2017 enrollment guide enrollment guide...m the thro plan the plan spo blu the hea ass cove hm with...
TRANSCRIPT
Kansas City Kansas Public Schools Employee Benefits Enrollment Guide Plan Year 2017
WBE USDour brinoffefamtheiasso
2 | CBIZ Be
WelcoENEFD #500 rememployeesg your own
ering you chily and your families –ociated cos
enefits & Ins
ome FITS! mains comms. A compren unique talhoices, you ur goals. W– and that’ssts.
surance Se
to A
mitted to oehensive beents to the will be able
We recognizs why the d
ervices
Annua
ffering a cenefits pacDistrict, yo
e to find theze the impoistrict is com
al En
omprehensckage meanou have youe combinatortance of mmmitted to
nrollm
sive and cons you shouur own uniqtion of covemedical benhelping you
ment
ompetitive buld have chque coveragerage that’snefits to ouu manage y
for y
benefits pahoices. Justge needs. Bs right for yur employeeyour health
your
ckage to t as your By you, your es and care and
Thaour
Sta
Fee
3 | CBIZ Be
at’s why wemployees
ay Healthy Medical
Dental –
Vision -
eling Sec Short Te
Health Sparticipa
Medical
Limited
Depend
Volunta
enefits & Ins
we are coms stay health
y - Blue Cro
– Guardian
Superior
cure erm Disabil
Savings Accate)
Expense F
Flexible Sp
dent Care E
ry Products
surance Se
mmitted to hy, feel sec
oss & Blue S
ity (STD) –
count (HSA
Flexible Spe
pending Acc
Expense Fle
s – UNUM
ervices
a comprecure and ma
Shield of Ka
– Administer
A) – UMB B
ending Acco
count - CBI
exible Spen
Our e
ehensive eaintain a wo
ansas City
red by UNU
ank (Must b
ount – CBIZ
Z
ding Accou
employ
employee bork/life bala
(BlueKC)
UM
be enrolled
Z
unt – CBIZ
yees avalu
benefit proance.
d in the Blue
are ouruable
ogram that
eSaver HDH
r most asset.
t helps
HP to
CRefeinfo
M
BK
P
H
U
D
G
P
V
S
P
F
C
V
U
P
S
U
P
K
S
4 | CBIZ Be
ontacer to this lrmation con
MEDICAL
Blue Cross BKC
Policy # 3207
HEALTH SA
UMB Bank
DENTAL
Guardian
Policy # 2877
VOLUNTAR
Superior Visi
Policy # 2877
FLEXIBLE S
CBIZ
VOLUNTAR
UNUM
Policy # 1130
SHORT TER
UNUM
Policy # 8460
KPERS (Kan
State of Kans
enefits & Ins
ct Infolist when yntact Ja’Nic
Blue Shield o
76000
AVINGS ACC
77
Y VISION
ion
77
SPENDING A
Y LIFE
075
RM DISABIL
057
nsas Public
sas
surance Se
ormayou need toce Mitchell.
of (81
(86
COUNT (HS
(86
(80
(80
ACCOUNTS
(80opt
(86
LITY and CR
(86
c Employees
(88
ervices
tion o contact o
16) 395-2270
66) 811-4589
SA)
66) 520-4472
00) 541-7846
00) 507-3800
S (FSA)
00) 815-3023tion 4
66) 679-3054
RICITAL ILL
66) 679-3054
s Retiremen
88) 275-5737
one of you
0
9
w
2 ww
6 w
0 w
3, w
c
4 wa
NESS
4 w
nt System)
7 w
ur benefit v
www.myblue
www.mybluewww.hsa.um
www.guardia
www.superio
www.myflexo
claims fax (8
www.unum.caskunum@u
www.unum.c
LONG TER
www.kpers.o
vendors. Fo
ekc.com
ekc.com or mb.com
ananytime.c
orvision.com
online.com
800) 584-418
com or unum.com
com
RM DISABILI
org
or general
Pa
Pa
om Pa
m Pa
85
Pa
Pa
Pa
ITY
Pa
age 7
age 11
age 14
age 18
age 20
age 22
age 23
age 22
Elig
WOpeNov201
RETyou you
NEWyou Fall nev
5 | CBIZ Be
ible depend
Your sp
Unmarr
Unmarrbecause
When isen enrollmevember 11. 7 through D
TIREE and will need tr PIN is you
W HIRES: don’t enro enrollmenter been to
enefits & Ins
dents includ
pouse
ied children
ied depende of mental
s Enrolent runs froThe benef
December 3
COBRA Po completeur date of b
To enroll, sll in your bet. It is yourthe site, yo
surance Se
WAll cmordiscdete Depund
de:
n through th
dent childre or physica
llmentom Octobefits you elec31, 2017.
HoACTstatchawwwthe of b
PARTICIPAe and send birth - mmdd
simply acceenefits withr responsibiour PIN is yo
ervices
ho is Ecertified andre per weekcuss with Hermine eligi
pendents ofer many of
he end of th
n over age al handicaps
t? er 24 througct during an
ow doTIVE EMPLus changesnges, simpw.cbizesc.cevent. If yoirth - mmdd
ANTS: You back by Dedyyyy.
ess the Emin 31 days ility to enrolour date of
Eligibled full-time ck are considuman Resobility and y
f eligible emthese bene
he calendar
26 who ares (upon app
gh Novembnnual enrol
o I EnroLOYEES: As are done ly access th
com/kcps. Cou have nedyyyy.
will receiveecember 1,
ployee Servof first becoll during yobirth - mmd
e? classified emdered eligibources youryour benefit
mployees mefits plans.
r year (Dec
e incapableproval).
ber 11. Finlment will b
oll? All enrollmethrough thehe EmployeChanges m
ever been to
e a paper e2016. If yo
rvice Centeoming eligibur 31-day eddyyyy.
mployees wble to particr employmet effective d
may also be
cember 31)
e of support
nal electionbe effective
ent and mide internet. ee Service
must be mado the site, y
enrollment fou have ne
r at www.cbble, you mueligibility pe
working 30 cipate. Pleaent status todate.
eligible for
in which th
ting themse
s must bee from Janu
d-year qualTo enroll oCenter at de within 3
your PIN is
form in the ver been to
bizesc.comust wait unteriod. If you
hours or ase o
r coverage
hey turn 26
elves
made by uary 1,
ifying r make
1 days of your date
mail that o the site,
m/kckps. If til the next u have
ShofromEmpope If yoduri If yo#50becand
6 | CBIZ Be
ould you wism the eventployee Ser
en enrollme
ou are eligibng the yea
ou or your d00’s plan; yoome eligibl your depe
enefits & Ins
sh to make to notify thrvice Centeent period t
ble to enrolr, you will b
dependentsou must reqe for premindents in U
surance Se
HoUnlemakenrochildprovor ythento furedu
changes tohe Employer is not noto adjust yo
ll in the Fedbe permitted
s become inquest enrollum assista
USD #500’s
ervices
ow doess you hake changesollment perid, adoptionvision of insyour spousen lose thatull-time, mouction in ho
o your elecee Service
otified withiour benefit
deral Marked to drop co
neligible forlment withinnce from M
s plan; you
o I Maave a qual to the beniod. Qualifie, marriage,surance toe/dependencoverage),
ove or tranours that ma
ctions due toe Center atn this times.
etplace (Exoverage un
r Medicaid on 60 days.
Medicaid or must reque
ke Chlified changnefits youed changes death, div a dependnts are cov Medicaresfer out ofakes you in
o a qualifyit www.cbiz
e frame, yo
xchange) duder this pla
or CHIP, yo AdditionallCHIP, you
est enrollme
hangege in statuelect until s in status vorce, a codent, loss overed undeeligibility, gf the plan’sneligible for
ng event, yzesc.com/ku must wa
ue to a Spean.
ou may be ly, if you ormay be ab
ent within 6
es? us, you canthe next ainclude birt
ourt order rof coverager another p
going froms service ar coverage.
you have 3kckps. If thit until the
ecial Enrollm
able to enror your depeble to enroll 60 days.
nnot nnual th of a requiring e (if you plan and part-time
area, or a
1 days he next
ment
oll in JSD ndents yourself
MThethroplan TheplanSpo
BluTheheaasscove
HMWithservrecosimdoe
7 | CBIZ Be
Medicae USD #500ough Blue Cns and the B
e differencen, you haveouse, Emplo
ue KC Ce plan you calth needs, burance of sered by you
MO – Heah an HMO, vices. You ommend spply select th
es not cover
The HM
Prevent
Higher P
enefits & Ins
al Insu0 plan offersCross Blue Blue Saver
in each plae the optionoyee & Chi
Choicechoose shobudget, and
some financur plan. Yo
alth Maithere’s no choose a p
pecialists ashe specialisr any servic
MO plan utili
tative care c
Premiums/N
surance Se
urancs you five leShield of K
r High Dedu
an is the ou to choose ld (ren), or
es uld simply d personal cial protectiour choices
intenancdeductible.
primary cars needed. st and makces from no
izes the Blu
covered at
No deductib
ervices
ce evels of cov
Kansas City uctible Heal
ut-of-pocketbetween foEmployee
be the one preferenceon against include all
ce Organ. Your share physicianTo visit a se an appoin
on-participa
ue Care Ne
100%
ble
verage insu(Blue KC)
lth Plan wit
t cost to yoour levels o& Family.
you’re moss. No mattany major,of the plan
nizationre of the co
n (PCP) whpecialist whntment. Noting provide
etwork.
ured that include
th H.S.A (H
u and the pof coverage
st comfortater which pl unexpecte
ns briefly de
n osts includeo will providho participao referral is ers, except
e one HMOealth Savin
premium yo: Employe
able with – alan you enred medical escribed be
es copaymede most of ates in the B required. t for emerge
O plan, threengs Accoun
ou pay. On e Only, Em
a plan that roll in, you’lexpenses t
elow.
ents for manyour care aBlue Care NAn HMO geencies.
e PPO nt).
each mployee &
fits your l have the that are
ny and Network, enerally
PPA P
8 | CBIZ Be
PO – PrePO allows
The PP
Prevent
First Docoverag
Foser
Thdru
Onrea
Thmeser
enefits & Ins
eferred Pyou to see
O plans uti
tative Care
ollar Coverage (2500PP
r each covervices from
e calendar ugs, or any
nce the planach your de
e plan offeedications arious illness
surance Se
Providerparticipatin
lizes the Pr
covered at
age. Two oPO and 100
ered person participatin
year benefservices fr
n has paid teductible.
rs a good oand it includs or injury.
ervices
r Organing and non-
referred Ca
t 100%
of the PPO p0PPO).
n, the plan ng provider
fit does notrom non-pa
the First Do
option if youdes a safety
zation -participatin
are Blue Ne
plans offere
pays up to rs.
t apply to corticipating p
ollar Amoun
u rarely visity net to cov
ng provider
etwork.
ed through
the 50 of e
opaymentsproviders.
nt, you pay
t the doctorver a catast
rs.
BCBS offe
eligible expe
, office visit
all other ex
r or take prtrophic hea
er first dollar
enses for c
ts, prescrip
xpenses un
rescription alth event, s
r
covered
tion
ntil you
such as
9 | CBIZ Beenefits & Inssurance Seervices
Blu
Thi
1. B
Your cover
The S
10 | CBIZ B
ue Save
s medical
Blue Sav
The offipreventoffice vi
The placharges$2,600.
If you reproviderbill. Co
Your upmake toor lose i
r plan makes avrage option in a
SBC is located
Benefits & In
r High D
l plan con
ver High D
ce visit andive exams/ssits, hospit
n provides s are paid in
emain in-ners. Only thentracted dis
p-front deduo the HSA. it” rule) and
vailable a Suma standard form
d at www.kckps
nsurance S
Deductib
nsists of tw
Deductibl
d Rx co-payscreeningsal services,
100% coven full. This m
etwork, you e discountescounts ave
uctible is offKeep in min
d may even
mary of Benefimat, to help yo
s.org.
Services
ble Healt
wo parts:
le Health
ys are elimi paid by BC, and presc
erage in-nemeans that
will still bend "allowablerage 40-50
fset by redund, all conttually provi
fits and Coveragu compare you
th Plan w
Plan ins
nated. WithCBS at 100cription drug
twork after t your out-o
nefit from Be" amount 0% savings
uced premiributions tode full reim
ge (SBC), whicur options.
with He
urance c
h the excep0%, all othegs will apply
the deductof-pocket m
BCBS’ contwill apply t
s.
ums as weo the HSA rmbursement
ch summarizes
alth Sav
coverage
ption of in-nr charges ry to your de
tible is met,aximum un
racts with to your ded
ll as contribroll over yeat of all out-o
s important info
vings Ac
though B
network rourelated to deductible.
, so all remnder this pla
their networuctible, not
butions youar to year (nof-pocket co
ormation about
ccount
Blue KC
tine iagnostic
aining an is truly
rk t the full
u may no “use it osts.
t any health
2. ES
A Hdedthe Ava Wha
How
For for inote
Who
Thoby aaccoa tacan
Who
You
11 | CBIZ B
EnrollmeSavings A
ealth Savinuctible heainsurance.
ailable as a
at are the a
A HSA waccumuvendor, investm
Contributo pay fo20% pedisability
Besidesof thingsvision, ado not aMedicarpremium
w much ca
2017, maxndividuals
ed above. T
o is eligibl
ose coveredany non-quount and la
ax-free, pennot contribu
o is NOT e
u are NOT e
You hav
You hav
Benefits & In
ent in the Account
ngs Accounalth plan. It
The HSA a
an option O
advantage
works muchulating as yo
you may bent return i
utions and or qualifiednalty in addy, or attainm
s your healts as covereand prescripallow: COBRre supplemms if you ar
an I contrib
ximum contrage 55 and
The “catch-
e to partic
d by a HDHalified plan
ater enroll inalty-free baute to the p
eligible to p
eligible to m
ve other me
ve medical
nsurance S
HDHP al
nt (HSA) is aprovides fuaccount is p
ONLY to th
es of HSA?
h like an IRou age, and
be able to dis often gua
investment expenses.dition to norment of Me
th plan deded by a tradption drug oRA premiument policiesre receiving
bute to my
ributions tod over, a “caup” contribu
cipate in a H
P. Employ, including n a non-quaasis and yoplan while e
participate
make or rec
edical insur
coverage p
Services
llows you
a special, taunding to paprovided by
hose who e
?
RA. The mod from one irect how th
aranteed.
t earnings a Funds withrmal taxatio
edicare eligi
uctible, HSditional Cafeout-of-pockm, post-ages, Long Terg unemploy
HSA?
your HSA atch-up” coution for 20
HSA?
yees, depenMedicare, aalified plan,ur account
enrolled in t
in a HSA?
ceive contrib
rance cover
provided by
u to consi
ax exempt ay for qualify UMB Ban
enroll in th
ney is yourqualified H
hose funds
are tax-freehdrawn for on. The penible age.
A qualified eteria 125 Fket costs), ae 65 retireerm Care insment.
are $3,400ontribution i017 is an ad
ndent spousare not elig you can cowill continu
he non-qua
?
butions to a
rage, unles
y TriCare, M
ider a He
account usfied medicak.
e BlueSav
rs and rolls HDHP to ano
are investe
, as are disnon-qualifi
nalty is waiv
medical exFlexible Spand some the health insusurance pre
0/individual s allowed in
dditional $1
ses and/or gible for the ontinue to pue to accumalified plan.
a HSA if:
s that cove
Medicare or
ealth
sed in conjual expenses
ver HDHP.
over year tother. Depeed, and a 2
sbursemented expenseved in the e
xpenses incpending Acchings whichurance pre
emiums, an
or $6,650/fn addition t,000.
children wh HSA. If yopay for heamulate inter
erage is also
r Medicaid,
unction withs NOT cove
to year, ending on t-4% annua
ts from the es will be aevent of de
clude the sacount (e.g. h Cafeteria mium otherd health ins
family. Addto the maxim
ho are alsou own a HSlthcare exprest tax-free
o a HDHP,
OR
h the high ered by
the HSA al
account assessed a ath,
ame type dental, 125 plans
r than surance
itionally, mums
o covered SA penses on e, but you
OR
How
You
How
Whe
Will cove The 1. U
uCr
2. Pac
If yoBudexp If yoto pfor m Are
To odoc
12 | CBIZ B
You havAffairs (you are
You or yYou areplan to Cafeteripremium
You or y
w do I open
u will need t
w do I know
en choosing
it provide terage you n
ere are two
Up-front coup-front cosCOBRA, yoregularly, li
Pay-as-youa hospital ocopayment
ou need medgeting is eenses for a
ou see a dopay less up-more cover
e my provid
obtain a listtors, hospit
BLUE C
PREFE
Benefits & In
ve been in (VA) or oneexcluded f
your spouse considere
run your eia 125 Depm payments
your spous
n my HSA?
to elect the
w which pl
g a health b
the right amneed, cons
o ways you
osts. This ists are dedou write a cke any bill,
u-go costsor outpatiens, deductib
edical care asier becau
any major, u
octor or nee-front and mrage than y
ders in the
t of providetals and ph
CARE NETW
RRED CAR
nsurance S
receipt of e of its facfrom contrib
se participated to be a expenses tpendent Cas for medic
e are cover
?
HSA durin
lan is right
benefits pla
mount of covider the cos
u contribut
is the part oducted fromcheck or ba
no matter h
s. These arent clinic, or hbles, and co
often, you muse your prunexpected
ed prescriptmore as-youou might us
Blue KC n
rs participaarmacies.”
WORK for t
RE BLUE fo
Services
non-prevenilities, inclubuting or re
te in a Cafe“beneficiarythrough it. are Accounal, dental, v
red under a
g Open En
t for me?
an, the mos
verage for sts – and w
e to the co
of the healt your paychnk draft for how often –
e the out-ofhave a pres
oinsurance.
might want remium cosd medical tr
tions only twu-go. This se.
network?
ating in netw When sele
the HMO pl
or all other
ntive care buding prescceiving con
eteria 125 My” of your s(NOTE: Th
nt, Limited vision, and
a Health Re
rollment if y
st important
you and yowhen you pa
ost of a hea
h insuranceheck. If youthe premiu
– or how se
f-pocket doscription fillThese amo
to pay morsts are alwareatment.
wo or threeway, you c
work, visit wecting your
lan
plans
benefits frocription drugntributions t
Medical Flespouse’s Mhere is no Flexible Slife insuran
eimburseme
you select t
t question is
our family? Aay them.
alth plan:
e premium u’re retired um. Either weldom – you
ollars you paled. Pay-asounts will a
re up-front ays the sam
e times a yecan save the
www.bluekcinsurance
om the Depgs, in the pthe next 3 m
exible SpenMedical FSA
restriction Spending Ance.), OR
ent Accoun
the BlueSa
s:
After decid
you pay. If or on a nonway, you pau need hea
ay when yos-you-go coaccumulate
and less asme, and you
ear, it mighte premiums
c.com. Seleplan, choos
partment of prior 3-monmonths, OR
nding AccoA even if yto particip
Account or
nt.
aver HDHP.
ing how mu
f you’re an en-employeeay premiumlth care.
ou see a doosts include.
s-you-go cou won’t have
t make mors and avoid
ect “find Bluse:
Veteran’s nth period, R
unt (FSA). you do not pating in a
sheltering
.
uch
employee, e plan like m costs
octor, go to
osts. e huge
re sense d paying
ue KC
Yo
13 | CBIZ B
our 20
Blu
EmpEmpEmpEmpSpe
HMO
EmEmEmEmSpe
PPO
EmEmEmEmSpe
PPO
EmEmEmEmSpe
PPO
EmEmEmEmSpe
Benefits & In
017 M
ueSaver HD
ployee Onlyployee + Spployee + ployee + Fa
ecial Family
O
ployee Onlyployee + Spployee + ployee + Fa
ecial Family
O $500
ployee Onlyployee + Spployee + ployee + Fa
ecial Family
O $1000
ployee Onlyployee + Spployee + ployee + Fa
ecial Family
O $2500
ployee Onlyployee + Spployee + ployee + Fa
ecial Family
PLEASE Nrequiremewellness r
nsurance S
Month
DHP with HST
y $pouse $
$amily $y
T
y $pouse $
$amily $y
T
y $pouse $
$amily $y
T
y $pouse $
$amily $y
T
y $pouse $
$amily $y
NOTE: Prements – add $2requirements
Services
hly Me
SA Total Cost$ 487.94 $1067.47 $ 951.54 $1434.52
Total Cost$ 670.42 $1468.32 $1308.73 $1973.64
Total Cost$ 668.27 $1463.57 $1304.50 $1967.22
Total Cost$ 546.51 $1195.58 $1065.74 $1606.68
Total Cost$ 487.94 $1067.47 $ 951..54 $1434.52
miums listed20/month ons.
edica
Dis$ 4$ 4$ 4$ 4
Dis$ 4$ 4$ 4$ 4
Dis$ 4$ 4$ 4$ 4
Dis$ 4$ 4$ 4$ 4
Dis$ 4$ 4$ 4$ 4
d are assumin top of these
al Ins
strict Pays487.94 487.94 487.94 487.94
strict Pays487.94 487.94 487.94 487.94
strict Pays487.94 487.94 487.94 487.94
strict Pays487.94 487.94 487.94 487.94
strict Pays487.94 487.94 487.94 487.94
ing you havee rates if yo
suran
You P
$ 579$ 463$ 946$ 458
You P$ 182$ 980$ 820$1485$ 997
You P$ 180$ 975$ 816$1479$ 991
You P$ 58$ 707$ 577$1118$ 630
You P $ 579$ 463$ 946$ 458
e met your wu did not me
ce C
Pay $0
9.53 3.60 6.58 8.64
Pay 2.48 0.38 0.79 5.70 .76
Pay .33 5.63 6.56 9.28 1.34
Pay .57
7.64 7.80 8.74 .80
Pay $0 9.53 3.60 6.58 8.64
wellness eet the
Cost
DeUSDwill wwwove
Yo
YOU
Theyou PartGuachafile a Youyou bill ythe To oin thchoo
14 | CBIZ B
entalD #500 will want to usew.guardianarview of be
our 20Monthly R
Employee O
Employee +
Employee +
Employee +
UR CHOIC
e Guardian should choticipating Dardian’s rearge. Particany paperw
u do have th choose to you the exccost for the
obtain a list of e gray box onose “PPO” an
Benefits & In
Insurcontinue to
e a participanytime.co
enefits that w
017 MRates
Only
Spouse
Child(ren)
Family
ES
plans allowoose a dent
Dental Guarasonable & cipating denwork.
he option ofdo so, you
cess over Ge total servi
f dentists partin the right hand when selec
nsurance S
ranceo offer dentating dentism or call 1-will be effec
Month
w you to rectist who pa
rd Preferredcustomary
ntists will als
f going outsmay have
Guardian’s rces up fron
ticipating in thnd side of thecting your netw
Services
e
tal benefits st. You can-800-541-7ctive Janua
hly De
ceive servicrticipates in
d dentists camount, an
so file your
side the Dea reduced reasonablent and then
he network, vie page. Thenwork, choose
through Gu find a list o846. The fo
ary 1, 2017.
ental IGu
ces from ann the Guardannot bill ynd they havclaims dire
ental Guardbenefit. In and customsubmit a c
isit www.guar select “Find
e “DentalGuar
uardian. Toof participatollowing cha.
Insurauardian Low
$27.62
$50.28
$59.62
$90.07
y dentist. Bdian Dental you for any ve discountectly with G
d Preferred addition, a
mary amoulaim to Gua
rdiananytime.a Dentist.” W
rd Preferred.”
o maximizeting dentistart provides
ance w
But, for max Guard Precharges thated the fees
Guardian, so
network fora non-particunt. You mardian direc
com. Select When selectin”
e your benets at s a high lev
Cost
Guardian
$36.60
$66.65
$79.21
$119.8
ximum costeferred PPOat are in exs that they o you won’t
r services. cipating denay also havctly.
“Provider Onng your insura
efits, you
vel
High
0
5
1
87
t savings, O network. xcess of do t have to
Should ntist can ve to pay
line Search” ance plan
PRE
A prprocpredin aandproc$30item
TheEmathe MAX
GuaRollann To qyeaEac
*If a pmaxim
15 | CBIZ B
EDETERMI
redeterminacedures recdeterminatidvance the whether thcedure limit
00. You or ymized bill or
Patient Membe ID # Procedu Teeth # Fee DDS na
e predetermail: cru@glidates of se
XIMUM RO
ardian will rlover Accouual maximu
qualify, your. You and
ch member’
plan has a diffeimum determin
Plan Annual
Maximum*
$1,000
Benefits & In
INATION
ation of bencommendeon from Gu
e percentaghe services tations. Guyour dental r a complete
name r name or G
ure codes
ame and ad
mination canic.com , faxervice, sign
OLLOVER
roll over a punt (MRA). um.
u must submeach of yos MRA may
erent annual mes the Maximu
Thre
$
nsurance S
nefits is simd are withinuardian prioge Guardian
recommenardian suggprovider caed claim for
Group Num
dress
n be submitx: (509) 465the predete
portion of eaThe MRA c
mit a claim ur dependey not excee
maximum for PPum Rollover pla
eshold
$500
Services
mply a notifin the servicor to receivin will pay, hnded by yougests havinan submit thrm with the
mber
tted directly5-3404. Oncermination
ach membecan be use
and not excents maintaed the MRA
PO benefits vs.an.
MaxRollover
$2
cation to yoces coveredng dental s
how much yur dentist fang a predetehe predeter following in
y to the Guace the servand submit
er’s unusedd in future y
ceed the paain separateA limit.
non-PPO ben
imum r Amount
250
ou and youd by the Guservices, yoyou will be rall within theerminationrmination bnformation
ardian Dentvices are cot it to Guard
d annual mayears if a m
aid claims te MRAs bas
nefits ($2,000 P
In-NeM
Rollo
r dentist asuardian conou have theresponsiblee benefit mfor all serv
by sending G:
tal Claims Dompleted, ydian for pro
aximum intomember rea
threshold dsed on you
PPO/$1,000 no
etwork OnlyMaximum over Amoun
$350
s to whethetract. By ob
e security ofe for out of
maximums aices that exGuardian a
Departmenour dentist
ocessing.
o your Maxaches the p
uring the beur own claim
n-PPO), the no
y
nt
$
r the btaining a f knowing pocket
and xceed
an
t at: can fill in
ximum lan’s
enefit m activity.
on-PPO
MRA Limit
$1,000
Lo
D
P
B
MOL(p
C(p
C(p
In-nefee snetwoamou
Pleasdiscre
16 | CBIZ B
w Plan –
Dental Plan
Preventive S Oral Exam Teeth Cle X-Rays – Periodon Emergen Fluoride T Space M Topical S
treatmentperiod
Basic Servic Fillings – X-Rays – Periodon
Maintena Endodon Diagnost Crowns – General A Injectable condition Laborato Repairs o
Major Servic Oral Surg Crowns – Bridges I Dentures Inlays, O TMJ – an
Orthodontic Children Not subje
Lifetime Ortper child)
Calendar Yeper person,
Calendar Yeper person)
etwork and out-chedule. Wheork care, chargunt that is char
se refer to the aepancy in bene
Benefits & In
– Dental
Features
Services (nomination – eeaning – eve– four bitewintal Maintena
ncy PalliativeTreatments aintainers fo
Sealants for t for children
ces amalgam &
– full mouth stal Services
ance Procedtic Services/ic Consultat
– stainless sAnesthesia –e Antibiotics only ry Test of dentures,
ces gery – resin, metanstallation –
s – full and pnlays, Posts
nnual limit of
c Services (nunder age 1
ect to Maxim
hodontic M
ear Deductibmaximum 3
ear Annual M
-of-network benen seeking in-neges will be paidrged over the fe
actual dental befits, the carrie
nsurance S
Guard P
ot subject tevery six moery six montngs every twance Procede Treatment – every six m
or Children (un-restored n under age
& anterior comseries every(other than ure) /Root Canalion – one peteel – surgical pr– for treatm
bridgework,
al – fixed and repartial s f $200
not subject9
mum Rollove
Maximum
ble per family)
Maximum
nefits receive thetwork care, yo
d for only up to ee schedule is
benefit summarr benefit summ
Services
Preferred
o the deducnths hs
welve monthsdure – every
months (to aunder age 1molar teeth 14 in a three
mposites five years Periodontal
Therapy er year
rocedures onment of a den
crowns, etc
emovable
t to the dedu
r
he same coinsou receive reguthe maximum the responsibil
ry/Summary Plamary/SPD will a
d Networ
ctible)
s six months
age 19) 4) – one
e year
nly ntal
c.
uctible)
urance percenular contractedfeel level establity of the patie
an Description always govern.
rk
In-Ne
10
8
4
4
$1
$
$1
tages, but all b savings and nblished with Gu
ent.
(SPD) for deta
etwork
00%
80%
40%
40%
1,000
$50
1,000
benefits are paino balance billinuardian’s contr
ailed informatio
Out-of-N(Based
NetwEstablish
Sched
100
80%
40%
40%
$1,0
$5
$1,0
id based on theng. If choosingracted network
on. In the even
Network on In-
work hed Fee dule)
0%
%
%
%
000
50
000
e contracted g out-of-dentists; any
nt there is a
Hig
DP
B
MOL(C(C(
Thisserv
17 | CBIZ B
gh Plan
Dental PlanPreventive Oral Exa Teeth Cl X-Rays – Periodon
months Emergen Fluoride Space M Topical S
treatmenperiod
Basic Servi Fillings – X-Rays – Periodon
Maintena Endodon Diagnost Crowns – General Injectabl
condition Laborato Repairs Major Servi Oral Sur Crowns – Bridges Dentures Inlays, O TMJ – anOrthodontic Children Not subjLifetime Ort(per child) Calendar Ye(per person,Calendar Ye(per person)
s is intended tovices including
Benefits & In
– Denta
n Features Services (n
amination – eleaning – ev– four bitewintal Mainten
ncy PalliativeTreatments
Maintainers foSealants for nt for childre
ces – amalgam &– full mouth ntal Servicesance Procedntic Servicestic Consulta– stainless sAnesthesia e Antibiotics
n only ory Test of dentures,ces
rgery – resin, metInstallation –s – full and p
Onlays, Postsnnual limit oc Services ( under age 1ect to Maximthodontic M
ear Deducti maximum 3ear Annual )
o be a summaryplan limitations
nsurance S
lGuard P
not subject tevery six mo
very six montngs every twance Proced
e Treatment – every six or Children (un-restoredn under age
& anterior anseries every
s (other thandure) s/Root Canation – one psteel – surgical p
s – for treatm
, bridgework
al – fixed and rpartial s f $200 (not subject19
mum RolloveMaximum
ible 3 per family)Maximum
y only. Pleases and exclusion
Services
Preferred
to the deduonths ths welve monthdure – every
t months (to (under age 1
d molar teethe 15 in a thre
nd posterior y five years n Periodonta
al Therapy er year
procedures oment of a den
k, crowns, et
removable
t to the ded
er
refer to your Sns.
d Networ
uctible)
hs; y six
age 19) 14) h – one ee year
composites
al
only ntal
c.
ductible)
Summary Plan
rk
In-Ne
10
8
6
5
$1
$2
Description (S
etwork
00%
80%
60%
50%
1,000
$0
2,000
SPD) for a more
Out-of-N
90%
60%
40%
40%
$1,0
$2
$1,0
e complete listi
Network
%
%
%
%
000
5
000
ing of
Vi
USDthis can careVisi
20
18 | CBIZ B
ision I
D #500 offeplan, you w use any pre from a paon network
017 V
Benefits & In
nsura
ers you an awill have corovider, how
articipating Sk, simply vis
ision
Monthly
Employee
Employee
Employee
Employee
nsurance S
ance
affordable, overage for wever, you Superior Visit www.sup
Rates
Rates
Only
+ Spouse
+ Child(ren)
+ Family
Services
simple-to-uannual rouwill receivesion providperiorvision
s
use plan to utine eye exe a higher leder. To locan.com and s
keep your xams, mateevel of benate a providselect “Loca
G
eyes healtherials and cefits should
der participaate a Provid
Guardian Lo
$10.30
$20.40
$19.97
$30.39
hy. By enroontact lensd you receivating in theder.”
w
olling in ses. You ve your Superior
19 | CBIZ B
Benefits & Innsurance SServices
FleCBI
A grin thof yusedep Pre-fedeuse The
MED
Youthis Som
For sele The(the
20 | CBIZ B
exibleIZ, INC.
reat way tohe Flexible your salary od to pay me
pendent car
-tax meanseral incomed to pay for
ere are thre
The Me
The Lim
The Dep
DICAL FLE
u may elect account ar
me example
Plan de
Vision s
Prescrip
a completeect “Section
e IRS does e list below
Cosmet
Electroly
Hair los
Health c
Herbs &
Teeth w
Benefits & In
e Spe
plan aheadSpending Aon a pre-taxedical expere expenses
s the dollarse tax, and sr qualified e
ee ways to
dical Flexib
mited Flexib
pendent Ca
EXBILE SP
to contribure those no
es include:
ductibles, c
services, su
ption expen
e list of elign 125 Plan”
not allow thincludes so
tic surgery/p
ysis
s medicatio
club dues
& herbal me
whitening/bl
nsurance S
ending
d and saveAccount (FSx basis into
enses whichs.
s you use fotate and loc
expenses.
maximize
ble Spendin
le Spendin
are Accoun
PENDING A
ute up to $2t covered b
copayments
uch as conta
nses
ible expens, then selec
he followingome of the m
procedures
on
edicines
eaching
Services
g Acc
money oveSA) programo reimburseh are not re
or eligible ecal income
your pre-t
ng Account
g Account
t
ACCOUNT
2,550 each by your med
s, and othe
act lenses,
ses, log ontct “Qualifyin
g expensesmore comm
s
count
er the coursms. These
ement accoeimbursed b
expenses atax. Mone
tax saving
plan year. Edical, denta
r out-of-poc
eye exams
to www.cbizng Expense
s to be reimmon items a
ts
se of a yeae accounts aunts. Moneby your insu
re not subjeey you woul
s:
Eligible expal, and/or vi
cket costs
s, eyeglass
zesc.com/kes”.
bursed undand is not m
ar is to partiallow you toey from theurance plan
ect to sociald have pai
penses thatision plans.
ses and lase
kckps and f
der the Heameant to be
cipate o redirect a
ese accounn or to pay
al security tad in taxes c
t can be pa.
er eye surg
from the ma
althcare Acce all-inclusiv
a portion ts is then for
ax, can be
aid from
gery
ain menu
count: ve):
LIM
For are partONLLimunleconunu DEP
Funfunchilto $expcarenecscho REI
Som
21 | CBIZ B
MITED FLEX
those who not eligible
ticipate in thLY. All ruleited FSA, i.
ess you exptribution at sed amoun
PENDENT
nds contribds CANNOldren in da
$5,000 or upenses are fe for themsessary to aool.
MBURSEM
me importan
You are
You mapersona
You mainformat
You mato avoid
Yoofftha
YoWapu
Cecarver
Fade
Benefits & In
XIBLE SPE
enroll in the to participhe Limited es that appl.e. once yoperience a qany time, e
nts at the en
CARE ACC
buted to thOT be usedaycare, plep to $2,500for the careelves beca
allow you, o
MENTS
nt things to
e responsib
ay elect to hal account.
ay access thtion.
ay elect to ud filing claim
our debit cafices, visionat the card
ou can avoidal-Mart, Warchases to
ertain card srd swipe carified.
ailure to sebit card an
nsurance S
ENDING AC
he Blue Savate in the mFlexible Acy to the trau make youqualifying eeven if you nd of the pl
COUNT
his accountd for any tyase do not if you are m
e of childrenuse of men
or you and y
remember
le for filing
have reimbu
he website
use the freems. It is imp
rd is accepn care centeis used only
d having toalgreens or be charged
swipes canannot be ma
nd in reqund you may
Services
CCOUNT
ver High Demedical flexccount, allowditional Meur annual eevent; you chave not yean year an
t are for DEype of medt elect the married andn under agental or physyour spouse
r about flexi
claims for r
ursements m
https//:myp
e debit card portant that
pted at only ers, and hosy when pay
verify cardDrugstore.
d on the de
be automaatched with
ested docy be requir
eductible Hexible spendiwing you to
edical flexiblection you
can file claiet had the ad grace pe
EPENDENdical expenDependend file separe 13 or depical handice if you are
ible spendin
reimbursem
mailed to y
plans.cbiz.c
for healthct you keep y
qualified lospitals. Theying qualifie
d purchasescom. Onlybit card.
atically verifh your co pa
umentatiored to pay-
ealth Plan wing accouno pay for dele spending
ur contributims for any amount witriod are for
NT DAY CARnse. If you
nt Care Accrate tax retupendents of cap. The dee married, to
ng account
ment.
your home o
com at any
care reimbuyour receip
ocations, suese IRS-imed expense
s by using ay retail partn
fied. Howeays, the IRS
n could re-back the p
with H.S.A,t. You are,
ental and vig account aons will remamount up
thheld from rfeited.
RE EXPENu do not cucount. Youurns. Eligibf any age thependent co work or a
ts:
or deposited
time for cur
ursement, wpts on file.
uch as pharposed limit
es.
a retail partner systems
ever, if the tS requires t
sult in susplan
IRS rules showever, esion care e
also apply tmain unchap to your tot
your pay a
NSES ONLYurrently hav
may contrble dependehat are unaare servicettend full-tim
d directly in
rrent accou
which may a
rmacies, doations help
tner such ass allow qua
total amounthat all deta
spension o
state you eligible to expenses, o the
anged tal annual and any
Y , these ve ibute up ent care ble to
es must be me
n your
unt
allow you
octor’s p to insure
s CVS, alified
nt of a ails be
of your
IMP
In e
Expand
VoUSDabofollo
I
F
F
F
Beninsuand
REMKPE
22 | CBIZ B
PORTANT R
exchange fo
You maunless y
Any fun“Use it
The HeaAccountimportakind.
The moexpensethe next
penses for t submitted
oluntaD #500 will out your claiowing chart
nsured
For Yourse
For Your S
For Your C
neficiaries:urance be
d/or childre
MINDER: KERS Conta
Benefits & In
RULES
or the tax ad
ay not stop oyou have a
ds remaininor lose it.”
althcare Act function snt to note th
ney you coes you incut.
the Januaryby March 3
ary Gcontinue toims, pleaset provides a
elf
Spouse
Children
: Your benenefits in ten.
KPERS incct Informati
nsurance S
dvantages,
or change yqualifying s
ng in the ac”
ccount, Limeparately; fhat the Dep
ontribute to ur during tha
y 1 – Decem31, 2018.
Groupo offer Life e go to wwwa high level
neficiaries the event
cludes a lifion: State
Services
the IRS ha
your contribstatus chan
ccounts at t
ited Flexiblfunds may pendent Ca
each accouat same pla
mber 31, 20
TermInsurance p
w.unum.comoverview o
Choose frof $10,00
Coveragecannot exfor yourse
Coverageto exceedyourself, w
are the peof your d
fe insurance of Kansas
as strict rule
bution amonge.
the end of t
e Spendingnot be tran
are Account
unt for the pan year. Yo
017 plan ye
m Life
programs thm or call cuof benefits t
rom 1-5 tim00 (not to ex
e must be pxceed $250elf, whichev
e must be pd $10,000 owhichever
eople or indeath. You
ce benefit os (888
es about ho
unts until th
the plan yea
g Account ansferred fromt is NOT for
plan year cou may not
ear must be
hrough UNustomer serthat will be
Bene
mes your anxceed $500
purchased i0,000 or halver is less.
purchased ior half the ais less.
nstitutions u are the
of 150% of8) 275-5737
ow these ac
he next Ope
ar grace pe
and the Depm one to thr medical e
an only be roll over fun
e incurred b
UM. To accrvice at 1-80effective Ja
efit
nnual earnin0,000)
n incremenlf the amou
n incremenamount you
you namebeneficiar
f your sala7 ww
ccounts mu
en Enrollme
eriod are fo
pendent Cahe other. It iexpenses of
used for elnds from on
by March 15
cess inform00-421-034anuary 1, 2
ngs in incre
nts of $5000unt you purc
nts of $2000u purchase
e to receivery for you
ary. ww.kpers.o
ust work.
ent,
rfeited.
are is f ANY
igible ne year to
5, 2018
mation 44. The 017.
ements
0 and chase
0 not for
e your life ur spouse
rg
Vo
SHO
Sho– cadisaoff-t
Pre-
A prwoucovethatcoveexis
REM
VoTheas hmayillnecove Youeligare
REM
23 | CBIZ B
oluntaORT-TERM
ould a sicknan impact thability insurathe job acci
Secures
You cho
Your preyou get
Benefits6 month
If you lepremium
-Existing C
re-existing uld cause yerage effect disability berage is eff
sting condit
MINDER: S
oluntae critical illneheart attacky elect to usesses such erage for y
u may be reibility periodeligible the
MINDER: C
Benefits & In
ary ShM DISABILI
ness or injurhe financialance can hident.
s up to 60%
oose how m
emiums areolder
s are payabhs. (KPERS
eave employm. UNUM w
Condition Lim
condition isou to seek ctive date. begins withifective, is cions, pleas
Short-Term
ary Cess plan pak, stroke, orse these beas lost wagourself and
equired to cd has expir
e Open Enro
Critical Illn
nsurance S
hort TITY
ry strike, yol well-beingelp replace
% of your gr
much covera
e based on
ble after a 1S include a
yment or rewill bill you d
mitation
s defined intreatment fBenefits foin 12 month
considered ae email ben
m Disability
Criticaays a lump r cancer. Penefits to heges, rehabid your family
complete Evred or if youollment follo
ness is ON
Services
Term D
our out-of-pg of you ande a portion o
ross salary
age you wa
your age w
4-day elimlong-term d
etire, you cadirectly at h
n your policyfrom a physr a disabiliths of your ca pre-existinefits@kck
y is ONLY
al Illnesum benef
Plan benefitelp pay the litations, fay and may
vidence of Iu increase yowing your
NLY availab
Disab
pocket exped your famiof your sala
(not to exce
ant – betwe
when you b
ination peridisability be
an take thehome.
y as a condsician, or toy due to a pcoverage efng conditiops.org.
available d
ess fit upon the s may be unon-medicmily care achoose an
Insurability your coveradate of hire
ble during t
bility
enses – notly. UNUM’s
ary in the ev
eed $5,000
een $400 an
uy the insu
iod and youenefit after a
policy with
dition for whook medicinpre-existingffective dat
on. For mor
during the
initial diagnused for anycal costs asand transpo
amount fro
if you electage past thee.
the open e
t to mentions voluntary vent of a co
0 monthly).
nd $5,000.
urance and
u can receiva 6 month w
h you and p
hich symptone within 12g condition e. Pregnanre informat
open enro
nosis of a cy purpose yssociated wortation. Yoom $5,000 t
t coverage e guarantee
enrollment
n lost time oindividual s
overed sick
will not incr
ve benefits waiting per
pay the sam
oms existed2 months bewill not be
ncy, at the tion about p
ollment pe
covered illnyou choose
with catastroou may purcto $50,000
after your ie issue limi
t period.
on the job short-term kness or
rease as
for up to iod.)
me
d that efore your paid if time
pre-
riod.
ess such e. You ophic chase .
nitial it. You
NO
You
Thisget a
YOU
YOUYou
OUR
We
YOUWhesom
Get
24 | CBIZ B
OTICE O
ur Informatio
s notice desaccess to th
UR RIGHTS
You hav
Get a cop Correct y Request Ask us to Get a list Get a cop Choose s File a com
UR CHOIC have some
Answer c Provide d Market o
R USES AN
may use an
Help man Run our Pay for y Administ Help with Do resea Comply w Respond Address Respond
UR RIGHTSen it comes
me of our res
t a copy of h You can
informati
We will prequest.
Benefits & In
F PRIVA
on. Your Ri
cribes how is informatio
S
e the right to
py of your heyour health aconfidential
o limit the inft of those witpy of this prisomeone to mplaint if yo
ES choices in t
coverage qudisaster relieur services a
ND DISCLO
d share you
nage the heaorganization
your health ser your heal
h public healarch with the law d to organ anworkers’ com
d to lawsuits
S to your heaponsibilities
health and n ask to seion we have
provide a copWe may ch
nsurance S
ACY PRA
ghts. Our R
medical infoon. Please re
o:
ealth and claand claims re
communicaformation weth whom weivacy notice act for you u believe yo
the way that
estions fromef and sell you
OSURES
r information
alth care tren services th plan lth and safet
nd tissue donmpensation,and legal ac
alth informatto help you.
claims recoe or get a about you.
py or a sumarge a reaso
Services
ACTICES
Responsibil
ormation aboeview it care
aims recordsecords ation e share ’ve shared y
our privacy ri
we use and
m your family
r information
n as we:
atment you
ty issues
nation reque, law enforcections
tion, you hav.
ords copy of yoAsk us how
mary of youonable, cost
S
ities.
out you mayefully.
s
your informa
ghts have b
share inform
y and friends
n
receive
ests and worement, and o
ve certain ri
our health ato do this.
r health and-based fee.
y be used a
tion
een violated
mation as w
s
rk with a medother govern
ights. This s
and claims
d claims reco
and disclose
d
we:
dical examinnment reque
section expla
records an
ords, usually
d and how
ner or funeraests
ains your rig
nd other he
y within 30 d
you can
al director
ghts and
alth
days of your
Ask
Req
Ask
Get
Get
Cho
File
YOUFor prefeyou
In th
25 | CBIZ B
k us to corre You can
incomple
We may s
quest confid You can
a differen
We will danger if
k us to limit You can
operation
We are n
t a list of tho You can
prior to t
We will operationaccountione with
t a copy of t You can
electroni
oose someo If you ha
person c
We will m
a complain You can
page 1.
You can Rights b877-696
We will n
UR CHOICcertain hea
erence for hwant us to d
hese cases
Share inf Share inf
Benefits & In
ect health aask us to
ete. Ask us h
say “no” to y
dential comask us to cont address.
consider af we do not.
what we usn ask us nons.
not required
ose with whask for a l
he date you
include all ns, and cerng a year in 12 month
this privacyask for a pa
ically. We wi
one to act foave given scan exercise
make sure th
nt if you feecomplain if
file a compby sending a-6775, or vis
not retaliate a
ES alth informathow we shado, and we w
s, you have
formation wiformation in
nsurance S
and claims rcorrect yourhow to do th
our request,
municationontact you in
ll reasonab
se or shareot to use o
to agree to y
hom we’ve sist (accountask, who w
the disclosrtain other dfor free bus.
y notice aper copy ofill provide yo
or you someone me your rights
he person ha
el your rightyou feel we
plaint with ta letter to 20siting www.h
against you
tion, you caare your infowill follow yo
both the rig
th your famia disaster re
Services
records r health andis.
but we’ll tell
ns n a specific w
le requests
or share ce
your request
shared infoting) of the e shared it w
ures exceptdisclosures (t will charg
f this noticeou with a pap
edical poweand make c
as this autho
ts are violate have viola
the U.S. De00 Independ
hhs.gov/ocr/p
for filing a co
an tell us yormation inur instructio
ght and cho
ly, close frieelief situation
d claims rec
l you why in
way (for exa
, and must
rtain health
t, and we ma
ormation times we’ve
with, and wh
t for those(such as ane a reason
at any time,per copy pro
er of attornehoices abou
ority and can
ted ated your rig
epartment ofdence Avenprivacy/hipaa
omplaint.
our choicesthe situatio
ns.
oice to tell u
ends, or othen
cords if you
writing withi
mple, home
t say “yes”
information
ay say “no” i
e shared youy.
about treatny you askenable, cost-b
even if youomptly.
ey or if somut your health
n act for you
ghts by cont
f Health andue, S.W., Wa/complaints
s about whaons describe
us to:
ers involved
think they
n 60 days.
e or office ph
if you tell
n for treatm
if it would aff
ur health in
tment, paymed us to mabased fee
u have agree
meone is yoh information
before we ta
tacting us us
d Human SWashington, s/.
at we shareed below, ta
in payment f
are incorrec
hone) or to s
us you wo
ment, payme
ffect your car
formation fo
ment, and hake). We’ll pif you ask
ed to receive
ur legal guan.
ake any actio
sing the info
Services OffiD.C. 20201
e. If you haalk to us. T
for your care
ct or
send mail to
ould be in
ent, or our
re.
or six years
health care provide onefor another
e the notice
ardian, that
on.
ormation on
ce for Civil1, calling 1-
ave a clear ell us what
e
If yosharneed
In th
OURHowin th Help
Run
Pay
HOWWe publshar
For
HelpW
Do
W
ComWH
26 | CBIZ B
ou are not are your infoded to lesse
hese cases
Marketin Sale of y
R USES ANw do we typiche following w
p manage t
We can doctor seservices
n our organ We can
necessa
We are nthe price
This doedevelop
y for your he We can u
share inf
W ELSE CAare allowed lic good, sucre your infor
more inform
p with publiWe can sha
Preventin Helping w Reporting Reporting Preventin
research
We can use
mply with thWe will sharHealth and
Benefits & In
able to tell urmation if w
en a serious
s we never s
g purposes our informat
ND DISCLOcally use or sways.
the health c
use your heends us info.
ization use and dry.
not allowed e of that cove
s not apply tbetter servic
ealth servicuse and discformation ab
AN WE USor required
ch as public mation for th
mation see:
ic health anre health info
ng disease with product g adverse reg suspectedng or reducin
or share yo
he law re informatioHuman Ser
nsurance S
us your prefwe believe it
and immine
share your
tion
OSURES share your h
care treatm
alth informatrmation abo
isclose your
to use generage.
to long term ces for you.
ces close your hbout you wit
E OR SHAto share youhealth and r
hese purpos
: www.hhs.g
nd safety issormation ab
recalls eactions to md abuse, negng a serious
ur informatio
on about yourvices if it w
Services
ference, foris in your b
nt threat to h
information
health inform
ent you rec
tion and shaout your diag
r informatio
etic informa
care plans.
ealth informh your denta
ARE YOURur informatioresearch. Wes.
gov/ocr/priva
sues out you for c
medicationsglect, or doms threat to an
on for health
u if State or
wants to see
example ifbest intereshealth or saf
n unless yo
mation? We
ceive
are it with prognosis and tr
n to run ou
ation to deci
Example: W
mation as weal plan to co
HEALTH INon in other we have to me
cy/hipaa/und
certain situat
mestic violencnyone’s heal
h research.
r Federal lawthat we’re
you are uncst. We mayfety.
u give us w
e typically us
ofessionals wreatment pla
ur organizat
de whether
We use healt
e pay for youoordinate pay
NFORMATways – usual
eet many co
derstanding/
tions such a
ce lth or safety
ws require itcomplying w
conscious, walso share
written perm
se or share y
who are treaan so we can
tion and con
we will give
th informatio
ur health seryment for yo
ION? ly in ways th
onditions in t
/consumers/
as:
t, including wwith Federa
we may goyour inform
mission:
your health i
ating you. Exn arrange ad
ntact you w
e you cover
on about you
rvices. Examour dental w
hat contributethe law befo
/index.html.
with the Depl privacy law
ahead andation when
nformation
xample: A dditional
when
rage and
u to
mple: We work.
e to the re we can
partment ofw.
Res
AddW
ResWt
OUR
For CHAWe new
27 | CBIZ B
spond to org
We can s
We can sindividua
dress workeWe can use
For work
For law e
With hea
For speprotectiv
spond to lawWe can shato a subpoen
R RESPON We are r
We will leyour info
We must
We will nwriting. Ichange y
more inform
ANGES TOcan change
w notice will b
Effective
Privacy c
Benefits & In
gan and tiss
share health
share healthal dies.
ers’ compene or share h
kers’ compen
enforcement
alth oversigh
cial governve services
wsuits and re health infona.
NSIBILITIESequired by la
et you know ormation.
t follow the d
not use or shf you tell us your mind.
mation see:
O THE TERthe terms o
be available
date of Noti
contact: De S
nsurance S
ue donation
information
h information
nsation, lawealth inform
nsation claim
t purposes o
ht agencies f
ment functi
legal actionormation ab
S aw to mainta
promptly if a
duties and pr
hare your infowe can, you
: www.hhs.g
MS OF THf this notice,upon reque
ice: 10/1/20
Soto School
Services
n requests a
about you w
n with a coro
w enforcememation about
ms
or with a law
for activities
ons such a
ns out you in re
ain the priva
a breach occ
rivacy practic
ormation othu may chang
gov/ocr/priva
IS NOTICE, and the chast, on our we
014
District, Ja’N
and work wit
with organ p
oner, medica
ent, and otht you:
enforcemen
authorized b
as military,
esponse to a
cy and secu
curs that ma
ces describe
her than as dge your mind
acy/hipaa/un
E anges will apeb site, and
Nice Mitchel
th a medica
procurement
al examiner,
her governm
nt official
by law
national se
a court or ad
urity of your p
ay have com
ed in this no
described hed at any time
derstanding
pply to all infwe will mail
l, 35200 We
al examiner
organization
or funeral d
ment reque
ecurity, and
dministrative
protected he
mpromised th
tice and give
ere unless yoe. Let us kno
/consumers
formation we a copy to yo
est 91st Stre
or funeral d
ns.
irector when
ests
presidentia
order, or in
ealth informa
he privacy or
e you a copy
ou tell us weow in writing
/noticepp.ht
e have abouou.
eet, De Soto
director
n an
al
response
ation.
r security of
y of it.
e can in if you
ml.
ut you. The
, KS 66018
Ge
Intr
If yopertawhiccoveto gemay The RecmemrightDes Youeligithe MAddyou Wha
COBlife ea qubeneundeCOB If yothe
If yocov
28 | CBIZ B
eneral No
roduction
ou have receains to you. ch is a tempoerage, whenet it. When yy cost less th
right to COBconciliation Ambers of youts and obligacription or c
may have oble to buy aMarketplaceitionally, youare eligible
at is COBR
BRA continuevent. This ualifying eveeficiary.” Yoer the Plan iBRA continu
ou’re an emPlan beca
Your hou
Your emp
ou’re the sverage und
Your spo
Your spo
Your spo
Your spo
You beco
Benefits & In
otice of
ently gained This notice orary extens it may beco
you become han COBRA
BRA continuAct of 1985 (ur family wheations underontact the P
other optionsn individual
e, you may qu may qualify(such as a s
RA continu
ation coverais also callednt, COBRA cu, your spous lost becauation covera
mployee, yuse of the
urs of employ
ployment en
spouse of ader the Plan
ouse dies;
ouse’s hours
ouse’s emplo
ouse become
ome divorce
nsurance S
COBRA
coverage unhas importa
sion of coverome availableligible for Ccontinuation
uation coveraCOBRA). COen group hear the Plan anlan Adminis
s available toplan throughualify for lowy for a 30-daspouse’s pla
uation cove
age is a contd a “qualifyincontinuationuse, and youuse of the quage must pa
you’ll becofollowing
yment are re
nds for any re
an employen because
of employm
oyment ends
es entitled to
d or legally s
Services
A Contin
nder a groupnt informatiorage under te to you andCOBRA, youn coverage.
age was creOBRA continalth coveragnd under Fedtrator.
o you when yh the Health wer costs onay special enn), even if th
erage?
tinuation of Png event.” Sn coverage mur dependentualifying eveny for COBRA
me a qualiqualifying
educed, or
eason other
ee, you’ll bof the follo
ment are redu
s for any rea
o Medicare b
separated fr
uation C
p health planon about youhe Plan. Thid your familyu may also b
ated by a Fenuation covee would othe
deral law, yo
you lose groInsurance M your monthnrollment pehat plan gen
Plan coveragpecific qualif
must be offert children cont. Under theA continuatio
ified benefevents:
than your g
become a qowing qua
uced;
son other th
benefits (und
om your spo
Coverag
n sponsored ur right to COis notice expy, and what ybecome eligi
ederal law, terage can beerwise end.
ou should rev
oup health coMarketplace.hly premiumseriod for anoterally doesn
ge when it wfying eventsred to each pould becomee Plan, qualion coverage
ficiary if yo
ross miscon
qualified balifying eve
han his or he
der Part A, P
ouse.
ge Rights
by Blue ValOBRA continplains COBRyou need to ible for other
he Consolidecome availaFor more infview the Pla
overage. Fo. By enrollings and lower other group hn’t accept lat
would otherws are listed laperson who
e qualified beified benefic
e.
ou lose you
nduct.
eneficiary ents:
er gross misc
Part B, or bot
s
ley Schools,nuation coveRA continuat
do to protecr coverage o
ated Omnibable to you aformation ab
an’s Summar
r example, yg in coveragout-of-pockeealth plan fo
te enrollees.
wise end becater in this nois a “qualifie
eneficiaries iciaries who e
ur coverag
if you lose
conduct;
th); or
, this notice erage, ion ct your rightoptions that
us Budget and other bout your ry Plan
you may be ge through et costs. or which
cause of a otice. After ed if coverage elect
ge under
e your
Youbeca
Whe The has The
For losinqual239-prov How Onccoveindecontbeha COBto emevencove The Disa
If yoyou addihaveleas
29 | CBIZ B
ur dependenause of the
The pare
The pare
The pare
The pare
The pare
The child
en is COBR
Plan will offbeen notifie
employer m
The end Death of
The emp
all other quang eligibility flifying event -4235 or calvided.
w is COBRA
ce the Plan Aerage will beependent rightinuation covalf of their ch
BRA continumployment tnt during theerage.
re are also
ability exten
ou or anyonenotify the Plitional 11 moe to have sta
st until the en
Benefits & In
nt children w following q
ent-employee
ent-employee
ent-employee
ent-employee
ents become
d stops being
RA continuat
fer COBRA ced that a qua
must notify
of employmthe employe
ployee’s beco
alifying evenfor coverageoccurs. You
l the BV Enr
A continuati
Administratoe offered to eht to elect Cverage on behildren.
ation coveratermination oe initial perio
ways in wh
nsion of 18-
e in your famlan Administonths of COBarted at somnd of the 18-
nsurance S
will becomequalifying ev
e dies;
e’s hours of
e’s employm
e becomes e
e divorced or
g eligible for
tion covera
continuation alifying event
the Plan Ad
ent or reducee; or
oming entitle
ts (divorce oe as a depenu must providrollment Call
on coverag
r receives noeach of the qOBRA contiehalf of their
age is a tempor reduction d of coverag
hich this 18-
-month peri
mily covered trator in a timBRA continu
me time befor-month perio
Services
e qualified bvents:
employment
ment ends for
entitled to Me
r legally sepa
coverage un
age available
coverage tot has occurre
dministrato
ction of hours
ed to Medica
or legal sepandent child), de this notic Center at (8
ge provided?
otice that a qqualified bennuation cover spouses, a
porary continof hours of w
ge, may perm
-month peri
iod of COB
under the Plmely fashionuation coverare the 60th dod of COBRA
beneficiarie
t are reduce
r any reason
edicare ben
arated; or
nder the Pla
e?
o qualified beed.
or of the foll
s of employm
are benefits (
aration of theyou must noe to: Shila R888) 972-34
?
qualifying evneficiaries. Eerage. Covend parents m
nuation of cowork. Certaimit a benefic
od of COBR
RA continu
lan is determ, you and yoage, for a maday of COBRA continuatio
es if they los
ed;
n other than
efits (Part A
an as a “depe
eneficiaries o
owing qual
ment;
(under Part
e employee aotify the Plan
Rolleston in t30. Note, pr
vent has occEach qualifiedered employemay elect CO
overage thatn qualifying
ciary to recei
RA continua
uation cover
mined by Socour entire famaximum of 2
RA continuaton coverage
se coverage
his or her gr
A, Part B, or b
endent child
only after th
ifying even
A, Part B, or
and spouse n Administrathe BV Beneroof of the qu
curred, COBRd beneficiaryees may eleOBRA contin
t generally laevents, or aive a maxim
ation cover
rage
cial Securitymily may be 29 months. Ttion coverag
e.
e under the
ross miscon
both);
d.”
e Plan Admi
ts:
r both).
or a dependator within 60efits Departmualifying eve
RA continuay will have act COBRA nuation cove
asts for 18 ma second quaum of 36 mo
rage can be
y to be disabentitled to g
The disabilitye and must
Plan
duct;
inistrator
dent child’s 0 after the
ment (913) ent must be
ation an
erage on
months due alifying onths of
extended:
bled and get up to an y would last at
Sec
If yothe scoveexteif thebothdepespou
Are
Yesyour(succostwww
If yo
QuecontPatieReg(EBSEBSwww
Kee
To pmem
30 | CBIZ B
cond qualify
our family exspouse and erage, for a ension may be employee h); gets divorendent childuse or depen
there other
. Instead of r family throuch as a spout less than Cw.healthcare
ou have que
estions concetact or contaent Protectioional or DistSA) in your a
SA Offices arw.HealthCare
ep your Plan
protect your mbers. You s
Plan con
Kansas C
CBIZ teamKansas C
Benefits & In
ying event e
periences adependent cmaximum ofbe available or former emrced or legal. This extenndent child t
r coverage o
enrolling in Cugh the Hea
use’s plan) thCOBRA contie.gov.
estions
erning your acts identifiedon and Affortrict Office ofarea or visit re available e.gov.
n informed o
family’s righshould also k
tact informat
City, KS 66104
m: Jennifer McCity, MO 6411
nsurance S
extension o
nother qualifchildren in yf 36 months,to the spous
mployee dieslly separatedsion is only to lose cover
options bes
COBRA conlth Insuranc
hrough what inuation cove
Plan or yourd below. Forrdable Care Af the U.S. Dewww.dol.gothrough EBS
of address
ts, let the Plkeep a copy
tion: KCKPS 4
cKee, Account2
Services
f 18-month
fying event dour family ca, if the Plan ise and any ds; becomesd; or if the deavailable if trage under t
sides COBR
tinuation cove Marketplais called a “erage. You
r COBRA cor more informAct, and othepartment ofv/ebsa. (AdSA’s website
changes
an Administy, for your rec
USD #500, J
t Executive; A
period of c
during the 18an get up to is properly ndependent centitled to Mependent chthe second qhe Plan had
RA Continua
verage, therce, Medicaidspecial enrocan learn m
ntinuation comation abouter laws affecf Labor’s Em
ddresses ande.) For more
rator know acords, of any
a’Nice Mitche
Ann Spletstose
continuation
8 months of18 additiona
notified abouchildren gettiMedicare benhild stops beiqualifying evd the first qua
ation Cover
re may be otd, or other gollment perio
more about m
overage right your rightscting group
mployee Bend phone num information
about any chy notices yo
ell, Senior Ben
er, Senior Acc
n coverage
COBRA conal months of
ut the secondng COBRA
nefits (undering eligible u
vent would haalifying even
rage?
ther coveragroup health
od.” Some ofmany of thes
hts should be under the Chealth plans
nefits Securitmbers of Reg about the M
hanges in theu send to th
nefits Specialis
count Manage
ntinuation cof COBRA cod qualifying econtinuation
r Part A, Parunder the Plaave caused
nt not occurre
ge options foplan coveraf these optioe options at
e addressedCOBRA law,s, contact thety Administragional and D
Marketplace,
e addressese Plan Adm
st, 2010 N. 59
r, 700 West 4
overage, ontinuation event. This n coverage rt B, or an as a the ed.
or you and ge options
ons may
d to the the
e nearest ation
District visit
s of family inistrator.
9th Street,
47th Street,
PreInsIf yoempfrombe ethro If yocont If yodepe1-87has If youndeenroof bemp If yoheaStat
AL
W
Ph
AL
W
htt
Ph
Ph
CO
Me
Me
FL
W
Ph
31 | CBIZ B
emium Asurance ou or your chployer, your sm their Mediceligible for thugh the Hea
ou or your detact your Sta
ou or your deendents mig77-KIDS NOa program t
ou or your deer your empolled. This isbeing determployer plan, c
ou live in onlth plan prete for more
LABAMA –
Website: http://
hone: 1‐855‐69
LASKA – M
Website:
tp://health.hs
hone (Outside
hone (Anchora
OLORADO
edicaid Webs
edicaid Custo
LORIDA –
Website: http://
hone: 1‐877‐35
Benefits & In
AssistanProgram
hildren are estate may hacaid or CHIPhese premiumalth Insuranc
ependents aate Medicaid
ependents aght be eligibl
OW or www.ithat might he
ependents aloyer plan, ys called a “smined eligibcontact the D
ne of the folemiums. Thinformation
– Medicaid
/myalhipp.com
92‐5447
Medicaid
ss.state.ak.us/
e of Anchorage
age): 907‐269
O – Medicaid
ite: http://ww
mer Contact
Medicaid
/flmedicaidtp
7‐3268
nsurance S
nce Undm (CHIPligible for Meave a premiu
P programs. m assistancece Marketpla
re already ed or CHIP off
re NOT curre for either oinsurekidsnelp you pay t
re eligible foyour employpecial enroll
ble for premDepartment
llowing stathe followingn on eligibil
m/
dpa/program
e): 1‐888‐318‐8
‐6529
d
ww.colorado.g
Center: 1‐800
lrecovery.com
Services
der MediP)
edicaid or Cum assistan If you or yoe programs
ace. For mo
enrolled in Mfice to find o
rently enrolleof these prognow.gov to fthe premium
or premium aer must allowlment” oppo
mium assistaof Labor at w
tes, you mag list of statlity –
ms/medicaid/
8890
gov/hcpf
‐221‐3943
m/hipp/
caid and
CHIP and youce program ur children abut you mayre informatio
edicaid or Cout if premium
ed in Medicagrams, contafind out how
ms for an em
assistance uw you to enrrtunity, and yance. If youwww.askeb
ay be eligibltes is curren
GEO
Webs
‐ Clic
Phon
INDI
Healt
Webs
Phon
All ot
Webs
Phon
IOW
Webs
Phon
KAN
Webs
Phon
d the Ch
u’re eligible fthat can he
aren’t eligibley be able to on, visit www
CHIP and yom assistanc
aid or CHIP, act your Sta
w to apply. Ifmployer-spon
under Medicaroll in your eyou must re have quest
bsa.dol.gov
le for assistnt as of Jan
ORGIA – M
site: http://dc
k on Health I
ne: 404‐656‐45
IANA – Me
thy Indiana Pl
site: http://ww
ne: 1‐877‐438‐4
ther Medicaid
site: http://ww
ne 1‐800‐403‐0
WA – Medica
site: http://ww
ne: 1‐888‐346‐9
NSAS – Med
site: http://ww
ne: 1‐785‐296‐3
hildren’s
for health colp pay for coe for Medicabuy individuw.healthcar
u live in a Ste is availabl
and you thinate Medicaidf you qualifynsored plan.
aid or CHIP,employer plaequest covetions about ev or call 1-86
tance payinnuary 31, 20
Medicaid
ch.georgia.gov
Insurance Prem
507
edicaid
lan for low‐in
ww.hip.in.gov
4479
d
ww.indianame
0864
aid
ww.dhs.state.i
9562
dicaid
ww.kdheks.go
3512
s Health
overage fromoverage, usiaid or CHIP, ual insurancere.gov.
tate listed bee.
nk you or an or CHIP off
y, ask your st
, as well as ean if you arenerage withienrolling in y66-444-EBSA
ng your emp016. Contac
v/medicaid
mium Payme
ncome adults 1
v
edicaid.com
ia.us/hipp/
ov/hcf/
h
m your ng funds you won’t
e coverage
elow,
ny of your fice or dial tate if it
eligible n’t already n 60 days
your A (3272).
ployer ct your
nt (HIPP)
19‐64
KE
W
Ph
LO
Whtt
Ph
M
Wass
Ph
TT
M
W
Ph
M
W
Ph
M
Whtthtm
Ph
M
WhttPP
Ph
NE
Whtteb
Ph
32 | CBIZ B
ENTUCKY
Website: http://
hone: 1‐800‐63
OUISIANA
Website: tp://dhh.louis
hone: 1‐888‐69
MAINE – Me
Website: http://sistance/index
hone: 1‐800‐44
TY: Maine rela
MASSACHU
Website: http://
hone: 1‐800‐46
MINNESOTA
Website: http://
hone: 1‐800‐65
MISSOURI –
Website: tp://www.dssm
hone: 573‐751‐2
MONTANA –
Website: tp://dphhs.mtP
hone: 1‐800‐69
EBRASKA
Website: tp://dhhs.ne.graska/Pages/a
hone: 1‐855‐63
Benefits & In
Y – Medicaid
/chfs.ky.gov/d
35‐2570
A – Medicaid
siana.gov/inde
95‐2447
edicaid
/www.maine.gx.html
42‐6003
ay 711
USETTS – M
/www.mass.go
62‐1120
A – Medicai
/mn.gov/dhs/
57‐3739
– Medicaid
.mo.gov/mhd
2005
– Medicaid
t.gov/Montan
94‐3084
– Medicaid
gov/Children_accessnebrask
2‐7633
nsurance S
d
dms/default.h
d
ex.cfm/subho
gov/dhhs/ofi/
Medicaid an
ov/MassHealt
id
/ma/
d/participants
naHealthcareP
d
_Family_Servika_index.aspx
Services
htm
ome/1/n/331
/public‐
d CHIP
th
/pages/hipp.
Programs/HI
ices/AccessNx
NEW
Webshttp:/
Phon
NEW
Medic
http:/
dmah
Medic
CHIPhttp:/
CHIP
NEW
Webshttp:/
Phon
NOR
Webs
Phon
NOR
Webshttp:/d/
Phon
OKL
Webs
Phon
ORE
Webs
Phon
PEN
Webs
Phon
W HAMPSH
site: //www.dhhs.n
ne: 603‐271‐521
W JERSEY
caid Website:
//www.state.n
hs/clients/med
caid Phone: 6
P Website: //www.njfami
P Phone: 1‐800
W YORK –
site: //www.nyhea
ne: 1‐800‐541‐2
RTH CARO
site: http://ww
ne: 919‐855‐41
RTH DAKO
site: //www.nd.gov
ne: 1‐844‐854‐4
LAHOMA –
site: http://ww
ne: 1‐888‐365‐3
EGON – Me
site: http://ww
http://wwne: 1‐800‐699‐9
NNSYLVAN
site: http://ww
ne: 1‐800‐692‐7
HIRE – Med
nh.gov/oii/do
18
– Medicaid
:
nj.us/humans
dicaid/
609‐631‐2392
ilycare.org/in
0‐701‐0710
Medicaid
lth.gov/health
2831
OLINA – Me
www.ncdhhs.go
100
OTA – Medi
v/dhs/services
4825
– Medicaid
ww.insureokla
3742
edicaid
ww.oregonhea
ww.hijossaluda9075
NIA – Medic
ww.dhs.pa.gov
7462
dicaid
ocuments/hipp
d and CHIP
ervices/
dex.html
h_care/medic
edicaid
ov/dma
icaid
s/medicalserv
and CHIP
ahoma.org
althykids.gov
ablesoregon.g
caid
v/hipp
papp.pdf
caid/
v/medicai
gov
NE
Me
Me
SO
W
Ph
SO
W
Ph
TE
W
Ph
UT
W
Me
CH
Ph
VE
W
Ph
To sinfor U.S. Empwww1‐86 OMB
33 | CBIZ B
EVADA – M
edicaid Webs
edicaid Phone
OUTH CAR
Website: http://
hone: 1‐888‐54
OUTH DAK
Website: http://
hone: 1‐888‐82
EXAS – Me
Website: http://
hone: 1‐800‐44
TAH – Med
Website:
edicaid: http:/
HIP: http://he
hone: 1‐877‐54
ERMONT–
Website: http://
hone: 1‐800‐25
see if any othrmation on s
Departmenployee Benefw.dol.gov/e6‐444‐EBSA
B Control Num
Benefits & In
Medicaid
ite: http://dw
e: 1‐800‐992‐0
ROLINA – M
/www.scdhhs
49‐0820
KOTA - Me
/dss.sd.gov
28‐0059
edicaid
/gethipptexas
40‐0493
dicaid and C
//health.utah
ealth.utah.gov
43‐7669
– Medicaid
/www.greenm
50‐8427
her states hav special enrol
t of Labor fits Security Aebsa A (3272)
mber 1210‐0137
nsurance S
wss.nv.gov/
0900
Medicaid
.gov
dicaid
.com/
CHIP
.gov/medicaid
v/chip
mountaincare.
ve added a pllment rights
Administrati
7 (expires 10/3
Services
d
org/
premium assis, contact eit
ion
31/2016)
RHO
Webs
Phon
VIRG
Medichttp:/e.cfm
Medic
CHIPhttp:/e.cfm
CHIP
WAS
Webshttp:/s/inde
Phon
WES
Webshttp://Page
Phon
WIS
Webs
https5.pdf
Phon
WYO
Webs
Phon
istance progrther:
U.S. D Cente www. 1‐877‐
ODE ISLAN
site: http://ww
ne: 401‐462‐530
GINIA – M
caid Website://www.coverv
m
caid Phone: 1
P Website: //www.coverv
m
P Phone: 1‐855
SHINGTON
site: //www.hca.waex.aspx
ne: 1‐800‐562‐
ST VIRGIN
site: //www.dhhr.wes/default.asp
ne: 1‐877‐598‐
SCONSIN –
site:
://www.dhs.wf
ne: 1‐800‐362‐3
OMING – M
site: https://w
ne: 307‐777‐753
ram since Ja
Department ers for Medic.cms.hhs.go‐267‐2323, M
ND – Medic
ww.eohhs.ri.g
00
Medicaid and
: va.org/program
1‐800‐432‐592
va.org/program
5‐242‐8282
N – Medicai
a.gov/medica
‐3022 ext. 1547
NIA – Medic
wv.gov/bms/Mpx
5820, HMS Th
Medicaid a
wisconsin.gov
3002
Medicaid
wyequalitycare
31
anuary 31, 201
of Health ancare & Medicov
Menu Option
aid
gov/
d CHIP
ms_premium
24
ms_premium
id
id/premiump
73
caid
Medicaid%20E
hird Party Lia
and CHIP
/publications
e.acs‐inc.com/
16, or for mo
nd Human Secaid Services 4, Ext. 61565
_assistanc
_assistanc
pymt/page
Expansion
ability
/p1/p1009
/
ore
ervices s 5
No
TheempwellAmethe to passebehdisefor Hrequ
How$24Althemp
AddrelascreA HHeaachreasacco
Theprovalsoactivor c
Pro
We infomayworinfofor apermwithuse
34 | CBIZ B
otice Reg
e USD 500 ployees. Thlness progrericans withHealth Insu
participate inessment oraviors and
ease). You HDL, LDL, uired to com
wever, emp40 additionahough you aployees wh
ditional inceated activitieeening and ealthier Yo
alth Savingsieve any ofsonable accommodatio
e informatiovide you wio be used tovities throu
concerns wi
otections fr
are requirermation. Aly use aggrerkplace, thermation eitha reasonabmitted by lah the wellned to make d
Benefits & In
garding
Employee Whe program rams that seh Disabilitieurance Portn the wellner "HRA" thawhether yowill also beGlucose, Bmplete the H
ployees whoal premium are not requo do so wil
entives of upes or achievhealth risk
ou program s account. f the health commodati
on or an alte
n from youth informato offer you gh the empth your own
rom Disclo
ed by law tothough the
egate informe KCKPS Emher publicly
ble accommaw. Medicaless programdecisions re
nsurance S
Wellnes
Wellness Pis administ
eek to impres Act of 19tability and ess program
at asks a seou have or e asked to cBlood PressHRA or to p
o choose towaived from
uired to coml have the $
p to $200 mve certain hassessmewill receiveIf you are uoutcomes on or an alternative sta
r HRA and ion to help services th
ployee wellnn doctor.
osure of Me
o maintain twellness p
mation it comployee Wy or to the e
modation nel informatio
m will not beegarding yo
Services
ss Progr
Program is atered accorrove employ990, the Ge
Accountabm you will beries of quehad certain
complete a sure, Heightparticipate
o participatem your heamplete the H$240 additio
may be avahealth outcont, employe
e a $200 counable to prequired toternative st
andard by c
the results you unders
hrough the Bness progra
edical Info
the privacy program andllects to de
Wellness Proemployer, eeded to pan that perse provided our employ
ram
a voluntary rding to fedyee health netic Inform
bility Act, asbe asked tostions abou
n medical cobiometric st, Weight ain the blood
e in the welalth premiumHRA or paronal premiu
ilable for emomes. In aees who eaontribution tparticipate ino earn an intandard. Yocontacting S
from your stand your cBlue Cross am. You al
rmation
and securid Kansas Csign a progogram will nexcept as nerticipate in onally idento your supment.
wellness pderal rules p
or prevent mation Nons applicableo complete ut your heaonditions (escreening, wnd Waist Cd test or oth
lness progrms for the nrticipate in tum waived.
mployees wddition to c
arn a total oto their Medn any of the
ncentive, yoou may requStephanie C
biometric scurrent heaA Healthie
lso are enc
ty of your pCity Kansasgram basednever discloecessary tothe wellnestifies you th
pervisors or
program avapermitting edisease, indiscriminat
e, among ota voluntary
alth-related e.g., cancerwhich will in
Circumferenher medica
ram will recnext insuranthe biometr.
who participcompleting tof 3200 poindical Flexibe health-relou may be euest a reasConner at (
screening walth and poter You progcouraged to
personally ids Public Schd on identifiose any of yo respond tss programhat is providr managers
ailable to aemployer-spncluding thetion Act of 2thers. If you
y health riskactivities ar, diabetes,nclude a blo
nce. You arl examinati
ceive an incnce plan yeric screenin
pate in certathe biometrnts in the Ble Spendinated activit
entitled to asonable 913) 279-2
will be used tential risksram, as we
o share you
dentifiable hools – USed health ryour persono a request
m, or as expded in conn
s and may n
ll ponsored e 2008, and u choose k nd , or heart ood test re not ons.
centive of ear. ng, only
ain health-ric
Blue Cross g or ties or a
030.
to s, and may ell as r results
health D 500 isks in the nal t from you ressly nection never be
Youthe will partinfosamidenprog
In asepinfodecbreanoti
Youprovyou
If yoand
35 | CBIZ B
ur health infextent permnot be asketicipating inrmation for
me confidenntifiable heagram.
addition, all arate from rmation youision. Apprach occurs fy you imm
u may not bvide as part choose no
ou have que retaliation,
Benefits & In
formation wmitted by laed or requir the wellne
r purposes ontiality requialth informa
medical infyour persou provide aropriate preinvolving in
mediately.
be discrimint of particip
ot to particip
estions or c, please co
nsurance S
will not be soaw to carry ored to waiv
ess programof providingirements. Tation is Blue
formation onnel record
as part of thecautions wnformation
nated againpating in thepate.
concerns rentact Steph
Services
old, exchanout specifice the confid
m or receiving you servicThe only inde Cross in o
btained thrds, informate wellness
will be takenyou provide
st in emploe wellness p
egarding thihanie Conn
This guid
nged, transfc activities rdentiality ofng an incences as part dividual(s) worder to pro
ough the wtion stored program w
n to avoid ae in connec
yment becaprogram, no
is notice, orer at (913)
de prepared
ferred, or orelated to thf your healtntive. Anyonof the well
who will recovide you w
wellness proelectronica
will be used any data brection with th
ause of theor may you
r about pro279-2030.
d by:
otherwise dihe wellnessth informatione who recness progr
ceive your pwith services
ogram will bally will be e
in making each, and inhe wellness
e medical inu be subject
tections ag
isclosed exs program, on as a con
ceives your am will abidpersonally s under the
be maintainencrypted, aany employn the events program, w
nformation yted to retali
gainst discri
xcept to and you ndition of
de by the
e wellness
ned and no yment t a data we will
you iation if
mination