EMPLOYEE BENEFITS GUIDE

Casa Grande Union High School District

2013 / 20142014 / 2015

TABLE OF CONTENTS

INTRODUCTION

Enrollment InformationLife Status Change / COBRA Medical Medical PlansMedical Coverage ExamplesDental PlansVision Plans Life InsuranceShort & Long Term DisabilityEmployee Assistance ProgramRate WorksheetEnrollment InstructionsImportant Phone Numbers

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Whether you are a new employee enrolling into your benefits for the first time or considering your benefits during open enrollment, this guide is designed to help you through the process.

Casa Grande Union High School District is proud to offer you a broad range of benefit options. You can choose from a number of plans including medical, dental, vision, life insurance and voluntary supplement programs. In addition, we provide health care and dependent care reimbursement accounts to assist employees in managing their out-of-pocket expenses with before-tax dollars.

Please take the time to read this information and ask questions so you can make the best benefits decisions for both you and your family.

If you should have any questions:

1. Contact the carrier directly. Phone number and web-site information is on page 14.

2. Contact Mary Ann Amerson, Director of Human Resources, at 520.316.3360 x 1104 or mamerson@cguhsd.org.

This booklet highlights important features of Casa Grande Union High School District’s benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information pre-sented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.

Pre-Tax Dollars: Your insurance premiums are paid with money removed from your gross wages prior to any tax calculations. This reduces your tax liability and is a more efficient way to pay for premiums. Remem-ber, you must choose pre-tax deductions for all your benefits to participate in a flexible spending account. You may elect to opt-out of this method of paying.

Post-Tax Dollars: You may elect to have your insur-ance premiums paid after taxes are deducted from your gross pay. If you would like to choose this option, please contact Mary Ann Amerson, Director of Human Resources, prior to enrollment.

Open Enrollment is from May 14 through May 23, 2014. This is your one time per year to make changes.

If you do not login and make changes during Open En-rollment, your current benefit elections will carry over to the new plan year (with the exception of the FSA).

However, you are required to re-elect medical/depen-dent FSA amounts for the new plan year.

New Employees have 31 days from your hire date to complete enrollment in the group insurance program. If you have moved from a non-benefits eligible status to a benefits eligible status, you will have 31 days from the new benefits eligible status to complete your enrollment. All insurance coverage starts at the first of the month.

Remember, if elections are not made within the 31-day initial period of eligibility, you will be required to wait until Annual Open Enrollment or until a Qualifying Life Event takes place. Late Enrollees will be required to complete an evidence of insurability form for volun-tary life insurance. You may be turned down for these benefits if you do not enroll within your first 31 days as a new hire.

ENROLLMENT INFORMATION

OPEN ENROLLMENT

NEW EMPLOYEES

PRE-TAX VS POST-TAX DEDUCTIONS

The elections that you make during Open Enrollment or at initial benefits eligibility will remain in effect for the plan year (July 1, 2014 – June 30, 2015). During that time, if your life or family status changes accord-ing to the recognized events listed below, you are per-mitted to revise your benefits coverage to accommo-date your new status. You may make benefits changes by contacting the Benefits Department and providing the proper documentation.

IRS regulations govern under what circumstances you may make changes to your benefits, which benefits you can change and what kinds of changes are permitted.

In most cases, if your employment ends, benefits will terminate on the last day of the month in which you worked. Benefits will end on the day of termination in cases of employee fraud.

Through federal legislation known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may choose to continue coverage by paying the full monthly premium cost plus an administrative charge of 2% (if applicable).

Each individual who is covered by a Casa Grande Union High School District benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental, vision, or Flexi-ble Spending Accounts (FSA) plan.

The right to continuation of coverage ends at the earli-est of the date: • you, your spouse or dependents become covered under another group health plan; or, • you become entitled to Medicare; or, • you fail to pay the cost of coverage; or • your COBRA Continuation Period expires

• All changes must be consistent with the qualifying life event.

• In most cases, you cannot change your benefit plan, but may modify the level of yourcoverage (in other words, you can add or de- lete dependents, enroll or dis-enroll yourself or dependents, but not switch insurance carri- ers or plans).

Any changes in benefit levels must be completed within 31 days of the qualifying life event.

QUALIFYING LIFE EVENT

COBRA

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QUALIFYING LIFE EVENTS LISTMarital Status Changes

Covered Dependent Changes

• Marriage• Death of spouse• Divorce• Spouse gains or loses coverage from another source• Spouse employer’s Open Enrollment

• Birth or adoption of a child• Death of dependent child• Dependent becomes ineligible for coverage

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MEDICAL PLAN INFORMATION

SUMMARY HEALTH SAVINGS ACCOUNT (H.S.A.)

Medical benefits provide you and your family access to quality health care. Casa Grande Union High School District offers three medical plans with different cover-age levels from which to choose. All plans are provided through Arizona School Boards Association Insurance Trust (ASBAIT). ASBAIT contracts with BlueCross BlueShield of Arizona to use their PPO Network with claims processing and customer service being provided by Meritain Health Company.

To search for a BlueCross BlueShield of Arizona PPO provider please go to www.azblue.com. Click on the Search the Provider Directory.

To contact Meritain, please go to www.meritain.com or contact them at 800.762.2234.

If you choose to enroll in the HDHP plan, you will have the option of opening up a Health Savings Account (H.S.A.) provided by HealthEquity. An H.S.A. is a tax-advantaged savings and spending account that can be used to pay for qualified health care expenses. There are two components to an H.S.A.-based coverage plan: 1. A qualified health plan is the insurance compo-nent that provides medical coverage for you and your family. This health plan includes a deductible of $1,250 for individuals and $2,500 for family coverage.2. An H.S.A. with HealthEquity which can be funded by pre-tax payroll contributions from you, the district, or both. Please visit www.healthequity.com or contact them at 866.346.5800 for more information.

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2ASBAIT

CGUHSD

MeritainHealth

Company

Blue Cross/ Blue Shield

1

2 3 3

The Trust that will provide medical insurance to Casa Grande Union High School District.

The network Casa Grande Unified School District will use for hospitals and physicians.

The company that will process Casa Grande Union High School District’s medical claims.

MERITAIN CONTACT

www.mymeritain.com

Value Gold (C30)HDHP*

In NetworkIn Network

w/ Health Savings Account

Lifetime MaximumCalendar Year

Deductibles

Out-of-Pocket Maximum(Deductible Included)

Hospital Services

Routine Services

Prescription Drugs

Inpatient HospitalOutpatient HospitalEmergency RoomUrgent Care

Office VisitSpecialist VisitPreventive CareLab & X-RayChiropracticRehabilitation

Tier 1Tier 2Tier 3Mail-OrderDiabetic Medications

$250 Copay, then 25%Deductible, then 25%Deductible, then 25%$50 Copay, then 25%

$250 Copay, Deductible, then 20%Deductible, then 20%Deductible, then 20%$50 Copay, Deductible, then 20%

$35 Copay$45 CopayCovered in FullDeductible, then 25%$35 Copay$35 Copay

Deductible, then 20%Deductible, then 20%Covered in FullDeductible, then 20%Deductible, then 20%Deductible, then 20%

$15 Copay20% (min$25-max$80) 30% (min$40-max$110)2x Retail$5 Generic, $10 Brand

Deductible, then 20%Deductible, then 20%Deductible, then 20%Deductible, then 20%Deductible, then 20%

$250 Copay$75 Copay$150 Copay$50 Copay

$30 Copay$40 CopayCovered in Full$30 Copay$30 Copay$30 Copay

$15 Copay20% (min$25-max$80) 30% (min$40-max$110)2x Retail $5 Generic, $10 Brand

IndividualFamily

$5,000$10,000

$6,000$12,000

$6,350$12,700

IndividualFamilyCoinsurance

$500$150025%

$1,250$2,500**20%

NoneNoneN/A

UnlimitedUnlimited

UnlimitedUnlimited

UnlimitedUnlimited

In Network

Copay Gold (A25)

**If you have Family coverage under the HDHP, the Family Deductible must be satisfied before the Plan will pay any benefits.

MEDICAL PLANS

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MEDICAL COVERAGE EXAMPLES

HDHP

HDHP

Value Gold (C30)

Value Gold (C30)

Copay Gold (A25)

Copay Gold (A25)

Hospital Charges (mother)Routine obstetric careHospital charges (baby)AnesthesiaLaboratory tests Prescriptions RadiologyVaccines, other preventive Total

PrescriptionsMedical Equipment and SuppliesOffice Visits and ProceduresEducationLaboratory tests Vaccines, other preventive Total

DeductiblesCopaysCoinsuranceLimits or exclusionsPatient Pays

DeductiblesCopaysCoinsuranceLimits or exclusionsPatient Pays

$2,700$2,100$900$900$500$200$200$40$7,540

$2,900$1,300$700$300$100$100$5,400

$1,250$250$310$150$1,960

$1,250$0$800$80$2,130

$500$270$570$150$1,490

$500$920$290$80$1,790

$0$970$0$150$1,120

$0$1,520$0$80$1,600

These examples show how each plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under the different plans available at Casa Grande Union High School District.

Example #1 – Having a baby (normal delivery)

Example #2 – Managing a well-controlled condition

DENTAL PLANS

All dental plans include preventive services and office visits.

DELTA DENTAL PPO BUY UP OPTION DELTA DENTAL PPO BASE OPTION

Annual Deductible Annual Deductible

Benefits Benefits

Orthodontic Benefits Orthodontic Benefits

Other Benefits Other Benefits

Individual Family Annual Plan Maximum

Individual Family Annual Plan Maximum

$50 $150 $2,000

$50 $150 $1,000

Type 1 - Diagnostic and PreventiveType II - Basic ServiceType III - Major Services

Type 1 - Diagnostic and PreventiveType II - Basic ServiceType III - Major Services

100% in / 100% out80% in / 80% out 50% in / 50% out

100% in80% in50% in

Orthodontia Age Limitation Lifetime Maximum

Orthodontia Age Limitation Lifetime Maximum

19 years old 50% to $1,500

N/AN/A

Periodontic Coverage Endodontic Coverage

* In & Out-of-Network Coverage Available

* Stay In-Network

Periodontic Coverage Endodontic Coverage

80% in / 80% out 80% in / 80% out

80% in80% in

Reimbursed to $45$10 Copay

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DELTA DENTAL PPO BASE OPTION

VISION PLAN

AVESIS VISION OPTION AT A GLANCE

All lenses are covered.Lasik Surgery allowance.

FrequencyMaterials

Frequency

Frequency

Frequency

Frequency

Exam

LensesSingle/Bifocal/Trifocal/Lenticular

Frames

Contact Lenses

Lasik Surgery

Every 12 Months$10 Copay

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Every 12 Months

Covered 100% Reimbursed to $30 to $100depending on lens

$50 Wholesale Allowance

Medically Necessary-Covered in FullElective-$130 Allowance

$150 Allowance

Reimbursed to $70

Medically Necessary-Reimbursed to $250Elective-Reimbursed to $130

$150 Reimbursement

In Network Out of Network

Life insurance provides protection for those who depend on you financially. Your need varies greatly due to age, number of dependents, dependent ages and your financial situation. Accidental Death and Dismem-berment (AD&D) benefits provide a benefit to you or your beneficiary if you are seriously injured or die in an accident.

Casa Grande Union High School District pays 100% of the cost of the Reliance Standard Term LifeInsurance Plan. Coverage for each benefit eligible employee is $50,000 Life and AD&D Benefit.

You may purchase additional coverage through a term life insurance policy available from Reliance Standard. If you are a new hire and do NOT enroll within your first 31 days of hire, then choose at a later date to enroll, you must qualify for this benefit by com-pleting an Evidence of Insurability form. If you have previously declined this benefit and would like to enroll during Open Enrollment, you must also complete an Evidence of Insurability form.

LIFE AND AD&D INSURANCE

BASIC LIFE INSURANCE AND AD&D

VOLUNTARY LIFE INSURANCE AND AD&D

Purchase up to $300,000 in $10,000 increments not to exceed 5 times salaryGuarantee Issue: $300,000

Employee

Spouse

Child(ren)

50% of employee benefit to a maximum of $30,000 in $5,000 increments Guarantee Issue: $30,000

Purchase up to $10,000 in $2,500 increments

Disability coverage can be one of the most important benefits you have. It provides you and your family with financial protection if you are ever unable to work due to an illness or non-work related injury.

DISABILITY INFORMATION

Casa Grande Union High School District pays the en-tire cost of the Reliance Standard policy.

Elimination Period: Benefit Amount:

Benefit Duration:

All employees who work 20 or more hours per week for 20 weeks per year will pay premiums through mandatory contributions to Arizona State Retirement System (ASRS) for Long Term Disability (LTD). Elimination period: Benefit Amount:

SHORT TERM DISABILITY

LONG TERM DISABILITY

Casa Grande Union High School District pays 100% of the cost of the Term Life and Short Term Disability Plan.

180 Days66 2/3% of monthly base salary as determined by ASRS

30 Days50% of pre-disability weekly earnings up to $750 22 Weeks

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EMPLOYEE ASSISTANCE PROGRAM CONTACT1-800-343-3822www.alliancewp.com

Alliance Work Partners - An EAP provides valuable services at no cost to employees and their families in the form of short-term counseling, legal and financial consultations through LawAccess, and worklife resources and referral through Work/Life Standard. Seven days a week, 24 hours a day, using one toll-free phone number, you can speak with registered nurses and master’s-level counselors who can help with almost any problem ranging from medical and family matters to personal legal, financial and emotional needs.

If face-to-face resources are appropriate for your situation, a representative can refer you to a local professional in the BCBS of Arizona PPO Network. If appropriate, the program also provides access to a wide range of national and community resources.

An EAP Teen Line 800-334-TEEN (8336) specializing in teen issues is an additional resource available as well as a 24-Hour Nurseline at 888-771-9116 for all medical questions and health issues.

To create a personal account:Go to www.alliancewp.comLogin using: email: asbaitmember@alliancewp.com password: AWP4me (Case Sensitive)You will be prompted to create a unique username and password.

EMPLOYEE ASSISTANCE PROGRAM

Use this worksheet to provide a general estimate of your benefits costs for the upcoming plan year. This is a great place to start planning for you and your family’s health and wellness for next year.

EMPLOYEE RATE WORKSHEET

MEDICAL PLANS

DENTAL PLANS

HDHP

BASE

VALUE GOLD

BUY UP

COPAY GOLD

VISION PLAN

26 PAYS$0.00$160.62$135.23$266.31

26 PAYS$0.00$11.61$11.84$23.62

EMPLOYEE ONLYEMPLOYEE & SPOUSEEMPLOYEE & CHILDRENEMPLOYEE & FAMILY

EMPLOYEE ONLYEMPLOYEE & SPOUSEEMPLOYEE & CHILDRENEMPLOYEE & FAMILY

22 PAYS$0.00$214.36$179.45$356.18

22 PAYS$9.69$33.08$38.56$67.34

22 PAYS$41.45$299.45$258.00$470.18

22 PAYS$0.00$2.71$3.98$5.78

22 PAYS$0.00$189.82$159.82$314.73

22 PAYS$0.00$13.72$13.99$27.91

26 PAYS$35.08$253.38$218.31$397.85

26 PAYS$0.00$2.29$3.37$4.89

26 PAYS$0.00$181.38$151.85$301.38

26 PAYS$8.20$27.99$32.63$56.98

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The annual Open Enrollment Period for making benefit changes is May 14 through May 23. During this period, you may review and update your benefit elections online per the following instructions.

Online assistance will be provided at the Benefit Fair dates listed below.

INSTRUCTIONS: Each screen contains step by step instructions to guide you through the enrollment process. Please read the instructions carefully before making your selection(s). There is a video tutorial/guide that will walk you through the process. The instruc-tions and video are available in multiple languages. Please review your current elections to ensure accuracy of your enrollment and personal information.

Go to: http://secure.commonbenefits.com/mars/

Click on “Select Company”

Click on “C” on top of screen and choose Casa Grande Union High School.

Click on “Employee Login”

Enter “Account Name” and “Password”

Click “Login”

ENTER YOUR BENEFICIARY INFORMATIONGroup Term Life AD&D - “View/Modify” and then “Edit”Voluntary LIfe & AD&D - “View/Modify” and then “Edit”

Benefit Fairs & Online Assistance

An Aflac Representative will be available May 14-16 during the scheduled times below.

Vista Grande High SchoolLocation: Computer LabWednesday, May 141:30 – 4:00

Casa Grande Union High SchoolCasa Verde High SchoolLocation: Room D204Thursday, May 152:30 – 4:30

Desert Winds High SchoolDistrict OfficeLocation: Computer LabFriday, May 162:00 – 3:30

Last opportunity for online assistance will be held at:Casa Grande High SchoolVista Grande High SchoolFriday, May 239:00 – 11:00

For account name and password help, please contact Julie Roden at 480.440.4116 or julie@cfplc.com

LOGIN INSTRUCTIONS FOR EMPLOYEES

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ASBAITBlue Cross/Blue Shield Medical800.762.2234www.azblue.comEmployee Portal: www.mymeritain.com

HealthEquityMedical866.346.5800www.healthequity.com Delta DentalDental PPO602.938.3131, option 1www.deltadentalaz.com Avesis Vision800-522-0258www.avesis.com Alliance Work PartnersEAP & Nurse Support800.343.8822 (EAP) 800.334.8336 (Teen Line)888-771-9116 (Nurse)www.alliancewp.com Reliance Standard Basic & Voluntary Life AD&D Short Term Disability800.351.7500www.reliancestandard.com

Arizona State Retirement SystemLong Term Disability520-239-3100 800-621-3778www.azasrs.gov

Mary Ann AmersonDirector of Human Resources520.316.3360 x 1104mamerson@cguhsd.org

FSA/COBRA/Retiree InquiriesRobert AmadoAccounting Supervisor520.316.3360 x 1105ramado@cghusd.org

Mary Jane RadelPayroll Clerk520.316.3360 x 1114mjradel@cghusd.org

IMPORTANT PHONE NUMBERS

This booklet highlights important features of Casa Grande Union High School District’s benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the con-tracts that govern these plans.

ABOUT THIS BOOKLET

Capital Financial21819 N Scottsdale Road, Suite 100 Scottsdale, AZ 85255Office / 480.440.4116Fax / 480.794.1703