2017 benefit overview - tcs education system
TRANSCRIPT
1 TCS_2017_Benefit Summary v4
2017
Benefit Overview
--Plan Year 2017-- 2
TCS_2017_Benefit Summary v4
Disclaimer
This document is an outline of the coverage proposed by the carrier(s), based on information provided by them. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed to your human resources department. For more information about each of the benefit plans, visit the Benefits worklet in Workday or contact your Human Resources Department.
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Contents
Disclaimer .........................................................................................................................................................2
Contents ..........................................................................................................................................................3
Benefits Overview ......................................................................................................................................4
Benefit Plans Offered .......................................................................................................................................4 Eligibility for Benefits .......................................................................................................................................4 Electing Coverage .............................................................................................................................................5 When Coverage Begins ....................................................................................................................................5 When Coverage Ends .......................................................................................................................................5 Coverage for Dependents ................................................................................................................................6 Qualifying Life Events and Changing Your Elections ........................................................................................7
Employee Contribution Rates – 2017 Plan Year ........................................................................8
Medical Benefits .........................................................................................................................................9
Member ID Cards .............................................................................................................................................9 BCBSIL PPO Prescription Plan Change (effective 1/1/17) ................................................................................9 Overview of Medical Benefits ....................................................................................................................... 10
BCBSIL Resources .................................................................................................................................. 12
Doctor on Demand Virtual Visits .................................................................................................... 14
Dental Benefits ......................................................................................................................................... 15
Vision Benefits ......................................................................................................................................... 16
Finding Doctors and Dentists ........................................................................................................... 17
Flexible Spending Accounts .............................................................................................................. 18
Commuter Spending Accounts ........................................................................................................ 19
Life and Accidental Death & Dismemberment (AD&D) Insurance ................................ 20
Overview of Life and AD&D Insurance .......................................................................................................... 21
Disability Coverage ................................................................................................................................ 22
TCS 403(b) Plan ........................................................................................................................................ 23
Employee Assistance Program ........................................................................................................ 23
Resource Guide ........................................................................................................................................ 24
Contact Information ............................................................................................................................... 25
--Plan Year 2017-- 4
TCS_2017_Benefit Summary v4
Benefits Overview
TCS Education System and your employer are proud to offer a comprehensive benefit package to eligible full-time and part-time employees. The complete benefit package is briefly summarized in this booklet. Employees share the costs of some benefits (medical, dental, and vision), and your employer provides other benefits at no cost to employees (life, accidental death & dismemberment, short-term disability, and long-term disability). In addition, there are voluntary benefits which may be purchased at reasonable group rates through payroll deductions and a 403(b) retirement plan to which you may contribute.
Benefit Plans Offered
Medical Dental Vision Doctor on Demand Healthcare Flexible Spending Account Dependent Daycare Flexible Spending Account Commuter Spending Accounts Basic Life and Accidental Death & Dismemberment Insurance Voluntary Employee, Spouse and Child Life and AD&D Insurance Short-Term Disability Long-Term Disability 403(b) Retirement Plan Employee Assistance Program
Eligibility for Benefits
Your eligibility for each of the benefits summarized in this Benefit Overview document depends on your employment type. The chart below provides an overview of each benefit and the employment types that qualify for each.
Employment Type and Benefit Plan Eligibility Indicator
Benefit Plan Regular Full-time (37.5+ hours/week)
Regular Part-time (20-37.4 hours/week)
Temporary* and Adjunct Faculty
Medical Employee Only
Dental Employee Only
Vision Employee Only
Doctor on Demand
Flexible Spending Accounts
Commuter Spending Accounts **
Basic and Voluntary Life and AD&D
Short- and Long-term Disability
Employee Assistance Program
TCS 403(b) Plan
*Temporary workers that are not employed by TCS Education System or an affiliate are excluded. **Applies only to temporary workers and adjunct faculty in Washington, D.C. Student workers are ineligible for any benefits except those who work in Washington, D.C; they are eligible to participate in the Commuter Spending Accounts.
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Electing Coverage
If you are a new hire or a newly eligible employee, you must elect coverage for certain benefits within 30 calendar days of your hire date or status change date (your “eligibility date”). If you do not enroll within 30 calendar days of your eligibility date, you will not be permitted to enroll until the next open enrollment period or unless you experience a qualifying life event. (Refer to ”Qualifying Life Events and Changing Your Elections” for additional information.) If you want to participate in the following plans, you must elect coverage: medical, dental, vision, Voluntary Life and AD&D, Flexible Spending Accounts, Commuter Spending Accounts, and the 403(b) Plan. If eligible, you are automatically enrolled in the Basic Life and AD&D plan, Short- and Long-Term Disability Plans, and Employee Assistance Program. The benefits in which you enroll—when you are first eligible or during an open enrollment period—will generally stay in effect until the following open enrollment period and you will not be able to change your benefits during the plan year unless you have a qualifying life event.
When Coverage Begins
If you are a new hire or a newly eligible employee, the benefits you elect will become effective on the first calendar day of the month following your eligibility date. For example, if you are hired on July 6 and enroll in Medical insurance, your coverage will begin on August 1. Coverage under Doctor on Demand, the Basic Life and AD&D, Short Term Disability, and Long Term Disability plans will automatically begin on the first calendar day of the month following your eligibility date. If you elect Voluntary Life and AD&D coverage in excess of the guarantee issue amount, coverage amounts that require Evidence of Insurability (EOI) will not be effective unless Lincoln Financial Group approves coverage.
When Coverage Ends
In general, you will be covered by the benefits you elect until your employment ends or until you are no longer considered an eligible employee. If your employment ends or you are otherwise ineligible for benefits, your coverage under Medical, Dental, and Vision will end on the last day of the calendar month in which your employment status changes. Your coverage under the Flexible Spending Accounts (FSAs), Basic and Voluntary Life and AD&D plans, the Short Term Disability plan, and the Long Term Disability plan will end on the date your employment status changes. As long as you remain employed in any capacity (other than a student worker), you may continue to access the Doctor on Demand benefit. When a covered child reaches the limiting age, their coverage will end as of the last day of the month in which the limiting age is reached.
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Coverage for Dependents
If you are a full-time employee, you may elect coverage for your eligible dependents under the Medical, Dental, Vision, and Voluntary Life insurance plans. Eligible dependents include your spouse, domestic partner, civil union partner, and children under age 26, regardless of their student status. If you are enrolling your dependents for the first time, or enrolling a new dependent, you must provide proof of eligibility when enrolling. The chart below lists the documents that are accepted as proof of eligibility for each dependent type. Part-time employees are eligible for employee-only coverage under the Medical, Dental, and Vision plans.
Dependent Type Acceptable Documentation
Spouse
Legal Spouse Marriage certificate; or If the most recent income tax return was filed jointly, a copy of the first page of the
IRS Form 1040 (with the financial information blacked out)
Civil Union Partner
Legal Civil Union Partner Civil union certificate; or If the most recent income tax return was filed jointly, a copy of the first page of the
IRS Form 1040 (with the financial information blacked out)
Domestic Partner
Same Sex or Opposite Sex Domestic Partner
TCS Education System Affidavit of Domestic Partnership
Child
Biological Child Birth certificate showing the employee or qualifying partner as a parent; or If the child was claimed as a dependent on the employee’s most recent income tax
return, a copy of the first page of the IRS Form 1040 (with the financial information blacked out)
Adopted Child
Official adoption paperwork showing the employee or qualifying partner as a parent; or
If the child was claimed as a dependent on the employee’s most recent income tax return, a copy of the first page of the IRS Form 1040 (with the financial information blacked out)
Stepchild
Birth certificate showing the employee’s spouse or as a parent; or If the child was claimed as a dependent on the employee’s most recent income tax
return, a copy of the first page of the IRS Form 1040 (with the financial information blacked out)
Legal Guardianship of Child
Court orders stating that employee or qualifying partner is the legal guardian of child
Incapacitated dependent (age 26 or older)
Statement from the child’s treating physician attesting that the child is physically or mentally incapable of self-care
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Qualifying Life Events and Changing Your Elections
In most cases, your benefit elections will remain in effect for the entire year (January 1 - December 31). During each open enrollment period, you will have the opportunity to review your benefit elections and make changes for the coming year. You are responsible for reviewing your paystubs each pay period to ensure that the correct deductions are being taken from your pay, and for notifying your Human Resources department immediately if you believe a correction needs to be made. Certain coverages allow limited changes to your benefit elections during the year. These benefits include the medical, dental, vision and flexible spending accounts. For these benefits, you may only make changes to your elections during the year if you experience a qualifying life event. The benefit election changes you make must be consistent with your qualifying life event. You have 30 days from the date of the event to request your enrollment change. In most cases, your election will become effective the day of the qualifying event. Otherwise, you must wait until the next annual enrollment period to make a change to your elections. The table below explains some of the qualifying life events and the types of changes you can make when they occur. If you are not sure if you’ve had a qualifying life event, contact your Human Resources department for assistance.
Benefit Type and Election Change Allowed
Qualifying Life Event
Medical, Dental, and/or Vision Voluntary Life and AD&D Medical FSA Dependent Daycare FSA
Change in Employee’s Marital Status
Marriage Add spouse (and children, if applicable)
Drop coverage to join spouse’s plan
Increase voluntary employee coverage*
Enroll in voluntary spouse coverage
Enroll or increase
Divorce, legal separation, annulment
Drop coverage for spouse Enroll self and/or children (if
lost under former spouse’s plan)
Drop voluntary spouse coverage
Enroll in voluntary child coverage (if lost under former spouse’s plan)
Decrease No change
Death of spouse Drop coverage for spouse Enroll self and/or children (if
lost under deceased spouse’s plan)
Drop voluntary spouse coverage
Enroll in voluntary child coverage (if lost under deceased spouse’s plan)
Decrease Enroll or increase (if lost under deceased spouse’s plan)
Increase in Number of Dependents
Birth, adoption, placement for adoption
Enroll self and/or child Enroll or increase voluntary employee and/or child coverage*
Enroll or increase
Decrease in Number of Dependents
Reaching limiting age
Drop child’s coverage (age 26) Drop voluntary child coverage (age 19)
Decrease (age 26)
No change
Death of child Drop coverage for deceased dependent
No change No change Decrease
Change in Spouse’s or Dependent’s Employment
Start new job and gain coverage
Drop coverage for self and dependents who are enrolling in new coverage
Drop coverage for self and dependents who are enrolling in new coverage
No change
Terminate employment and lose coverage
Enroll yourself and spouse and/or child(ren)
Enroll or increase* Enroll or increase
*Evidence of insurability (EOI) may be required before enrollment or coverage increases are approved.
--Plan Year 2017-- 8
TCS_2017_Benefit Summary v4
Employee Contribution Rates – 2017 Plan Year
You pay for your benefits via payroll deductions from each of your bi-weekly paychecks. Your medical, dental, and vision coverages are paid for on a pretax basis. This means that premiums are withheld from your pay before federal, state (in most cases), and FICA taxes are calculated. This can reduce the amount of taxes you pay per paycheck. You are responsible for reviewing your paystubs to ensure proper deductions are being withheld. Bi-weekly contribution rates are provided in the chart below.
Pre-tax Deduction per Bi-Weekly Paycheck
Benefit Plan Employee
Only
Employee +
child(ren)
Employee +
Spouse
Employee +
Family
BlueAdvantage HMO $55.00 $169.00 $174.00 $251.00
BCBS PPO ($1,000 Deductible) $77.00 $189.00 $194.00 $288.00
BCBS PPO ($250 Deductible) $90.00 $220.00 $227.00 $336.00
Kaiser HMO $47.00 $185.00 $203.00 $296.00
GroupHealth HMO $69.00 $173.00 $180.00 $268.00
MetLife Dental $7.00 n/a n/a $15.00
VSP Vision $1.85 $2.97 $3.03 $4.89
Deductions and Imputed Income per Bi-Weekly Paycheck
Employee + Domestic Partner Employee + Domestic Partner + Child(ren)
Benefit Plan Pre-Tax Deduction
Post-Tax Deduction
Imputed Income
Pre-Tax Deduction
Post-Tax Deduction
Imputed Income
BlueAdvantage HMO
$55.00 $119.00 $144.98 $169.00 $82.00 $160.48
BCBS PPO ($1,000 Deductible)
$77.00 $117.00 $174.58 $189.00 $99.00 $192.59
BCBS PPO ($250 Deductible)
$90.00 $137.00 $203.14 $220.00 $116.00 $224.14
Kaiser HMO
$47.00 $156.00 $160.11 $185.00 $111.00 $205.10
GroupHealth HMO
$69.00 $111.00 $168.58 $173.00 $95.00 $184.59
MetLife Dental
$7.00 $8.00 $17.35 $11.00 $4.00 $8.67
VSP Vision
$1.85 $1.17 $0.95 $2.97 $1.92 $1.56
Refer to the Benefits worklet in Workday for Voluntary Employee, Spouse, and Child Life and AD&D rates.
--Plan Year 2017-- 9
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Medical Benefits
Administered by BlueCross and BlueShield of Illinois (BCBS) (All locations) or Insured by Kaiser Permanente (CA & WA only)
Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way— especially in healthcare. Routine exams and regular preventive care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost. Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent Medical plan through TCS Education System. TCS Education System offers you a PPO or an HMO Medical plan (only employees who reside in Illinois, California, or Washington state may enroll in an HMO).
With the PPO, you may select where you receive your medical services and see specialists without getting a referral. If you use in-network providers, your costs will be less.
With an HMO, you must receive care from your chosen primary
care physician (“PCP”) or women’s healthcare provider. If you need to see a specialist, your PCP will refer you.
If you enroll in BlueAdvantage HMO, you will need to call BCBS to tell them your PCP choice once they receive your enrollment.
Member ID Cards
You will receive a member ID card at your home after BCBS, Kaiser, or GroupHealth processes your enrollment. If you enroll in an HMO, each covered member in your family will receive a member ID card. If you enroll in the PPO, you will receive two cards, each under the employee’s name (they are not personalized to each covered family member). You may request additional cards at any time by contacting your medical carrier.
BCBSIL PPO Prescription Plan
Change (effective 1/1/17)
CVS pharmacies and CVS pharmacies in Target
stores will no longer be a part of Blue Cross and
Blue Shield of Illinois PPOs’ standard pharmacy
network.
IT IS IMPORTANT TO KNOW WHAT DEDUCTIBLES, COINSURANCE, AND COPAYS ARE SO YOU CAN BETTER UNDERSTAND YOUR BENEFITS.
A deductible is the amount you pay for
health care services before your health
insurance begins to pay.
Copayments or Copays are fixed dollar
amounts (for example, $20) you pay for
covered health care, usually at the time
you receive the service.
Coinsurance is your share of the costs of
a covered service, calculated as a
percent of the allowed amount for the
service.
For example, if the plan’s allowed
amount for an overnight hospital stay is
$1,000, your coinsurance payment of
20% would be $200. Your total cost may
vary based on whether you have met
your deductible.
Important
Pharmacy
Change
Notice!
--Plan Year 2017-- 10
TCS_2017_Benefit Summary v4
Overview of Medical Benefits
The charts below and on the following page give an overview of the deductibles, copays, and coinsurance under each Medical option. For more information, please refer to the Benefits worklet in Workday.
Blue Cross and Blue Shield Participating Provider Options
PPO ($250 Deductible) PPO ($1,000 Deductible)
In-Network Out-of-Network* In-Network Out-of-Network*
Lifetime Benefit Maximum Unlimited Unlimited Unlimited Unlimited
Annual Deductible $250 Single $750 Family
$500 Single $1,500 Family
$1,000 Single $3,000 Family
$3,000 Single $9,000 Family
Annual Out-of-Pocket Maximum
$1,250 Single $3,750 Family
$2,500 Single $7,500 Family
$3,000 Single $6,000 Family
$6,000 Single $12,000 Family
Prescription Out-of-Pocket Maximum
$500 Single $1,500 Family
$500 Single $1,000 Family
Coinsurance (amount you pay after you meet the deductible, excluding copays)
20% 40% 20% 40%
DOCTOR’S OFFICE
Primary Care Visit $20 copay 40% coinsurance $30 copay 40% coinsurance
Specialist Office Visit $40 copay 40% coinsurance $50 copay 40% coinsurance
Wellness Care (routine
exams, x-rays/test, immunizations, well baby care, and mammograms)
$0 copay 40% coinsurance $0 copay 40% coinsurance
PRESCRIPTION DRUGS
Retail (34-day supply) Generic Formulary Non-Formulary
$15 copay $30 copay $50 copay
$15 copay1 $30 copay1 $50 copay1
1plus 25% of eligible amount
$15 copay $30 copay $50 copay
$15 copay1 $30 copay1 $50 copay1
1plus 25% of eligible amount
Mail Order (90-day supply) Generic Formulary Non-Formulary
$30 copay $60 copay
$100 copay
n/a n/a n/a
$30 copay $60 copay
$100 copay
n/a n/a n/a
HOSPITAL SERVICES
Emergency Room $150 copay $150 copay $150 copay $150 copay
Hospital Deductible n/a $300/admission n/a $300/admission
Inpatient 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance Outpatient Surgery 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance Ambulance Service 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Inpatient Services 20% coinsurance 40% coinsurance after $300 deductible
20% coinsurance 40% coinsurance after $300 deductible
Outpatient Services $20 copay 40% coinsurance $30 copay 40% coinsurance
OTHER SERVICES
Maternity Services $20 copay for first visit
40% coinsurance $30 copay for first visit
40% coinsurance
All other maternity hospital/physician services
Paid same as medical/surgical
services
Paid same as medical/surgical
services
Paid same as medical/surgical
services
Paid same as medical/surgical
services
Muscle Manipulation Services
20% coinsurance (up to 25 visits per plan
year)
40% coinsurance (up to 25 visits per plan
year)
20% coinsurance (up to 25 visits per plan
year)
40% coinsurance (up to 25 visits per plan
year)
Physical, Occupational and Speech Therapy Services
20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
TMJ and Related Services 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
Skilled Private Nursing 20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
Other Services (artificial
limbs and other prosthetic devices; blood and blood components; leg, arm and neck braces; surgical dressing; casts and splints)
20% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
*If an out-of-network provider charges more than the allowed amount, you may have to pay the difference.
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Overview of Medical Benefits - continued
Health Maintenance Organization (HMO) Options
BCBS BlueAdvantage HMO (IL Residents)
Kaiser HMO (CA Residents)
GroupHealth HMO (WA Residents)
In-Network (no benefits are provided Out-
of-Network)
In-Network (no benefits are provided Out-of-
Network)
In-Network (no benefits are provided Out-of-
Network)
Lifetime Benefit Maximum Unlimited Unlimited Unlimited
Annual Deductible n/a n/a n/a
Annual Out-of-Pocket Maximum
$1,500 Single $3,000 Family
$1,500 Single $3,000 Family
$2,000 Single $4,000 Family
Prescription Out-of-Pocket Maximum
$500 Single $1,000 Family
Coinsurance (amount you pay after you meet the deductible, excluding copays)
0% 0% 0%
DOCTOR’S OFFICE
Primary Care Visit $30 copay $10 copay $10 copay
Specialist Office Visit $50 copay $10 copay $10 copay
Wellness Care (routine
exams, x-rays/test, immunizations, well baby care, and mammograms)
$0 copay $0 copay $0 copay
PRESCRIPTION DRUGS
Retail (34-day supply) Generic Formulary Non-Formulary
$15 copay $30 copay $50 copay
$10 copay2 $20 copay2 $20 copay2
2Up to a 90-day supply
$10 copay $20 copay $20 copay
Mail Order (90-day supply) Generic Formulary Non-Formulary
$30 copay $60 copay
$100 copay
n/a n/a n/a
$20 copay $40 copay $40 copay
HOSPITAL SERVICES
Emergency Room $150 copay $50 copay $100 copay
Inpatient Hospital $250/day for first 5 days $250/admission $100/admission
Outpatient Surgery 0% coinsurance $10 copay/procedure $10 copay/procedure
Ambulance Service 0% coinsurance $50 copay/trip $100 copay/trip
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Inpatient Services $250/day for up to 5 days $250/admission $100/admission
Outpatient Services $30 copay $10/visit $10/visit
OTHER SERVICES
Maternity Services $30 copay for first visit $0 copay $10 copay
Maternity hospital services $250/day for up to 5 days $250/admission $100/admission
Muscle Manipulation Services
$30 copay Not covered $10/visit (up to 10 visits per plan year)
Physical, Occupational and Speech Therapy Services
$0 copay (up to 60 visits per plan year)
$10/visit $10/visit (up to 60 visits per plan year)
TMJ and Related Services Not covered Not covered $100/stay inpatient, $10/visit outpatient
Skilled Private Nursing $0 copay $0 copay (up to 100 visits per plan year)
$0 copay (up to 100 visits per plan year)
Other Services (artificial
limbs and other prosthetic devices; blood and blood components; leg, arm and neck braces; surgical dressing; casts and splints)
$0 copay 20% coinsurance 20% coinsurance
--Plan Year 2017-- 12
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BCBSIL Resources
If you enroll in a PPO or the BlueAdvantage HMO, you have access to a wide variety of services offered by BCBS that will help keep you and your family healthy.
24/7 Nurseline–Around the Clock
Toll-free Support at 800.299.0274
The 24/7 Nurseline is available 24 hours a day, 7 days a week. The registered nurses can: • Help you decide if you should call your doctor, go to the ER or treat the problem yourself
• Answer many of your health-related questions
• Help you understand your condition
When should you call? The toll-free Nurseline can help you or a covered family member get answers to questions regarding many health-related topics, including:
• Asthma, back pain or chronic health issues
• Dizziness or severe headaches
• High fever
• A baby’s nonstop crying
• Cuts or burns
• Sore throat
Urgent Care Center or Free-Standing ER
Knowing the difference can save you money. Urgent Care Centers and Free Standing Emergency Rooms (ERs) can be hard to tell apart. Free standing ERs often look a lot like Urgent Care Centers, but costs are higher, just as if you went to the ER at a hospital. Here are some ways to know if you are at a Free Standing ER. Free-Standing ERs:
• Look like Urgent Care Centers, but include EMERGENCY in facility names.
• Are open 24 hours a day, 7 days a week.
• Are physically separate from a hospital.
• Are subject to the deductible (urgent care has copay on the Traditional Plan).
• Are staffed by ER physicians.
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BCBSIL Resources - continued
Blue Care Connection
Sometimes managing your health requires more than doctor visits, lab tests and prescriptions. Blue Cross and Blue Shield of Illinois offers resources through Blue Care Connection, a program to help you and your covered family members reach your health and wellness goals. Some of these resources include:
• Lifestyle Management Programs – Provide tools and information which may help you lose weight, quit smoking or reduce your risk for developing heart disease, stroke or diabetes
• Utilization Management – You and your doctor can obtain information about your benefits and easily navigate the healthcare system to help you maximize your benefits for covered services
• CCEISM Care Coordination and Early Intervention – If you are in the hospital, a care management specialist may call to help coordinate special care you might need when you get home
• Condition Management – Blue Care® Advisors (registered nurses and other healthcare professionals) work with you and your doctor to provide education, coaching and monitoring if you are at risk for or already have a chronic condition
• Health Education and Support – There are tutorials on more than 170 health topics available online or by mobile device through your Blue Care Advisor (many tutorials are available in Spanish as well)
• Healthy Tips by Text – Receive secure text messages on such topics as diabetes prescription drug reminders, blood sugar reminders, coronary artery disease care management and diet tips, as well as exercise and fitness tips
• Special Beginnings®’ – Maternity program offering expectant mothers ongoing support and education from prenatal to postpartum care, including convenient online and mobile tools and educational materials
• Case Management – Case managers, registered nurses with specialized training and clinical experience, help you navigate complex medical situations and access the services you need
• Behavioral Health – Licensed behavioral health professionals help you access services and offer support with coexisting medical conditions and disorders such as anxiety, depression, etc.
Blue365 — A Discount Plan for Members www.blue365deals.com/bcbsil.com
Save money on healthcare products and services that are not covered by your health plan. Sign up on the Blue365 website and start receiving weekly “Featured Deals.” In addition to the Featured Deals, here are some of the Blue365 deals available to members:
• Davis Vision – Save on eyeglasses, contact lenses, exams and accessories through Davis Vision network providers
• Dental Solutions – Receive a dental discount card which provides access to discounts up to 50% at more than 61,000 participating dentists
• Jenny Craig, Nutrisystem and Seattle Sutton’s
• Procter & Gamble dental products – Save on dental packages with Oral B power toothbrushes and Crest products
• TruHearing – Save on hearing aids
• CORD:USE – Save on cord blood processing and storage fees
• Reebok – Enjoy 20% off plus free shipping on Reebok.com
• SeniorLink Care – Save on a 3- or 12-month SeniorLink Care membership, which offers help to caregivers and assistance with planning care
• Life Time Fitness – Sign up online for $0
• RetrofitSM – Receive 15 percent off Retrofit’s online, private weight loss coaching sessions
• Handstand Kids – The Handstand Kids cookbook brings the family together in the kitchen, cooking and eating healthy, delicious meals. You may save up to 25 percent on cooking accessories and cookbook
--Plan Year 2017-- 14
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Doctor on Demand Virtual Visits
What is Doctor on Demand?
Doctor on Demand offers all employees and their families the opportunity to access physicians for non-emergency medical needs from anywhere, even the comfort of your own home. Doctor on Demand board-certified physicians are available for consultations via computer, smartphone, tablet or telephone 24 hours a day, 7 days a week and can even prescribe medications. You will automatically be enrolled for this benefit on January 1, 2017, or the first day of the month following your eligibility date, whichever is later. This benefit is available to all employees (except student workers) and their household family members.
What can Doctor on Demand treat?
Doctor on Demand physicians can help treat the following conditions and more: Cough, cold, flu, rash, pink eye, sports injury, bug bite, urinary tract infection, vomiting, travel issues, and sore throat.
What does Doctor on Demand cost?
Doctor on Demand is not only convenient but also cost effective at a $20 copay per standard medical visit.
How do I get started?
1. Download the app, visit the App Store, Google Play, or text ENROLL to 68398
2. Follow prompts to register, be sure to enter TCS Education System when setting up your account.
NEW in
2017!
--Plan Year 2017-- 15
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Dental Benefits
Insured by MetLife
Good oral care enhances overall physical health, appearance, and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the TCS Education System Dental benefit plan. The chart below is an overview of the benefits provided by the dental plan. For more information, please refer to the Benefits worklet in Workday.
In-Network Out-of-Network*
Annual Benefit Maximum $2,000 $1,250
Annual Deductible (Basic and Major Services)
$50/person $150 family limit
$75/person $225 family limit
Preventive Dental Services (cleanings, exams, x-rays)
100%, no deductible
Basic Dental Services (fillings,
root canal therapy, oral surgery) 80% after deductible 60% after deductible
Major Dental Services
(extractions, crowns, inlays, onlays, bridges, dentures, repairs)
50% after deductible
Orthodontia Services (covered to age 19)
50% to $1,500 Lifetime Maximum
*If an out-of-network provider charges more than the allowed amount, you may have to pay the difference.
Mobile App To download and install the app on your devise visit the App Store (Apple) or Google Play (Android) and search for MetLife. Use the app on your iOS or Android powered device to:
• Find a dentist • View your plan summary and claims • View your ID card
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Vision Benefits
Insured by VSP
Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern for everyone. The chart below is an overview of the benefits provided by the vision plan. For more information, please refer to the Benefits worklet in Workday.
In-Network Provider Out-of-Network Provider*
Eye Exam (once every 12 months) $10 copay $10 copay, then $25 benefit
Lenses (once every 12 months) Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Lenticular Lenses
$25 copay (lenses
and/or frames) plus $130 allowance,
then 80%
$25 copay, then $30 benefit $35 benefit $45 benefit $60 benefit
Frames (once every 24 months) $25 copay (lenses and/or frames) plus
allowance
Up to $45
Contact Lenses (once every 12 months if you elect contacts instead of lenses/frames)
Covered 100% if medically necessary;
up to $130 if elective
Up to $210 if necessary; up to $105 if elective
*If an out-of-network provider charges more than the allowed amount, you may have to pay the difference.
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Finding Doctors and Dentists
Finding doctors and dentists who participate in the medical, dental, and vision networks is easy. Simply follow the instructions below.
BlueCross / BlueShield PPO
Go to www.BCBSIL.com Click “Provider Finder” In the new window (or tab) that opens, select the state in which you live and click “Start Search” When asked to choose your plan network, select “Participating Provider Organization [PPO]” Enter any
additional search criteria and click “Search”
BlueAdvantage HMO (Illinois residents only)
Go to www.BCBSIL.com
Click “Provider Finder” In the new window (or tab) that opens, select the state in which you live and
click “Start Search” When asked to choose your plan network, select “BlueAdvantage HMO [ADV]” Enter any additional search criteria and click “Search”
Kaiser HMO (California residents only)
Go to www.kp.org Click “Find a doctor” Select an area from the dropdown menu and click “Go” Enter any additional search criteria and click “Search”
Group Health HMO (Washington residents only)
Go to www.ghs.org/provider
Choose your search and select plan Core/Group Health Choose your search Enter in location and any additional search criteria and click “Search”
MetLife
Go to www.MetLife.com
Click “Find a Dentist” Enter your zip code and select the “PDP Plus Network” Click “Go”
VSP
Go to www.VSP.com At the top of the page, click “Find a Doctor” Enter your zip code or address Under “Doctor Network”, select “Signature” Enter other optional search criteria and click “Search”
BEFORE YOU CHOOSE A PRIMARY CARE PHYSICIAN, IT IS A GOOD
IDEA TO CALL THE PCP TO ENSURE THE PROVIDER IS ACCEPTING
NEW PATIENTS.
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Flexible Spending Accounts (FSA)
Administered by ADP Spending Accounts
There are two types of FSAs offered by your employer: Healthcare FSA and Dependent Care FSA. When enrolling in your benefits, you can choose to participate in either, both or neither FSA. The FSA plans allow you to save by putting money aside for healthcare expenses not covered by your medical plan and dependent daycare expenses — TAX FREE! There are no Federal income, State income (in most cases) or Social Security taxes withheld for dollars contributed toward an FSA plan. Because contributions are made on a pretax basis, the IRS requires that changes to your election can only be made when you experience an approved status change and must be made within 30 days of the status change.
Healthcare Flexible Spending Account
With your Healthcare Flexible Spending Account, you can use tax-free dollars to pay for eligible medical, dental, vision and hearing expenses incurred by you or an eligible dependent if the expenses are not paid by other plans. The maximum annual amount that you may contribute to this plan in 2017 is $2,600. You can use the Healthcare FSA to pay for healthcare-related expenses such as:
• Copays and coinsurance
• Cost of eligible service above reasonable and customary limits or above other plan limits
• Other health-related expenses not paid by other plans that are eligible for tax reduction by Section 213 of the IRC.
• A full list of eligible Healthcare FSA expenses can be found at www.irs.gov, publication 502.
ADP Spending Accounts administers
the spending accounts If you want
more information before enrolling,
visit their website at
MySpendingAccount.ADP.com
The Healthcare and Dependent Daycare
spending accounts are “use it or lose
it”. The FSA plan year (incurral period) is
January 1 to December 31. You must
submit your claims for reimbursement
no later than March 15. Any remaining
balance after all claims have been
processed for the incurral period will be
forfeited. Please plan carefully.
Consult your tax advisor regarding
potential tax implications associated
with participation in these pre-tax
benefit plans.
Note:
Over-the-counter (OTC) medications are no longer reimbursable through the Healthcare FSA unless prescribed by a physician
When submitting a claim, Healthcare FSA participants will need to provide a receipt detailing the eligible purchase, including an Rx number for prescriptions
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Dependent Care Flexible Spending Account (for expenses such as daycare)
You can receive tax-free reimbursement from your Dependent Care FSA for expenses incurred by you for the care of eligible dependents, such as daycare for children. The expenses must enable you and your spouse, if you are married, to be gainfully employed or attending school full-time for the period that you have eligible dependents. The IRS maximum annual contribution to a Dependent Care FSA in 2017 is a per household limit of $5,000. If you are married, the most you and your spouse can contribute is a combined $5,000. A qualifying eligible dependent is any individual considered your dependent within the same meaning of Section 152 of the IRC who meet the following criteria:
• A dependent under the age of 13 for whom you are entitled to a deduction for income taxes
• A spouse or dependent who is physically or mentally incapable of taking care of himself or herself
Commuter Spending Accounts
Administered by ADP Spending Accounts
The Commuter Spending Accounts allow you to pay for your transit and parking expenses with pre-tax dollars, which can reduce the cost of your daily commute to and from work. Unlike most of the other benefits offered, you are not limited to an annual enrollment for these benefits. You may start and stop participation in one or both accounts on a monthly basis. The deadline to enroll, make changes, or cancel participation is the fifth calendar day of each month. The IRS limits the amount of pre-tax dollars you can use to pay for your commuting expenses each month. If your expenses exceed the monthly limit, the difference will be withheld from your paychecks on a post-tax basis. The monthly pre-tax contribution limits for each of the spending accounts is shown below:
Transit: $255 Parking: $255
Please note: Payroll deductions for the Commuter Spending Accounts are withheld from the first two paychecks of each month, on a current-month basis. For example, if you order a train ticket in February to be used in March, half of the ticket’s cost will be deducted from your first March paycheck and half from your second March paycheck.
First-time Enrollees in the Commuter Spending Accounts
If you would like to enroll in the Commuter Spending Accounts for Parking and/or Transit benefits, send an e-mail to [email protected]. The subject of your e-mail must read “Commuter Plan Enrollment Request”. Within two business days, you will receive a reply which will include a link to ADP’s spending account website which will allow you to register and enroll. Returning enrollees may use their exiting Commuter Spending Account User ID and Password.
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Life and Accidental Death & Dismemberment (AD&D)
Insurance
Insured by Lincoln Financial Group
With Lincoln Life and Accidental Death and Dismemberment (AD&D) insurance, your family will be protected with benefits and a variety of support services designed to help them cope with both emotional and financial issues. It can help you preserve your dream of a secure lifestyle for your family, even if you can’t be there. If you are a regular full-time employee, your employer provides Basic Employee Life and AD&D insurance of $50,000* at no cost to you. Your employer understands not everyone’s personal situation is the same; your family needs may be different from the needs of your coworkers. For this reason you are offered voluntary life and AD&D for yourself and your dependents, which can be purchased at group rates, above and beyond the employer provided coverage. Rates for the voluntary coverage can be found on the Benefits worklet in Workday. The chart on the following page presents an overview of the benefits provided by the life and AD&D plans. For more information, please refer to the Benefits worklet in Workday. *Coverage amount is reduced at age 65 and older. See chart on following page.
Guarantee Issue and Evidence of Insurability
The insurance company provides a guarantee issue of a certain amount of life insurance if you meet certain enrollment and age requirements. If you elect coverage over the guarantee issue amount, the insurance company will require you to provide evidence of insurability (“EOI”) before the additional coverage amount is approved. EOI is required by the insurance company if any of the following apply:
You are electing voluntary employee or spouse coverage over the guarantee issue amount during your initial eligibility enrollment period
You are enrolling in voluntary employee or spouse coverage after your initial eligibility enrollment period If EOI is required, your Human Resources representative will provide you with a form to complete and fax to Lincoln Financial Group. Enrollments for coverage amounts that require EOI will not be processed unless the life insurance company approves coverage.
Annual Open Enrollment Opportunity
Each year during annual enrollment new enrollees and existing enrollees in the Voluntary Employee Life and AD&D insurance plans may elect or increase insurance coverage equal to two benefit levels on a guaranteed acceptance basis provided that you or your spouse have not been previously declined, withdrawn, or pending for coverage.
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Overview of Life and AD&D Insurance
The chart below is an overview of the benefits provided by the Life and AD&D plans. For more information, please refer to the Benefits worklet in Workday.
Basic Employee Life and AD&D Plan
Benefit Employee Spouse Child
Life Amount Guarantee Issue
$50,000 $50,000
n/a n/a
AD&D Amount Guarantee Issue
Equal to Life Amount n/a n/a
Benefits will reduce: 35% at age 65; An additional 25% of the original amount at age 70; and An additional 15% of the original amount at age 75. Benefits terminate at retirement.
n/a n/a
Voluntary Life and AD&D Plans
Life Benefit Employee Spouse Child
Life Amount AD&D Amount
Choice of $10,000 increments. Not to exceed 7 times your annual salary. Employees age 70 and older, maximum benefit is $50,000. Same as Life Amount
Choice of $5,000 increments. Employee must elect Voluntary Employee coverage for spouse to be eligible. Not to exceed 50% of Employee elected amount.
$250: 14 days to 6 months $10,000: 6 months to age 19 (to age 25 if full-time student) Newborn children to age 14 days are not eligible for a benefit. Employee must elect Voluntary Employee coverage for child to be eligible.
Minimum Amount $10,000 $5,000 $10,000
Maximum Amount $500,000, limited to 7 tjmes your annual salary Employees age 70 and older, maximum benefit is $50,000
$250,000, limited to 50% of employee amount
$10,000
Guarantee Issue $200,000 $20,000 age 70-74 No Guarantee Issue age 75 and older
$30,000 if employee is under age 60 No Guarantee Issue if employee is age 60 and older
$10,000
Benefit Reduction Employee Spouse Child
Benefits will reduce: 35% at age 65; An additional 25% of the original amount at age 70; and An additional 15% of the original amount at age 75. Benefits terminate at retirement.
35% at employee age 65 Benefits terminate at employee age 70 or retirement, whichever occurs first.
n/a
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Disability Coverage
Administered by Lincoln Financial Group
Meeting your basic living expenses can be a real challenge if you become disabled over a long period of time. Your options may be limited to personal savings, spousal income and possibly Social Security. Disability insurance provides protection for your most valuable asset — your ability to earn an income.
Short-Term Disability
Short-Term Disability (STD) coverage provides income if you become disabled due to a non-work-related injury or illness. STD coverage provides you a benefit of 60% of your weekly earnings, up to $1,500. Benefits begin immediately for an injury and after 7 calendar days for an illness and are payable for up to 13 weeks. If eligible, enrollment is automatic and coverage is provided at no cost to you.
Long-Term Disability
Your employer also provides Long-Term Disability (LTD) insurance coverage, which pays 60% of your monthly base salary up to a monthly maximum (see below) after 90 calendar days do disability, for as long as you are found to be disabled (until you reach age 65*). If your annual salary is less than $120,000, your benefit maximum is $7,500 per month. If your annual salary is $120,000 or greater, your benefit maximum is $12,500 per month. If eligible, enrollment is automatic and coverage is provided at no cost to you. *See your LTD Policy Certificate for more details on the LTD benefit.
BENEFITS PAID BY THE STD AND LTD PLANS ARE REDUCED BY
OTHER BENEFITS YOU ARE ELIGIBILE TO RECEIVE, SUCH AS FROM A
STATE DISABILITY PROGRAM.
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TCS 403(b) Plan
Recordkeeper: Transamerica Retirement Solutions
With the TCS 403(b) Plan you can save for your retirement with convenient payroll deductions. You choose how much to save and whether to contribute pre-tax or after-tax dollars. In addition, the 403(b) plan offers a wide variety of investment options to help you meet your retirement goals. You can also rollover your retirement savings from other employers’ qualified retirement plans. In 2017, you may contribute up to $18,000 to the 403(b) plan and, if you are age 50 or over, you may contribute an additional $6,000. This additional amount is called a “catch-up contribution”. You can enroll in the TCS 403(b) Plan and change or cancel your payroll deductions at any time. You can also change your investment elections at any time (some investments require a minimum investment period). For more information, contact Transamerica Retirement Solutions.
Employee Assistance Program
Administered by ComPsych GuidanceResources
The Employee Assistance Program (EAP) is a program that your employer offers at no cost to you, for you and your household members. It’s here to help you with life’s challenges, whether workplace or personal. At no cost to you, the EAP can help you with concerns such as:
• Stress and depression • Caring for children and aging parents • Family, work or personal relationship issues • Alcoholism or substance abuse • Bereavement • Coping with a chronic illness • Job or career anxiety
Call the EAP to speak with a licensed counselor by telephone 24 hours a day, seven days a week. Refer to ”Contact Information” in this guide for information on how to reach ComPsych for assistance.
YOUR EMPLOYER MAY MAKE A CONTRIBUTION TO THE TCS 403(B)
PLAN ON YOUR BEHALF IF YOU MEET CERTAIN ELIGIBILITY
REQUIREMENTS. CONTACT YOUR HUMAN RESOURCES
REPRESENTATIVE FOR MORE INFORMATION.
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Resource Guide
The chart below will help you figure out which website to access or who to call when you want to take advantage of your benefits.
Action I want to take I can access or contact… Is there a deadline?
As a new employee or newly eligible employee, I want to enroll in: Medical Dental Vision Voluntary Life and AD&D Healthcare FSA Dependent Daycare FSA
The Benefits worklet in Workday
Yes, 30 calendar days from your hire or eligibility date
Change my benefit elections due to a qualifying life event such as: Having a baby Getting married or divorced Losing other coverage
The Benefits worklet in Workday
Yes, 30 calendar days from the qualifying event date
I have coverage under an HMO and I want to change my Primary Care Physician
If you’re enrolled in the BlueAdvantage HMO, call BCBS at 800.892.2803 If you’re enrolled in the Kaiser HMO, call them at 800.464.4000
Check with carrier for deadlines
I want to enroll or change my order in the: Transit Spending Account Parking Spending Account
First-time enrollees: e-mail [email protected] to request enrollment Returning enrollees: use your existing Spending Accounts User ID and Password at www.MySpendingAccount.ADP.com
Yes, by the 10th calendar day of any month to affect your order(s) for the following month
I want to file claims for the: Healthcare FSA Dependent Daycare FSA Commuter Spending Accounts
ADP Spending Account’s website at www.MySpendingAccount.ADP.com First time visitors, click “New Users - Register Here”
March 15th of the year following the calendar year in which expenses were incurred
I want to enroll in the TCS 403(b) Plan I want to change my contributions to the TCS 403(b) Plan I want to change my investment elections
Transamerica at https://tcs403b.trsretire.com
No (New employees may enroll as soon as the week after they receive their first paycheck)
REMEMBER: BENEFIT CHANGES DUE TO A QUALIFYING LIFE EVENT
MUST BE MADE WITHIN 30 CALENDAR DAYS OF THE EVENT.
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Contact Information
If you have specific questions about a TCS Education System benefit plan, please contact the carrier or your Human Resources Representative, according to the table below:
Benefit Contact Phone Website
BCBS PPO Options Blue Cross Blue Shield of Illinois 800.828.3116 www.bcbsil.com
BlueAdvantage HMO Blue Cross Blue Shield of Illinois 800.892.2803 www.bcbsil.com
Kaiser HMO Kaiser Permanente 800.464.4000 www.kp.org
GroupHealth HMO GroupHealth 888.901.4636 member.ghc.org
To register: ghc.org/register
Dental MetLife 800.942.0854 www.MetLife.com
Vision VSP 800.877.7195 www.vsp.com
FSAs – Healthcare, Dependent Daycare, and Commuter
ADP Spending Accounts 800.654.6695 www.MySpendingAccount.ADP.com
Life and AD&D Your Human Resources Representative
Short- and Long-Term Disability Your Human Resources Representative
Employee Assistance Program ComPsych GuidanceResources 800.272.7255 www.guidanceresources.com
Web ID: COM589
TCS 403(b) Plan Transamerica 800.755.5801 https://tcs403b.trsretire.com
Discount program Working Advantage https://workingadvantage.com
Member ID: 827198009