to: kyrene retiring and smartschoolsplus participating employees · 2019-09-16 · health insurance...

Spring Retirees

To: Kyrene Retiring and smartschoolsplus Participating Employees

Re: COBRA / May Benefits Open Enrollment / ASRS Health Insurance Premium Reimbursement / Ending Payroll Verification/ Cashout for accrued time to 403b

Dear Kyrene Retiring Employee:

Congratulations, what an exciting and busy time for you! The information in this letter comes from frequently asked retirement and benefits questions from employees who are getting ready to retire with the Arizona State Retirement System (ASRS). This information also pertains to those who are retiring with ASRS and working the following year through smartschoolsplus.

FAQ’s

When do my active health insurance benefits with Kyrene end? Your active health insurance benefits with Kyrene end June 30th of the active school year if you complete your employment contract. You will be offered COBRA continuation which is an option to continue using Kyrene health insurance plans at your full cost. If you elect COBRA and pay the monthly premium, you can continue a medical, dental or vision plan for up to 18 months after your employment ends.

Can I choose the same medical plan that I currently have? Yes, if you currently have the Choice Plus PPO or the HDHP Health Savings Account medical plans the same or similar plans will be available through COBRA. Please be aware that the benefit coverage within the plans may change each school year. This includes but is not limited to cost changes, deductible amounts, Rx co-pays and out of pocket limits.

Can I choose COBRA for my voluntary life insurance or the District paid life insurance? No, life insurance is not a plan that you can elect through COBRA continuation. You can request to convert or port your life insurance policies by requesting a quote from our life insurance carrier no later than 30 days after your active benefits end with Kyrene. Attached is a form to request conversion/or portability from the life insurance vendor. It is the employee’s responsibility to ensure the request is made by the deadline.

When will I get COBRA continuation information if I want to elect it for the medical, dental or vision coverage that I currently carry? You will be receiving a COBRA election form from our COBRA vendor by mid-June. If you are planning to elect COBRA coverage, you will want to send back the election form and your first payment for July prior to July 1st to ensure that you have no gap in coverage. The forms do state that you have 60 days to pay after electing COBRA coverage. This is correct, however until you have paid your premium any claims you might incur before they receive your first COBRA payment will show up as uncovered because your coverage is not technically reinstated until they receive your payment. If you do happen to have a gap, your coverage will be retroactively reinstated back to July 1, however you will need to work with your medical providers to resubmit any claims that were denied in the interim.

Do I need to do the spring benefits open enrollment if I am retiring in May or June? No. You will continue to receive information from Kyrene regarding open enrollment since you are actively employed now, however if you are retiring at the end of this school year, you do not need to complete the online enrollment process for the coming school year. You will be offered the COBRA continuation option for the coverage option types you had for medical, dental and vision plans. You can choose COBRA due to retirement for up to 18 months after your employment ends. If you want insurance through Kyrene's COBRA offer, you must reply to the COBRA open enrollment. Your COBRA election form will be sent to your home address by early June by the carrier.

I’ve heard that there is a Health Insurance Premium Reimbursement available from ASRS if I am retiring and drawing my pension and if I elect a COBRA plan through Kyrene, is that true? Yes. If you elect to participate in COBRA for your medical or dental plans, there is a Health Insurance Reimbursement from ASRS that you may be entitled to once you retire. The amount you may be eligible for is based on your vested years of service. Please see your ASRS materials for the amount.

How do I apply for the Health Insurance Premium Reimbursement (HIPR)? You may have received the necessary HIPR form from ASRS in your retirement paperwork or you may obtain one from the ASRS website. A copy is also attached to this FAQ. You will need to complete the retiree portions on the form. Please return the form to the Benefits department by the end of June. Your election into the COBRA plan and first payment to our COBRA carrier must be confirmed by Kyrene. Once COBRA participation is verified, your HIPR form will be forwarded to ASRS on your behalf in July.

When and how will I receive the Health Insurance Premium Reimbursement? Generally it takes 3 months for ASRS to process and pay the first installment of your premium reimbursement. ASRS sends the payment to Kyrene in a single check for all retirees each month after they have processed your request. This check is deposited into the Kyrene Employee Benefit Trust monthly. Our Kyrene accounts payable department will cut a check to you individually for your share of the reimbursement. You will receive your first check around mid- October to your home address. Your first payment includes retroactive payments back to the first month of your retirement. You must always pay your monthly COBRA premium in full. Please do not adjust the amount that you pay to the COBRA vendor based on your reimbursement amount. The COBRA vendor does not track ASRS premium reimbursements and will deny payments that are insufficient to cover the premium and will cancel your COBRA coverage.

When does my premium reimbursement end? When you discontinue your COBRA plan during the 18 months or you have reached the end of your 18 months of coverage, your ASRS premium reimbursement that comes to you from ASRS during your COBRA participation ends. Please notify us in the Kyrene Benefits department when you have stopped your COBRA coverage, so that we can update ASRS on your behalf. If overpayments are made of the premium reimbursement for months you do not have COBRA coverage, you will be required to reimburse ASRS. There are certain circumstances such as disability that could extend your COBRA for additional months, please refer to the COBRA information you receive from the COBRA carrier in June or our KEBT Summary Plan Document (SPD), which is posted online on the Kyrene website for all details.

What if I return to work following my retirement? You will need to review the 20/20 rules on the ASRS website or contact ASRS directly. Please also contact Kyrene HR or Benefits to ask about any Kyrene rules regarding return to work.

Will I receive a cash out of my accrued sick/ personal/ vacation time? You may be eligible for a cash out. Please check the Meet & Confer or Terms & Conditions document for your employee group. These documents are posted online at www.kyrene.org, Departments, Human Resource Services, Employee Information & Forms for details. Attached is a form to request all or a portion of your cashout to be deposited into your existing Kyrene-AIG/Valic 403b account.

Who processes the required Ending Payroll Verification for ASRS for my pension? The Kyrene Business Services / Payroll department processes this verification for you. ASRS requires that Kyrene verifies your ending payroll amount to accurately calculate your pension. Once you have notified ASRS of your retirement date, ASRS will generate the verification for you and will submit it electronically to our payroll department on your retirement date. Your payroll representative will complete this form following the last paycheck that is issued to you. Please contact your Kyrene payroll representative if you have any questions.

I hope you have found this information helpful. Our best wishes to you as you begin your new journey! Please let us know if we can assist you.

The Kyrene Benefits Team:

Deb Spurgin, GBA – Chief Benefits Officer, (480) 541-1315

Jessica Bowman – Benefits Specialist, (480) 541-1317

Taylor Schroeder – Benefit Specialist (480) 541-1302

Jennie Truman – Human Resource Specialist (480) 541-1307

http://www.kyrene.org/

Employee Resignation/Request for Release Form

Employee Name: Employee ID#: _

Position(s):

School/Department: Supervisor Name: _

Select the Employee Group

☐ Education Support Professional (ESP)

My last day will be on . A minimum fourteen (14) day notice is required.

☐ Certified My last day will be on . Requests for release prior to the end of a certified contract are contingent upon identification of a suitable replacement teacher and are subject to liquidated damages as indicated in the certified contract.

☐ Administrator

My last day will be on . Release prior to the end of an administrator contract must meet conditions included in the signed contract.

Select the most influential reason you are not returning to Kyrene. Check only one item. An exit survey will be emailed requesting additional feedback.

☐ Career change – other employment in education

☐ Career change – other employment in private sector

☐ Childcare

☐ Commute/Transportation

☐ Continuing education

☐ Family reasons

☐ Inadequate benefits

☐ Inadequate salary

☐ Inadequate school or classroom facilities

Update Contact Information in iVisions

☐ Lack of opportunity for advancement

☐ Medical reasons1

☐ Relocation or spousal relocation1

☐ Retirement

☐ Stress on the job

☐ Dissatisfied

1Documentation required for certified requests for release.

Individuals are requested to update contact information in iVisions, verifying residential and email addresses.

Interested in being a substitute?

☐ I would like to apply with SmartSchoolsPlus to be a substitute for Kyrene.

Employee Signature/Date:

Personal e-mail address:

All employees who are requesting a separation of employment are required to submit this form to their supervisor. Employees are welcome to include an additional letter if desired. Forms will be filed with Human Resource Services.

For school office use only: Resignation/Request for Release form received in Human Resources on:

Retirement Cash-out to 403b Request

Employees who are eligible to receive a cash-out of their accrued time may

choose between the following two options:

a) Take the cash disbursement subject to applicable taxes; or

b) Direct deposit the sum on a pre-tax basis into an existing Kyrene employee

403b account with the current provider *up to annual IRS limits.

If you are choosing option (b) to rollover the sum to an existing 403b account, fill

out the form below completely. Turn in the form to Human Resources with a

copy of your Employee Resignation/Request for Release form.

**I elect to direct deposit $_________________into my existing AIG/Valic 403b. (fill in request amount, not percent)

Today’s Date

Printed Name

Signature

Employee ID#

Date of Birth

Work Location

Phone Number

Effective date

Human Resources/Business Service use only

Rec’d Date Amount Date

Processed

*Employee is responsible to determine their annual maximum contribution to avoid excess deferral IRS penalties.

**Please direct questions about cash-out amounts to payroll.

Health Insurance Premium Benefit Authorization Page 1 of 1 Revised 04/01/2016

Disclosure of member’s Social Security number is mandated by Section 6109 of the Internal Revenue Code. The ASRS will use Social Security numbers only to obtain information about an individual’s ASRS account and to inform the Internal Revenue Service of distributions and withholdings with

respect to the individual’s account.

SECTION 1 – Member Information Social Security Number Member Name (Last) (First) (Middle Initial)

Mailing Address Daytime Telephone Number

City State ZIP Date of Birth (MM/DD/YYYY)

SECTION 2 – Status Information

Indicate participant status (check one):

Arizona State Retirement System Retiree Long Term Disability Plan Participant

Retirement Effective Date: Disability Effective Date:

SECTION 3 – Information for Coverage

Last Name First Name Social Security Number Birth Date

(MM/DD/YYYY) Medicare #

Member

Dependent

Dependent

Dependent

SECTION 4 – Medical Plan Section 5 - Dental Plan Carrier Name Carrier Name

Medical Premium Amount

$Dental Premium Amount

$

SECTION 6 – Effective Date Coverage to Begin

Date (MM/DD/YYYY)

SECTION 7 – To be Completed by the Employer Health Insurance Premium Benefit Specialist Employer Phone Number

Email AddressHI Premium Benefit Specialist Electronic Signature

Date

ARIZONA STATE RETIREMENT SYSTEM (ASRS)

HEALTH INSURANCE PREMIUM BENEFIT

AUTHORIZATION

COMPLETE AND SEND TO THE ASRS VIA EMPLOYER SECURE MESSAGING

www.azasrs.gov

By checking this box, I certify that I am the employer representative named below and the information on this form is current and correct. I also understand that typing my name in the Electronic Signature field is the legally binding equivalent to my handwritten signature.

Notice of Continuation of Coverage

As a terminated employee – or as an active employee or retiree – losing coverage or a portion of coverage for you or your dependents under your employer’s Group plan(s), you and/or your dependents may be eligible to continue all or a portion of that coverage without submitting evidence of good health. Potential options are explained below. The specific options available to you are based on the provisions as defined in the Group plan. Included with this notice is a form you can submit to obtain additional information. Based on your selection, you will receive a personalized quote, details on the specific coverage options available to you, and the necessary forms to enroll.

Life Conversion The Life Conversion option provides the opportunity for you to obtain an individual life insurance policy that accumulates cash value and is offered at individual insurance rates. There are no mandatory age reductions and coverage can continue with premium payment until the Scheduled Maturity Date (standardly age 121) at which time the cash surrender value is paid to the insured.

If coverage is ending because The Hartford Group Life policy is terminating or coverage for a class of employees is terminating, some restrictions may apply. If coverage is ending for any other reason, you can generally convert up to the full amount of your terminating coverage. Conversion is also available to your dependents if they had coverage under your group plan. You may have the option to obtain a one year term policy prior to the permanent life policy becoming effective. Please refer to The Hartford Group Life policy for information. Premiums for a Life Conversion policy are substantially higher than your Employer Group plan rates.

Portability Under the Portability option you may obtain a group life insurance policy to continue 100%, 75%, or 50% of the amount of life insurance coverage (Basic, Supplemental, or both) you had under your Group plan up to a maximum amount, generally $250,000 depending upon the provisions of your Group plan. The Portability policy provides group term coverage and is available to you provided you have not yet reached your Social Security full retirement age. The Portability option may also be available to your dependents if you carried dependent coverage under your employer’s group plan and if the group plan includes portability as an option for dependents. The amount of coverage you elect to port is reduced by 75% at age 65 and coverage terminates at age 75. Portability is not available if your employer is terminating the group plan. Note: if you choose to elect the Waiver of Premium provision as outlined in your contract you are not eligible for Portability. The same applies if you choose to elect Portability; Waiver of Premium would not be available. Additional restrictions may also apply. Premiums for a Life Portability policy may be higher than your Employer Group plan rates and rates increase every five years (years in which your age on your birthday ends in 5 or 0).

*********************************

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.

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Attached is a form that contains additional information about continuing coverage. You can use this to request a quote and the necessary forms to enroll.

Please note that there is a designated timeframe during which you can exercise your coverage continuation options. To continue coverage, you must mail or fax this form to request information within 15 days from the date of this notice or 31 days from your group coverage termination date, whichever is later. Under no circumstances, however, will continuation of coverage be available beyond 91 days from your group coverage termination date. Any issues regarding late notification by your employer must be addressed with the employer.

If you have questions about this information, your eligibility, or the status of any request you have submitted, please call a representative at 1-877-320-0484.

The Hartford, Portability and Conversion Unit P.O. Box 248108

Cleveland, OH 44124-8108 Fax 1-440-646-9339

GROUP LIFE INSURANCE PORTABILITY AND CONVERSION – Side By Side Employee Guide

To decide whether Portability or Conversion is the right choice for your personal situation, you need to understand the differences. We help you see them clearly with our side-by-side comparison. Please visit www.hartford-employee-guide.com to view the complete side-by-side comparison table. If you do not have access to the internet you may obtain a copy of this comparison by calling 1-877-320-0484.

Frequently Asked Questions Q: If I request a quote, how does The Hartford determine the amount of coverage to quote? A: The Hartford will contact your employer to obtain the amount of coverage you had in effect under the group plan. The quote is based on this amount as well as applicable plan provisions. Q: If I receive a quote for coverage, does this mean I qualify for the coverage amount quoted? A: The amount quoted is not a guarantee that a policy will be issued in that amount. Upon receipt of your application for coverage, The Hartford will perform an eligibility review to determine if the amount of coverage you have requested can be granted based on the coverage you had in effect under the group plan as well as plan provisions. Q: What is my policy effective date? A: The effective date of a Life Conversion policy is the 32

nd day following the group coverage termination date. The effective

date of a Life Portability Policy is the day following group coverage termination date. Q: If my application for coverage is not approved by the effective date, am I still covered? A: Yes, if your application is approved, the effective date of your policy will be retroactive to the date indicated above. Q: I understand that there is no medical underwriting or physical exam required but can I still be denied for coverage? A: Your request for coverage can be denied if you do not meet the timeliness requirement. You must mail or fax this form to request information within 15 days from the date of this notice or 31 days from your group coverage termination date, whichever is later. Under no circumstances will continuation of coverage be available beyond 91 days from your group coverage termination date. Coverage can also be denied if it exceeds the amount you had in effect under your employer’s Group plan or if it does not align with your employer’s plan provisions. In addition, any request for coverage that is not available under your employer’s Group plan will also be denied. Q: If I start to work for a new employer and obtain coverage under that employer’s Group plan, will that Group coverage impact any conversion or portability policy that I may have purchased? A: If you obtain coverage under a new employer’s Group plan, your portability or conversion policy will remain in effect provided you continue to pay the required premiums. However, benefits payable under conversion policies may be affected by the amount of your other coverage.

Notice of Continuation of Coverage

Employer:____________________________________________ Policy #:_______________________

The following information is to be completed by Employer or Employer Representative

Employee Name:____________________________________ Employee ID#:_______________ Date:__________________

Last Day Worked (or date employee is no longer in an eligible class):_____________________________________________

Date of Group Coverage Termination:___________________ Termination Reason:__________________________________

Signature________________________________________ Print Name___________________________________________

Email Address__________________________________________ Telephone_____________________________________

As noted above, Conversion and Portability options are available without submission of evidence of good health. The rates for Life Conversion will be substantially higher than your employer Group plan rates. The rates for Portability are based on the employer’s standard industry code and/or Group plan provisions and may be higher than your employer Group rates. Portability rates increase every 5 years (years in which your age on your birthday ends in 5 or 0).

Employee: To request specific rates and enrollment information, please complete the information below and mail or fax this entire page to:

The Hartford, Portability and Conversion Unit, P.O. Box 248108, Cleveland, OH 44124-8108 Fax 440-646-9339, Phone 877-320-0484

Yes, I am interested in receiving the information checked below.

Life Conversion Quote Portability Enrollment Form

Please print the following information:

Name:____________________________________________ Date of Birth:_____________________________________

Social Security # (indicate last 4 digits only):_____________________________________________________________

Address:___________________________________________________________________________________________

City:________________________________________ State: _______________ Zip Code:_________________________

Telephone Number:_________________________________________ Email:___________________________________

I am interested in receiving information for the following persons:

Myself My Spouse My Child(ren)

Please print the name(s), relationship, and date(s) of birth for each dependent who may be eligible for coverage. Include an additional sheet if necessary. Name:___________________________________ Relationship:________________ Date of Birth:_____________________

Name:___________________________________ Relationship:________________ Date of Birth:_____________________



I understand that I have only 31 days from the date of my group coverage termination OR 15 days from the date of this notice, whichever is later, to complete and submit this form to The Hartford. In no event, however, will my eligibility to continue coverage exceed 91 days from my group coverage termination date. ___________________________________________________ ___________________________________ Signature (required) Date You may be contacted by a licensed agent


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to: kyrene retiring and smartschoolsplus participating employees · 2019-09-16 · health insurance...

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