Employee Benefits Overview

Overview

Benefits at-a-Glance

• Medical/Prescription Drugs• Dental• Vision• Flexible Spending Accounts (FSAs)• Life and AD&D Insurance• Disability Insurance• Critical Illness Insurance

Employee Eligibility

• Employees who are regularly scheduled to work 20 or more hours per week– Exception: If you work more than 10 hours per week but

less than 20 hours per week, you may enroll only in medical coverage (at full cost)

Dependent Eligibility

• Your legal spouse• Your children up to age 26 regardless of marital or

student status

Important Note: Covering ineligible dependents may result in penalties up to and including removal from the TRS-ActiveCare medical plan

Employees Waiving Medical

• If waiving medical for the first time, you must submit a TRS ActiveCare Enrollment Application and Change Form

• Complete Sections 1,2 & 9• Submit to GPISD Benefits Department• Form can be downloaded from

www.galenaparkisd.com/benefits• Allows you to add coverage mid-year due to loss of

other coverage

When to Enroll

New Employees• Within 31 days of your eligibility date

Current Employees• During the Open Enrollment period:

August 1 – August 31, 2011

Qualifying Changes in Status

• Examples:– Marriage– Divorce– Birth or adoption of a child– Loss of other health coverage

(see also previous slide on Employees Waiving Medical)

How to Enroll• Review your benefit options• Make your decisions for 2011-2012• Go to www.go2myba.com • User Name: First Initial of First Name followed by last

name and last four digits of SSN• Example: For Leonardo da Vinci, SSN 123-45-6789,

user ID would be ldavinci6789• Password: gpisd• Print and save your Confirmation Statement!

“Pooled” Medical Premium(Formerly Called “Two Employee” Rate)

• Available if both you and your spouse work for GPISD and you are both eligible for benefits

• Saves you money on the Family rate• May result in lower family deductible and out-of-

pocket maximums• Also applies to Dental

“Split” Medical Premium

• Available if your spouse works for another entity that has TRS ActiveCare

• Causes total premium to be “split” between GPISD and the other entity

• SAVES YOU MONEY• Deadline for paperwork 9/1/11• Contact GPISD Benefits Department for Details

Your Cost for Coverage (per Paycheck)

Coverage Level ActiveCare 1-HD

ActiveCare 1 ActiveCare 2 ActiveCare 3

Employee only $31.00 $50.00 $92.00 $167.00

Employee & child(ren) $111.50 $147.00 $212.50 $333.00

Employee & spouse $239.00 $258.00 $343.50 $514.00

Family $347.50 $296.00 $392.50 $580.50

Pool: Two Employees $126.50 $145.50 $193.50 $364.00

Pool: Two EEs + Child(ren) $235.00 $183.50 $242.50 $430.50

Split: 2 EEs $63.25 $72.75 $96.75 $182.00

Split: 2 EEs + Child(ren) $117.50 $91.75 $121.25 $215.25

Your Cost for Coverage (per Paycheck)

Coverage Level Dental PPO Dental HMO Vision

Employee only $12.56 $2.09 $2.50

Employee & children

$27.34 $5.64 $9.08

Employee & spouse

$28.41 $6.50 $8.65

Family $40.40 $9.40 $11.25

Pool: Two Employees

$25.41 $7.00 N/A

Pool: Two EEs + Child(ren)

$37.40 $12.80 N/A

Open Enrollment 2011-2012

Open Enrollment

• Fall Enrollment Period– August 1 through August 31, 2011

• Generally, any changes go into effect on September 1, 2011*

• New Separate Active Care Medical & RX cards mailed in September 2011

• Plan year ends on August 31, 2012• Must reenroll to keep Flexible Spending Accounts

* Some changes to life and disability insurance require completion of evidence of insurability form and approval by the insurance company before changes go into effect

What’s New for 2011-2012?

• Increase in the eligibility age for dependent children– Because of recent health care reform, TRS Active Care will

cover your dependent children up to age 26, regardless of marital status, student status, or financial dependency

– District Dental and Vision plans also to allow dependents to age 26

• A TRS member cannot be covered as a dependent child of another TRS member

What’s New for 2011-2012?

• Premium increases, plan design changes, and district contribution changes– Medical/PPO dental premiums are changing– Premiums for vision, dental HMO and disability plans

remain the same

What’s New for 2011-12

• 100% Coverage for most Preventive Services• Applies only to In-Network Providers• Previous Active Care plans imposed maximums of

$500/yr or copays and deductibles• Effective September 1, 2011, eligible preventive care

available at no cost to employee• Refer to the 2011-12 TRS ActiveCare Enrollment

Guide for details

What’s New for 2011-12?ActiveCare 1 & 1-HD ActiveCare 2 ActiveCare 3

Deductible No change Individual: $750 (was $500)Family: $2,250 (was $1,500)

No change

Inpatient Copay No change $150/day (was $100), max 5 days, + 20%

$150/day (was $100), max 5 days, + 20%

Outpatient Copay No change $150 (was $100) plus 20%

$150 (was $100) plus 20%

Bariatric Surgeon Copay

$5,000 (was $0) $5,000 (was $0) $5,000 (was $0)

Retail Rx No change $15/$35/$60 (was $10/$25/$45)

$15/$35/$60 (was $10/$25/$45)

Retail Rx-Maint. No change $20/$45/$75 (was $15/$35/$60)

$20/$45/$75 (was $15/$35/$60)

Mail Order Rx No change $45/$105/$180 (was $20/$62.50/$112.50)

$45/$105/$180 (was $20/$62.50/$112.50)

What’s New for 2011-2012?

• New Option to enroll for critical illness insurance– Pays a lump sum benefit directly to you and your covered

dependents upon diagnosis of a covered illness• Examples: cancer, heart attack, stroke, paralysis or other covered

illness • You may elect a lump sum benefit up to $50,000

– Amounts over $15,000 require evidence of insurability– See the benefits overview brochure for more details on this plan– Coverage available for spouses and dependent children

What’s New for 2011-2012?

• Enhancements to supplemental life– Monthly rate for employees is decreasing 10%– Employees can enroll in supplemental life insurance

coverage up to the lesser of 3 x salary or $100,000 without answering any medical questions (one-time only, up to specified amounts)

– Spouses can enroll up to $30,000 without answering medical questions

– Employees/Spouses can increase existing coverage by $20,000 without medical questions

– See 2011-12 GPISD Benefits Guide for details

What’s New for 2011-2012?

• Enhancements to disability insurance– You may select a monthly amount up to the lesser of 66

2/3% of your salary or $5,000 per month without answering any medical questions• Amounts greater than $5,000/month require evidence of

insurability• As your salary increases you may be eligible for a higher benefit• Increases are not automatic—you must elect a higher benefit on

the enrollment Web site

Medical

Medical Plan Choices

• ActiveCare 1-HD• ActiveCare 1• ActiveCare 2• ActiveCare 3

How the Plans Work

• Two tiers– Network benefit– Non-network benefit

• Save money when you visit network providers– Lowest out-of-pocket costs

• Non-Network Benefits– 50% of non-network expenses are excluded from coverage

by ActiveCare and will be your responsibility to pay– Your non-network deductible and coinsurance is applied to

the remaining 50%

ActiveCare 1-HD Plan Overview

Feature Network Non-NetworkDeductible (per plan year) $2,400 employee only; $2,400 family

Out-of-pocket max. (per plan year; excludes deductible and copays)

$3,000 employee only; $5,000 family

Maximum lifetime benefit Unlimited

Office visit: you pay 20% after deductible 40% after deductible

Preventive care: you pay 0% 40% after deductible

Retail short-term (30-day supply): you pay

20% after deductible You will be reimbursed the amount that would have been charged by a

network pharmacy less the deductible & coinsuranceRetail maintenance (30-day supply):

you pay20% after deductible

Mail order (90 day supply): you pay 20% after deductible N/A

ActiveCare 1 Plan Overview

Feature Network Non-NetworkDeductible (per plan year) $1,200 employee only; $3,000 family

Out-of-pocket max. (per plan year; excludes deductible and copays)

$2,000 employee only; $6,000 family

Maximum lifetime benefit Unlimited

Office visit: you pay 20% after deductible 40% after deductible

Preventive care: you pay 0% 40% after deductible

Retail short-term (30-day supply): you pay

20% after deductible You will be reimbursed the amount that would have been charged by a

network pharmacy less the deductible & coinsuranceRetail maintenance (30-day supply):

you pay20% after deductible

Mail order (90 day supply): you pay 20% after deductible N/A

ActiveCare 2 Plan Overview

Feature Network Non-NetworkDeductible (per plan year) $750 employee only; $2,250 family

Out-of-pocket max. (per plan year; excludes deductible and copays)

$2,000 employee only; $6,000 family

Maximum lifetime benefit Unlimited

Office visit: you pay PCP: $30 copaySpecialist: $50 copay

40% after deductible

Preventive care: you pay 0% 40% after deductible

Rx drug deductible $100/person per year

Retail short-term (30-day supply): you pay

$15/$35/$60 You will be reimbursed the amount that would have been charged by a

network pharmacy less the deductible & coinsuranceRetail maintenance (30-day supply):

you pay$20/$45/$75

Mail order (90 day supply): you pay $45/$105/$180 N/A

ActiveCare 3 Plan Overview

Feature Network Non-NetworkDeductible (per plan year) $300 employee only; $900 family $500 employee only; $1,500 family

Out-of-pocket max. (per plan year; excludes deductible and copays)

$1,000 per person $3,000 per person

Maximum lifetime benefit Unlimited

Office visit: you pay PCP: $20 copaySpecialist: $30 copay

40% after deductible

Preventive care: you pay 0% 40% after deductible

Rx drug deductible $75/person per year

Retail short-term (30-day supply): you pay

$15/$35/$60 You will be reimbursed the amount that would have been charged by a

network pharmacy less the deductible & coinsuranceRetail maintenance (30-day supply):

you pay$20/$45/$75

Mail order (90 day supply): you pay $45/$105/$180 N/A

Things to Consider

• Employee premiums• Annual deductible– Must be satisfied before the plan pays benefits

• Copays– Set sum of money you pay at the time of service

• Coinsurance– Percentage of health care expenses you pay

• Out-of-pocket maximum

About Health Savings Account(s)

• If you enroll in ActiveCare 1-HD*, you can participate in an HSA– HSA balance is owned by participant– Accumulate interest tax-free– Your contributions are tax deductible– Use the money to pay for qualified expenses– HSA balance rolls over from year-to-year– You can keep the HSA if you change jobs• HSA not sponsored by GPISD or ActiveCare* ActiveCare 1 meets the IRS definition of a high deductible health plan for employee-only coverage

You Are Eligible to Enroll in an HSA If…

• You have coverage under an HSA-qualified high deductible health plan

• You have no other first-dollar medical coverage (other types of insurance such as specific injury or accident, disability, dental, vision or long-term care are permitted)

• You are not enrolled in Medicare• You cannot be claimed as a dependent on someone

else’s tax return

Dental

Dental Plan

Features UHC Options PPO National Pacific Dental DHMO

Network Non-Network Network Only

Annual calendar year deductible

$50 per person; $150 per family

$50 per person; $150 per family

None

Annual calendar year maximum

$1,000/person $1,000/person None

Diagnostic & preventive care (2 cleanings per 12-month period)

100%, deductible waived 100% of UCR, deductible waived

See copay schedule

Basic care 80% 80% of UCR See copay schedule

Major care 50% 50% of UCR See copay schedule

Orthodontia (children up to age 19)

50% 50% of UCR See copay schedule

Lifetime orthodontia max.

$1,000 $1,000 None

Vision

How the Vision Plan Works

• Use a network provider for your care– You pay a copay at time of service– Provider files claims for you– 1 exam, 1 set of frames and lenses (or contacts in lieu of

frames lenses) are covered every 12 months

• Use a non-network provider for your care– You pay expenses in full at time of service– You submit claim for reimbursement up to plan allowances

Vision Benefits

Features UHC Vision PlanNetwork Non-Network

You pay: Plan reimburses you:

Exam (every 12 months) $10 copay Up to $40

Materials $25 copay N/ALenses* (every 12 months)Single visionBifocalTrifocalLenticular

$0 after copay Up to:$40$60$80$80

Frames (every 12 months) Amounts over $130 Up to $45Contact lenses** (every 12 months-in lieu of glasses)

$0 after copay Up to $150 ($210 if medically necessary)

*Includes scratch-resistant coating and polycarbonate lenses** Contact lenses, fitting fees & evaluation fees are subject to $150 annual maximum after $25 copay.

Flexible Spending Accounts (FSAs)

Your FSA Choices

• Health Care FSA• Dependent Care FSA• You cannot contribute to

both a Health Savings Account (HSA) and a Health Care FSA

How the FSAs Work

• Choose your contribution each year– Automatically deducted in equal installments from your

paychecks on a pre-tax basis

• Incur eligible expenses• Receive reimbursement from your FSA

Reimbursement Options

• Use an FSA debit card• Submit a paper claim form• Submit an online reimbursement request

FSA Rules

• You cannot stop or change your FSA contribution until the next plan year unless you have a qualified change in status

• You cannot transfer funds from one FSA account to the other (e.g., not from Health FSA to Dep Care FSA)

• Any money remaining in an FSA at the end of the plan year will be forfeited

Health Care FSA

• Set aside up to $7,500 per year• Use pre-tax dollars to pay for eligible health care

expenses• Eligible expenses may include:– Deductibles and copays for medical, dental, and vision

plans– Prescription drugs– LASIK surgery– Chiropractic expenses

Dependent Care FSA

• Set aside up to $5,000 per year ($2,500 if married and filing separately)

• Use pre-tax dollars to pay for eligible dependent care expenses so that you can work

• Qualifying children must be under age 13• Dependents over age 13 must be incapable of self-

care

Life & AD&D Insurance

Basic Life & AD&D Insurance

• Basic life insurance – Provided at no cost to you– $25,000

• Basic AD&D insurance– Your beneficiary will receive an additional AD&D benefit if

your death is due to a covered accident or injury– Equal to your basic life insurance amount– Benefit depends on type of loss

Supplemental Life Insurance

• Employee– $10,000 to lesser of 5 x salary or $300,000 (in $10,000

increments)• Spouse– $10,000 to $50,000 (in $10,000 increments)– Cannot be more than 50% of the employee’s supplemental

life insurance coverage• Children– $5,000 or $10,000

Disability Insurance

Voluntary Long-Term Disability

• Pays you a monthly benefit up to 66 2/3% of your base salary

• Pays in addition to sick leave• 8 different plan options• Benefits reduced by other disability income sources• Preexisting condition exclusions apply

Critical Illness Insurance• Directly pays you a lump sum benefit at the diagnosis

of a covered illness (benefit varies by illness)– Covered illnesses include, but are not limited to:

• Cancer (not skin cancer)• Heart attack• Stroke• Major organ failure• Paralysis

• Employee coverage: $5,000 to $50,000 in $1,000 increments

Critical Illness Insurance (cont.)

• Dependent coverage– Spouse: 50% of employee amount up to $10,000– Child: 25% of employee amount up to $5,000Note: Evidence of insurability is required for employee coverage in excess of

$15,000 and for all amounts of dependent coverage. Preexisting condition exclusions apply.

• Preexisting Condition LimitationsRefer to Critical Illness brochure at www.galenaparkisd.com/benefits for

detailed information

Sources of Benefits Information(Available at www.galenaparkisd.com/benefits)

• 2011-12 TRS ActiveCare Enrollment Guide• 2011-12 GPISD Benefits Guide• Assurant LTD Disability Brochure• UHC Critical Illness Brochure• UHC Dental Insurance Certificate of Coverage• UHC Vision Insurance Certificate of Coverage• UHC Life Insurance Certificate of Coverage

Questions?

If you have a question about…

Contact Telephone Website or Email

Medical (TRS ActiveCare)

BlueCross BlueShield of Texas

1-866-355-5999 www.bcbstx.com/trs

Dental UnitedHealthcare (UHC) 1-800-232-0990 www.myuhcdental.com

Vision UnitedHealthcare (UHC) 1-800-638-3120 www.myuhcvision.com

Flexible Spending Accounts (FSAs)

TASC 1-800-422-4661 or Shelli Dean, Agent

832-878-2605

www.tasconline.com E-mail: shelliwdean@sbcglobal.net

Life and AD&D UnitedHealthcare (UHC) Specialty Benefits

1-888-299-2070 www.myuhcspecialtybenefits.com

Disability Assurant 1-800-877-2701 or Shelli Dean, Agent:

832-878-2605

N/A

Critical Illness UnitedHealthcare (UHC) Specialty Benefits

1-888-299-2070 www.myuhcspecialtybenefits.com

GPISD Benefits Department

Diana Villasana Gina Martinez

832-386-1245832-386-1276

dvillasana@galenaparkisd.comgmartinez@galenaparkisd.com