan are processed with an effective date of the first of the following month of such request.

2016

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W C U S D

Open EnrollmentSEPTEMBER 17, 2015—OCTOBER 16, 2015

Enrollment Forms and Changes during Open Enrollment are due on October 16, 2015.

Opt-Out Program/Section 125 Cafeteria Plan

The Open Enrollment Period also provides employees the opportunity to participate in the Opt-Out Program and the Section 125 Cafeteria Plan.

Please be advised that re-enrollment into the Opt-Out Program and/or the Section 125 Cafeteria Plan is required each year in order to continue.

Time: 1:30pm — 4:30pm

Location: Edgewood Middle School Cafeteria 1625 W Durness St , West Covina, CA 91790

Plan representatives and vendors will be here to assist in answering questions regarding health plans. Various products and services will also be introduced. Employees are encouraged to attend. Make sure you sign in!

Health Fair—Monday, September 28, 2015

Inside this packet: Medical Plan Benefits 2

Dental, Vision, and Life Benefits 3 Supplemental Insurances 3

Tax Sheltered Annuities 4 Opt-Out Program 5

Section 125 Cafeteria Plan 5

FAQs 6

Tenthly Payroll Deductions 7-10

Opt-Out Form 11-12

Cafeteria Plan Form 13-14

* For a list of Qualifying life events please visit CalPERS website at www.calpers.ca.gov

A listing of the eleven plans (8 HMOs and 3 PPOs) offered by the District through CALPERS is provided below. It is very important that you review each plan in detail information prior to mak-ing a decision on a medical plan that meets your needs.

Summary plan details are subject to change for 2016, check website for up to date information. Visit the CalPERS website at www.calpers.ca.gov for com-plete benefit details, provider networks, or to request an evidence of coverage booklet for more details.

CalPERS — Medical Plans

2016 OPEN ENROLLMENT

HMO PLANS*Anthem HMO Select

(855) 839-4524 www13.anthem.com/cp/web/calpers/home

Anthem HMO Traditional (855) 839-4524

www13.anthem.com/cp/web/calpers/home

BSC Access + (800) 334-5847

www.blueshieldca.com/sites/calpersmember/plans-benefits/active-employee/access-plus-

hmo/home.sp

BSC NetValue (800) 334-5847

www.blueshieldca.com/sites/calpersmember/plans-benefits/active-employee/netvalue-

hmo/home.sp

Health Net Salud y Más (888) 926-4921

https://www.healthnet.com/portal/member/content/iwc/mysites/calpers/plan_details.action

Health Net SmartCare (888) 926-4921

https://www.healthnet.com/portal/member/content/iwc/mysites/calpers/plan_details.a

ction

Kaiser Permanente (800) 464-4000 www.kp.org/calpers

United Healthcare (877) 359-3714

http://calpers.welcometouhc.com/

PPO PLANS* Pers Choice

(877) 737-7776 www.anthem.com/ca/shared/f0/s0/t0/pw_e2037

63.pdf?refer=popcontent

Pers Select (877) 737-7776

http://www.co.monterey.ca.us/personnel/benefits/2014/2014-select-sbc.pdf

PERSCare (877) 737-7776

www.anthem.com/ca/shared/f0/s0/t0/pw_e203762.pdf?refer=popcontent

Health Care Reform— Effective January 1, 2011, CalPERS accepts dependents up to age 26. If your dependent lost cov-erage prior to this date, an enrollment form must be completed in order for their insurance to be reinstated on January 1, 2016.

If you change your medical plan during Open Enrollment, you will remain on your current plan until December 31, 2015.Effective January 1, 2016, you will change to your new medical plan.

If you live in the Other Southern California Region, you can request to enroll using your work zip code.

(All services must be received within the Los Angeles Area except emergency and urgent care).

Please note that some of the Medical Plans above may be available only in certain counties and/or zip codes.Please check the CALPERS website on specific availability.

Submit insurance forms to Businessand Fiscal Services—Health Benefits.

If you are enrolling your spouse or childas a dependent for the first time, a copyof your marriage license and/or de-pendent’s birth certificates are re-quired.

The annual cost of health coverage isreported on Form W-2 in compliancewith the Patient Protection and Af-fordable Care Act.

Health plan information is availableon the Business and Fiscal Serviceswebsite!

Reminders

HEALTH BENEFIT CONTACTS:

CLASSIFIED EMPLOYEES CERTIFICATED EMPLOYEES

(626) 939-4600 EXT. 4639 (626) 939-4600 EXT. 4666

W C U S D

Other health benefits...

Life Insurance Supplemental Insurances

Reminders

The Hartford Life Insurance 1-800-303-9744

$15,000.00 Life, Accidental Death and Dismemberment (AD&D) benefit

for the employee only

Benefits reduce to $9,750.00 at age 65 Benefits reduce to $7,500.00 at age 70

Delta Dental Of California *(Delta Dental Premier)

1-888-335-8227 www.deltadentalins.com

$2,000.00 maximum benefit paid per calendar year

(January-December) per person

Vision InsuranceVision Service Plan

(VSP) 1-800-877-7195

www.vsp.com $10.00 co-pay every 12 months

Well Vision Exam/Prescription Glasses

$140.00 Allowance -or-

Contact Lens Care

(fitting and evaluation)

$ 105.00 Allowance

Various supplemental insurances for unexpected life events such as cancer, disability, accident, life, and/or income protection are of-fered through the following insurance carriers. Keep in mind that employees do not pay into the State Disability Insurance (SDI). These voluntary plans are available at the employees’ own expense to supplement their coverage.

Once membership is obtained with the insurance carrier, author-ized premiums will be payroll deducted. Brochures are available at the Open Enrollment Health Fair/Business and Fiscal Services office. For more information, contact:

THE HARTFORD 1-800-303-9744

(Newly hired employees qualify for guaranteed supplemental insurances with-out medical questionnaires, subject to conditions. Contact insurance carrier for deadlines.)

NATIONAL TEACHER’S ASSOCIATES 1-800-825-5682

PACIFIC EDUCATORS 1-800-722-3365

STANDARD INSURANCE (CTA) 1-800-522-0406

AFLAC 1-800-992-3522

(Offers guaranteed renewable policies.)

The dental and vision plans are currently negotiated as a composite plan which means there is no additional costto enroll your eligible dependents.

Dental and Vision plans accept unmarried dependents up to age 25.

Classified employees who work at least 30 hours per week are eligible for vision insurance.

Supplemental insurance policies are a contract between the employee and the insurance carrier. When your pol-icy is approved, authorization is given to the district to deduct your premiums from your payroll check.

Delta Dental of California *(DeltaCare USA)

1-800-422-4234 www.deltadentalins.com

There is no maximum benefit paid per calendar year

(January-December) per

Dental Insurance

*Visit www.deltadentalins.com for provider network and coverage.

OR AND

NEW: District Benefit Insurance Committee decided to introduce two Dental Plan options this year

SchoolsFirst Federal Credit Union is the District’s Third Party Administrator for your tax sheltered annuities.

SchoolsFirst FCU provides investment guidance, retirement education and plan compliance services.

A tax sheltered annuity (TSA) is a voluntary retirement plan option that allows employees to save for their retirement by investing payroll deducted contributions.

403(b) – Pre-tax contributions, taxes are paid on withdrawals which can begin at age 59 ½. Penalties may apply to with-drawals taken before this time.

Roth 403(b) – After-tax contributions, withdrawals can begin at age 59 ½ and are tax free if the account has been openedfor at least 5 years. You may withdraw upon severance of employment, or in cases of hardship, disability or death; penalties may apply.

457(b) – Pre-tax contributions; taxes are paid on withdrawals. Regardless of age, you may withdraw when you leave youremployer, or in case of death, disability or unforeseeable emergency. Supporting documentation is required and you may be subject to penalties.

Contact a TSA Agent if you are interested in opening a TSA. If you do not have a TSA Agent, please contact Fernando Gar-cia, Retirement Plan Representative from SchoolsFirst FCU at 800-462-8328, ext. 4116.

To ensure that there’s no delay in processing your TSA (i.e. new set-up, change in amount or provider, termination, etc.), please remind your TSA Agent that Salary Reduction Agreements must be sent to SchoolsFirst FCU at the address below for proper processing. Salary Reduction Agreements must be submitted a month prior to the effective date of your request.

You can also visit their website at www.schoolsfirstfcu.org for more information and updates. For a list of approved provid-ers you may log on at:

https://retirement.schoolsfirstfcu.org/SchoolEmployees/ApprovedProviderList/403bProviders.aspx

Tax Sheltered Annuities (TSA)

OR Online : https://retirement.schoolsfirstfcu.org/

Mail: Salary Reduction Agreement (SRA) forms to SchoolsFirst at:

P.O. Box 11547

Santa Ana, CA 92711-1547

Reminders


The Los Angeles County Office of Education charges a fee for returned contributions due to any errors in TSA enrollments. Thisfee will be charged to the employee at the current rate of $25 per returned contribution (fee subject to change).

Section 125 Cafeteria Plan P&A Group is the District’s Third Party Administrator for the Section 125 Cafeteria Plan.

The Section 125 Cafeteria Plan, also known as a Flexible Spending Account (FSA), is a pro-gram that the Federal Government allows your employer to sponsor. It enables employees to save on Federal, State, and Social Security taxes on the money they use to pay for eligible expenses. Employees and their eligible dependents can pay for health expenses, dependent care expenses, adoption expenses, and individual premiums on a pre-tax basis.

There are four types of accounts you can enroll in:

1. Medical Expense Reimbursement2. Dependent Care Assistance3. Adoption Assistance4. Individual Premium Reimbursement

Employees must estimate how much they will spend on eligible expenses over the 12 months (January 2016-December 2016). This amount is divided by ten and deducted from their paychecks on a tenthly basis (ten payroll deductions). Payroll deductions are deposited into a trust account to pay for eligible expenses. There is a $6.00 Administration Fee/Month to participate.

Enrollment does not roll forward each year. You must enroll during open enrollment each year to take advantage of the Section 125 Cafeteria Plan pre-tax deduction.

Contributions per plan year for each account Minimum Maximum

Medical Expense Reimbursement Account $150.00 $2,550.00 Dependent Care Assistance Reimbursement Account No minimum $5,000.00 Adoption Assistance Account No minimum $13,400.00 Individual Premium Reimbursement Account No minimum $10,000.00

Medical insurance premiums are automatically deducted on a pre-tax basis.

An enrollment form is not necessary and there are no fees if you are not taking advantage of other qualified expenses. However, should you decide that you would like your insurance premium to be deducted on an after-tax basis, you must contact the Benefits Department in writ-ing.

The tenthly Payroll deductions for Health Insurance premiums is calculated by dividing the annual insurance rates by a factor of 10 to determine the monthly deductions. There are no payroll deduc-tions in June & July for Classified employ-ees, and July & August for Certificated employees. If an employee terminates during those months, there may be a payment owed to the District.

Deductions will be adjusted if the employee terminates mid-year. A payment may be owed to the Dis-trict in certain circumstances.

Opt-Out ProgramAll Certificated and Classified employees who work at least 20 hours per week, qualify to participate in the Opt-Out Program. Employees who are currently covered through an outside group medical insurance may opt-out of the district medical insurance. If eligible, employees will receive an opt-out payment of up to $200.00 per month (maximum of $2,000.00 annually). Payment is fully taxa-ble and is paid through payroll.

Part-time employees eligible for pro-rated benefits may participate in the Opt-Out Program at a percentage equal to their pro-rated eligibility.

Attach the following: 1. Proof of medical coverage. (i.e. Copy of insurance card, letter from insurance carrier, etc.)2. If you are currently enrolled in the District’s medical insurance plan, a cancellation form must be

completed.

For Opt-Out benefits to continue for employees who were previously enrolled, a new enrollment form must be submitted on or before Friday, October 16, 2015.

P&A offers a Benefits MasterCard which works like a debit card. As you incur expenses, simply present your Benefits Card to the provider of the goods or services you are purchasing. Eligible expenses are automatically deducted from the trust account that is set up. If you are unable to use your Benefits Card, you can still be reimbursed for eligible expenses by submitting a claim with a copy of your receipt.

Please note: Benefits MasterCard may not have funds available until February 2016. Eligible expenses at the start of the plan year may require a claims submission for reimbursement, receipts are required.

You can also access your account by creating a user name and password at:

h t t p s : / / n e w . p a d m i n . c o m / e m p l o y e e -participants/benefit-programs/tools-and-resources/benefits-card/index.php3

Simply log in to check your balances


Reminders

2016 Plan Year for the Section 125 Cafeteria Plan: January 2016 through December 2016.

The “Use it or Lose it” rule under the IRS guidelines state that if you contribute dollars to areimbursement account and do not use all of the monies you deposit, you will lose any re-maining balance in the account at the end of the plan year (December 2016).

A new enrollment form must be submitted on or before October 16, 2015.

FSA Brochure—available on website: www.padmin.com.

Where do I submit my forms?

Submit forms through interoffice mail/USPS mail to: West Covina USD–Business and Fiscal Services Attn: Certificated Health Benefits -or- Classified Health Benefits, 1717 West Merced Avenue, West Covina, CA 91790. You may also submit your forms in person. Support-ing documents must be attached (i.e. marriage license, birth certificates, proof of coverage, etc.). Forms must be received by October 16, 2015. Late forms will not be accepted.

If I enroll in the Opt-Out Program, am I eligible to participate in the dental, vision, and life insurances?

The Opt-Out Program applies to medical insurance only. You are eligible to opt-out of the medical insurance and still enroll in the dental, vision, and life insurance.

If I enroll in a single medical plan, can I still add my dependents to my dental and vision insurance?

Yes. The District carries individual policies for each health insurance plan. If you enroll in a single medical plan, you can still add your dependents to your dental and vision insurance. Likewise, if you enroll in a two party or family medical plan, your dependents will not be enrolled into your dental and vision unless you submit an enrollment form to add them.

How are my tenthly payroll deductions calculated?

Tenthly payroll deductions reflect rates from January 2016– December 2016. Twelve months of health premiums less the district’s contri-bution towards your plan is then divided into ten equal payroll deductions.

If I make a health plan change during Open Enrollment, will the Tenthly Payroll Deductions on page 7-10 show what my new rates will be?

Depends. If you are making a health plan change (i.e. change in medical plan, change in dependent coverage, etc.) during Open Enroll-ment or if you experience a qualifying event which allows a change mid-year, your tenthly payroll deduction may be adjusted. Inquire with the Benefits Department.

What happens if my dependents are dropped from my plan due to overage limits? Do they have the option to continue?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows enrolled dependents who experience a loss of district health cover-age to enroll and pay at the employee’s own expense for continued membership in the medical, dental, and vision insurance plans when their benefits terminate under eligibility guidelines.

If I experience a qualifying event mid-year and my dependents are dropped from my plan, will I receive a refund for the amounts that have been prepaid?

Since the annual cost of your benefits is divided into 10 payments, you may qualify for a refund if you experience a change in benefits mid-year. Once a change is made, annual costs are re-calculated and a refund will be issued to you if you have overpaid. Refunds typically take 2-3 months to process.

Why does my insurance cost more if I live in the Other Southern California Region?

Since health care costs vary throughout California, regional pricing adjusts premiums to reflect the actual cost of health care in your spe-cific region. Premiums under the CalPERS Health Program are adjusted to each specific region. If your residential zip code falls within the following areas: Fresno, Imperial, Inyo, Kern, Kings, Madera, Riverside, Orange, San Diego, San Luis Obispo, Santa Barbara, or Tu-lare, you will pay the Other Southern California Region rate. To take advantage of lower premiums in the Los Angeles Area, you can re-quest to enroll using your work zip code. If you do, all covered services must be received within the Los Angeles Area, except emergency and urgent care.

When does the first tenthly deduction for 2016 start?

For Monthly Classified Employees, the first tenthly deduction will start with their December 30, 2015 payroll.

For Monthly Certificated Employees, the first tenthly deduction will start with their January 4, 2016 payroll.

Frequently Asked Questions

Reminders CalPERS will provide a uniform Summary of Benefits and Coverage for all health plans to applicants and enrollees under the Patient Protection

and Affordable Care Act (Federal Health Care Reform law) with their Open Enrollment materials.

To obtain a 2016 Health Benefit Summary and Health Program Guide, please mail the postcard from the CalPERS Open Enrollment packet bySeptember 17, 2015. The postcard must be postmarked no later than September 17, 2015.

To access doctor directories, explore health plan features and view overall plan satisfaction ratings, Visit www.calpers.ca.gov


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West Covina Unified School District 2016Business and Fiscal Services

Opt-Out Program

All Certificated employees and Classified employees who work at least 20 hours per week, qualify to participate in the Opt-Out Program. The Opt-Out Program allows employees to opt-out of medical insurance if they already have existing medical coverage. Employees may choose not to enroll for medical insurance and instead, receive an opt-out payment of up to $200.00 per month (maximum of $2,000.00 annually). Opt-out payments are pro-rated for part time employees.

Attach the following: 1. Proof of medical coverage. (i.e. Copy of insurance card, letter from insurance carrier, etc.)2. If you are currently enrolled in the District’s medical insurance plan, a cancellation form must be completed.

Certificated __ Classified __ (please check √)

Employee’s Name: __________________________________ SSN (last four digits): _______________

Work Location: ____________________________________ Job Title: _________________________

Telephone Number: _________________________________ Work Hours/Day:__________________

Subscriber’s Name: Subscriber’s Insurance Company’s Name:

_____________________________________________ __________________________________________

I elect to opt-out of the District’s medical insurance plan and receive an opt-out payment in lieu of medical ben-efits for the 2016 Calendar Year. I will provide proof of my current medical insurance.

I understand that if I should lose my medical insurance coverage and wish to enroll in the District medical in-surance, I must cancel my participation in the “Opt-Out Program” in order to enroll into the District’s medical insurance plan within 30 days of loss of coverage. (Employee must provide proof of loss of coverage.)

I certify that I have a current medical insurance coverage.

______________________________________________ ___________________________________________

Signature Date

This form must be returned to Business and Fiscal Services

Attention: Certificated or Classified

Enrollment Deadline: Friday, October 16, 2015

Employees who do not submit their forms by October 16, 2015 will no longer qualify for the Opt-Out Program


Attention: Certificated or Classified Enrollment Deadline: Friday, October 16, 2015

West Covina Unified School District Business and Fiscal Services 2016

Opt-Out Program

Employees who are currently covered through an outside group medical insurance may opt-out of the district medical insurance, subject to the following conditions:

The employee eligible for West Covina Unified School District medical insurance must provide satisfactoryevidence of current enrollment in another medical insurance plan of similar scope. An enrollment form and proof of medical coverage is required (i.e. copy of medical card).

Employees cannot opt out of district health coverage unless they are covered by another group medical insur-ance.

If eligible, employees will receive an opt-out payment of $200.00 per month (annual maximum of $2,000.00),pro-rated for part-time employees. Payment is fully taxable and is paid through payroll.

Part time employees eligible for pro-rated benefits are eligible to participate in the Opt-Out Program at a per-centage equal to their pro-rated eligibility. Classified employees must work at least 20 hours per week to be eligible.

Eligible employees who wish to enroll in the Opt-Out Program must submit an enrollment form and proof ofmedical coverage during the Open Enrollment Period. The enrollment form must be turned in annually.

Employees enrolled in the Opt-Out Program may enroll in District Dental, Vision and Life insurance.

FOR ELIGIBLE EMPLOYEES ONLY


West Covina Unified School District Business and Fiscal Services 2016 (January—December)

Section 125 Cafeteria Plan

Employee Name: SS#: __ __ __ __ (last four digits)

Address:

Telephone Number: ( ) Date of Birth:

School Site/Department: Certificated __ Classified __ (check √)

Spouse Name: Date of Birth:

Dependent Name: Date of Birth:

Dependent Name: Date of Birth:

Male / Female (circle) Single / Family (circle)

Accounts Monthly Amount (10 reductions) Minimum—Maximum

Medical Expense Reimbursement $ $15.00—$255.00

Dependent Care Assistance + $ No minimum—$500.00

Adoption Assistance + $ No minimum—$1,340.00

Individual Premium Reimbursement + $ No minimum—$1,000.00

Administration Fee + $ 6.00 N/A

Per Pay Period Total: = $ N/A

Payroll Reduction Authorization

I hereby authorize the above payroll reduction as my contribution(s) to the West Covina Unified School District Section 125 Cafeteria Plan which must be renewed each successive plan year in writing.

I understand that changes to the Cafeteria Plan can only be made by me at the end of the plan year unless there is a change in family status. Any amount that is not spent by the end of the plan year (December 31, 2016) will be forfeited.

I will have 90 days following the end of the plan year to submit claims for expenses incurred within the plan year. Claims must be received by P&A Group no later than March 31, 2017.

This authorization replaces any previous authorizations I have made.

Participant Signature: ___________________________________________________ Date: ______________________

Waiver of Pre-tax Benefits Under the Section 125 Cafeteria Plan

I certify that the features and benefits under the Cafeteria Plan have been explained to me completely. I elect to waive all pre-tax benefits under this plan and understand that the benefits may be elected on an after-tax basis. Except for a change in family status, I understand that I cannot elect pre-tax benefits until the next anniversary date, and that any after-tax coverage shall be outside the plan.

Participant Signature: ____________________________________________________ Date:

This form must be returned to Business and Fiscal Services Attention: Certificated or Classified

Enrollment Deadline: Friday, October 16, 2015 Information in this packet is subject to change. Updated information available on www.wcusd.org. Click Employee Benefits under Staff section


West Covina Unified School District Business and Fiscal Services 2016

Whether you are single, part of a dual-income household or a family with a non-working spouse, the Section 125 Cafeteria Plan (also known as a Flexible Spending Account) will provide you with additional benefits and more take home pay if you have eligible expens-es, see page 5 for more details.

Example of Tax Savings

INDIVIDUAL WORKING COUPLE WITH DEPENDENTS

COUPLE—ONE WORKING SPOUSE

Without FSA With FSA Without

FSA With

FSA Without

FSA With

FSA

GROSS MONTHLY INCOME $2,500 $2,500 $6,000 $6,000 $4,500 $4,500

LESS NON-DEDUCTIBLE BENEFITS

INSURANCE PREMIUMS $75 $150 $100

MEDICAL/DENTAL EXPENSES $75 $150 $100

DEPENDENT CARE EXPENSES() $400

TOTAL MONTHLY INCOME SUBJECT TO TAX $2,500 $2,350 $6,000 $5,300 $4,500 $4,300

MONTHLY FEDERAL AND STATE TAXES* $319 $286 $587 $434 $262 $220

MONTHLY SOCIAL SECURITY AND MEDI-CARE TAX $191 $180 $459 $405 $344 $329

AFTER TAX INCOME $1,990 $1,884 $4,954 $4,461 $3,894 $3,751

AFTER TAX EXPENSES

INSURANCE PREMIUMS $75 $150 $100

MEDICAL/DENTAL EXPENSES $75 $150 $100

DEPENDENT CARE EXPENSES $400

MONTHLY SPENDABLE INCOME $1,840 $1,884 $4,254 $4,461 $3,694 $3,751

ANNUAL INCREASE IN TAKE HOME PAY $528 $2,484 $684

*Federal and State taxes reflect 2011 federal tax rates and typical state taxes with standard deductions and exemptions.

A. Individual: In the illustration, the single employee earns $30,000. She uses flex Plan to pay for her health insurance copayments and deductibles. By enrolling in this plan, she is able to use pre-tax dollars to pay for her eligible expenses which reduced her taxable income for the year. By doing so, she has increased her take home pay by an additional $528.

B. Working Couple with Dependents: A working couple have decided to participate in the Section 125 Cafeteria Plan because they have health and day care expenses that they are obligated to pay for the year. They have a dual income of $72,000. This program has allowed them to deduct their monthly day care fees directly from their paycheck, pre-tax. These funds have been deposited into an account which they now use to pay for their children’s daycare. They have also used this program to pay for their children’s braces. Since they knew these expenses were definite, they benefited by enrolling into the flex Plan because it has allowed them to use pre-tax dollars to pay for their eligible expenses. Their take home pay was increased by $2,484 because their taxes were reduced.

C. Couple—One Working Spouse: With grown children, and only one spouse working, this couple has no daycare expenses. The annual salary of the working spouse is $54,000. They enroll into the flex Plan because they have dental expenses and health insurance copayments that they expect to incur throughout the next plan year. By enrolling and using pre-tax dollars to pay for these eligible expenses, they have increased their take home pay by $684.

Effective January 1, 2011, over-the-counter medicines will only be reimbursable if submitted with a doctor’s prescription. Sample eligible expenses without a doctor’s prescription include: Band aids, Elastic bandages & wraps, Birth control, First aid supplies, catheters, insulin/diabetic supplies, contact lens supplies and solutions.

Please refer to www.padmin.com or call customer service at (800) 688-2611 for additional details.


NOTES

This section intentionally left blank for employee notes

This notification is issued in compliance with the Fair Labor Standards Act (FLSA), as amended by section 1512 of the Affordable Care Act (ACA) that requires employers to issue the notice about the new Health Insurance Marketplaces created under the ACA. In California, the Marketplace is known as COVERED CALIFORNIA.The following attached information will assist you if you have any questions (Part A) or decide to complete an application (Part B) for coverage in COVERED CALIFORNIA:

Here is some basic information about health coverage offered by the District:As your employer, we offer a health plan to:

Som employees. Eligible employees are:-All Certificated employees and classified part-time employees who work at least 20 hours per week.

Eligible employees who regularly work less than full time are entitled to a prorated amount of the district's contribution.With respect to dependents:We do offer coverage. Eligible dependents are:

-Current spouse/registered domestic partner-Natural, adopted, step, or registered domestlc partner's children up to age 26-Disabled children of any age if enrolled prior to age 26-Children up to age 26 for whom the subscriber has assumed a parent-child relationship and is

considered the primary care parentThis coverage meets the minimum value standard and the cost of this coverage to you is intended to be affordable, based on employee wages.

2016 Open Enrollment2016 Open Enrollment2016 Open Enrollment

SEPTEMBER 17, 2015

to

OCTOBER 16, 2015

OPEN

ENROLLMENT

Health Fair Monday, September 28, 2015

Edgewood Middle School Cafeteria 1:30 pm — 4:30 pm

2016 open enrollment packet 091015 - amazon web...

Documents