your 2021 benefits guide - dublinschools.net
TRANSCRIPT
Your 2021 Benefits Guide Helping you make informed choices about your employee benefits
2 | Dublin City Schools
Table of Contents
Overview & Eligibility ........................................................................................... 3 Terminology ………………………………………………………………………………………4 Open Enrollment Process...................................................................................... 5EMB Login Instruction..................................…………….…………………………….….….6
Self Care Commitment Tracker ............................................................................. 8Employee Assistance Program …………………..………………………………….…….......10Medical Benefits Summary. .................................................................................11Health Savings Account Overview ………………………….………………………….….....12 Anthem Tools to help you Make the Most of Your Benefits
Anthem Sydney Mobile App ......................................................................13Estimate Your Costs—Care Comparison …………………………………....……..14Smart Shopper …………………………………………………………...…………...15Live Health Online Virtual Office Visit ……………………………………………….16 24/7 Nurseline …………………………………………………………....…………....18
Dental Benefit Summary.. ...................................................................................19Vision Benefit Summary.………………………………………………………………...……..21Insurance Rates and Contributions .......................................................................22 Flexible Spending Accounts ...………………………………………………………....….…..23Basic / Voluntary Life and Accidental Death & Dismemberment ……..….……………….25
Universal Life with Long Term Care ……..……………………….……………………….….27Disability Income Considerations…….…………………………….………………….....…...28Short Term Disability ……………………………………….…………………………...….....30Long Term Disability……………………………………………….……………..…….….…..31Voluntary Benefits……………………………….………...………………………….…….….32Accident Insurance……………………………………………….………………………….…33Cancer Insurance...............…..….……………………………………………………...….…34Critical Life Event Insurance……………….…………………………………………………..40Identity Theft Protection……………..........................……….……………………………...42Insurance Company Contact Information…….....…….……………………………..……...44
This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and condit ions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.
The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, yourcurrent employee benefits environment. It does not necessarily fully address all of your specif ic issues. It should not be construed as, nor is it intended to prov ide, legal advice. Questions regarding specif ic issues should be addressed by your general counsel or an attorney who specializes in this practice area.
Notes ……………………………………………………………………………………..……...45
EMB Mobile App..........................................…………….…………………………….….….7
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Benefits Overview
Dublin City Schools is proud to offer a comprehensive benefits package to eligible full-time and certain part-time employees. The complete benefits package is briefly summarized in this booklet.
You share the costs of some benefits (medical, dental and vision) and Dublin City Schools provides other benefits at no cost to you (basic life, accidental death & dismemberment). In addition, there are voluntary benefits with reasonable group rates that you can purchase through payroll deductions.
Benefits Offered
Medical * Dental Vision Health Savings Account (HSA) Flexible Spending Account (FSA) Life Insurance & Accidental Death & Dismemberment (AD&D)
Insurance (Basic and Optional) Short-Term Disability Long-Term Disability Cancer Accident Critical Life Events Universal Life with Long Term Care Identity Theft Protection Employee Assistance Program (EAP)
Summary Plan Descriptions may be found at www.explainmybenefits.com/dublin under Summaries.
Eligibility & Qualifying Events
You and your dependents are eligible for Dublin City Schools’ benefits on the first of the month following your first day of work or Board approval of your hire, whichever is later.
Please reference each specific Plan Document to verify the Dependent Eligibility rules. Elections made now will remain until the end of the benefit year unless you or a dependent experience a Qualifying Event. If you experience a qualifying event and w ish to change your benefit elections, you must contact your Benefits Office within 30 days of the event.
*Part-time employees who are contracted for less than twenty (20) hours per week and are hired on or after July 1, 2014, are noteligible to participate in health insurance coverage under the Negotiated Agreement between the Dublin Support Association/OEA/NEA and the Dublin Board of Education.
Qualifying Events for insurance changes include: marriage, divorce, annulment, birth or adoption, death, change in employment status, legal court orders, decrees or judgements, change in dependent eligibility status, change in spousal or adult dependent employer coverage, FMLA, COBRA, HIPAA, Medicaid or Medicare
Terms
BEFORE WE BEGIN: QUICK TERMS TO KNOW
Benefits jargon can be confusing. Before we begin, review these terms
so you can better understand your insurance options.
Deductible – The amount of money you must pay each year to cover your medical care expenses, including prescriptions before the Plan starts paying. Deductibles do not apply where a copay is noted. Your deductibles start over on January 1 each year.
Out-of-Pocket Maximum – The maximum amount you will spend out of your own pocket for eligible health care expenses during a calendar year while covered under the Plan.
Keep in mind that not all expenses count toward the out-of-pocket maximum. Those expenses include:
Premium deductions from your paycheck
Balance bills from out-of-network providers
Non-covered benefits
Preferred Provider Organization (PPO) Plan – A medical plan designed to give you the freedom to see providers both in - and out-of-network and see specialists without referral. You do not have to choose a primary care physician. With the PPO, there is an annual deductible, but once the deductible is satisfied, the plan begins paying its share of covered services.
High Deductible Health Plan (HDHP) – The IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments and coinsurance) can’t be more than $7,000 for an individual or $14,000 for a family. This limit does not apply to out-of-network services. A high deductible health plan can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with tax-free money.
Health Savings Account (HSA) – A type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. You may only contribute to a Health Savings Account while you are enrolled in a High Deductible Health Plan (HDHP).
By using the untaxed funds in an HSA to pay for expenses before you reach your deductible and other out-of-pocket costs, you may reduce your overall health care costs.
The money in the HSA bank account is yours. There is no “use it or lose it”, the HSA funds roll over year- to-year if you don’t spend them. You take the funds with you if you leave Dublin City Schools.
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Enrollment Process
Benefits Open Enrollment
October 17 - November 6
For more information about enrollment, videos and other important information, please visit:
www.explainmybenefits.com/dublin
Options to Enroll
Self-Service Enrollment – Complete your enrollment online using any computer or smartphone with internet access. • www.explainmybenefits.com/dublin
• Enrollment Available: October 17th - November 6th
Call Center - Have Questions regarding the enrollment system or benefits covered? Contact the EMB Enrollment Call Center! • Call Center Available: October 19th - November 6th
• 380-204-6410
• 9am - 5pm (Monday - Friday)
Mobile App - You can enroll through the EMB mobile app, to review the benefit guide, benefits, and see important documents. • Sign in using the Company Code: dublin
All benefit eligible employees are REQUIRED to complete enrollment even if waiving or declining coverage.
6 | Dublin City Schools
Login Instructions
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Mobile App
Simply Healthy
Wellness ProgramSelf-Care Commitment Tracker
2020 | 2021 You are invited to join the 4-time award winning wellness program with Dublin City Schools! The Simply Healthy Wellness Program supports your whole well-being. Explore the many resources and programs that support you and your family members in leading a happier, healthier life. Take charge of your health today!
Make a Self-Care Commitment!
Create a self-care commitment and accountability to know and understand the opportunities and resources offered through the Simply Healthy Wellness Program. Choose any combination of 3 different initiatives on page 2 to the compete self-care commitment. Your reward will be YOUR health and wellness!
Click Here to Receive a Certificate of Completion
Visit the Employee Wellness Website for details.
MAKE YOURSELF A PRIORITY.
Wellness Website Login Info
Visit the Dublin City Schools Homepage at https://www.dublinschools.net/.
Click on “For Staff” and login with your credentials below…
1. Username: last name_first name2. Password: your everyday DCS password3. Hover over "Staff" in the top menu bar to find
Employee Wellness
8 | Dublin City Schools
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LIFESTYLE CHANGE PROGRAMS
Enhance your life by exploring the following programs on the employee wellness site.
Manage a Chronic Condition Pregnancy/Parenting Support &
Future Mother’s Program Solera- Lifestyle Change Program
CPR/AED/FIRST AID CERTIFED
Save a life! Free onsite CPR classes foremployees!
STRESS LESS
Schedule a free counseling session for you oryour family member with EAP Matrix
Complete a webinar with EAP Matrix Visit the Stress Less page Try a free DCS yoga class Visit the Its Time to Relax site
WORK + LIFE
Explore the following programs on the employee wellness site.
Caregiver Support Spirit & Holistic Resources Substance Use Support Child & Parenting Resources Visit Home & Pet Care link
BE HEALTHY
Enroll in the Tobacco Cessation Program Schedule a Health Coaching session Visit the Online Doctor (if needed) Check out the Heart Health site Complete the “Build a self-care plan” on the
Self-Care Commitment site Visit the COVID-19 Employee Care Site
SELF CARE COMMITMENT TRACKERSimply Healthy Wellness Program
Use this tracker to provide self -care by exploring the follow ing programs on the Employee Wellness Site. Choose any combination of 3 different self-care initiatives. Click Here to Receive a Certif icate of Completion
DISCOUNTS & PERKS
-WW: 50% Discount -Free Counseling-24/7 Nurse Line -Free Lifestyle Change – Solera-Gym Discounts -Free ConditionCare Program-Free Flu Shots -Free Future Mother’s Program-Online Doctor -Free CPR-Free Yoga -Free Health Coaching
MOVE
Participate in a free DCS fitness class Join a community walk/run Join the DCS team via Charity Miles
App to give back (its free) Visit the Airrosti site- manage pain
without surgery
PREVENTATIVE SERVICES & SCREENINGS
Visit the Preventative Care site. Complete the following screenings according to the age and gender specific guidelines and per your doctor’s recommendations.
Routine Checkup- Well Exam Cholesterol Screening Glucose Screening Blood Pressure Screening Breast Cancer Screening Cervical Cancer Screening Prostate Cancer Screening Colon Cancer Screening Skin Cancer Screening Dental exam Vision exam Flu shot Other
NOURISH
Join WW- 50% Discount +Virtual Option! Complete a healthy eating challenge Check out the resources
MATRIXPSYCH.COM
MATRIX
DUBLIN CITY SCHOOLS / MATRIX EAP
Some things you should know:
• Everyone has personal problems from time to time. Your Matrix EAP is here to help you
• All Matrix services are absolutely confidential, unless you authorize release to your supervisor forwork-related performance issues. You get eight sessions absolutely free.
• Crisis services are available 24 hours a day
• In addition to psychological counseling, the EAP offers a number of other resources:
o Legal counseling- by phone or face-to-face followed by a discount on future fees
o Financial counseling- by phone
o Childcare/eldercare issues- online or by phone for more specialized problems
• Website services included customized answers to questions, library of links to other mental healthresources, ask-a-doc email portal which allows a client to ask a confidential question and receive aresponse within one business day. Free access to work and family referrals, such as pet care,fitness locators, adoption resources, and college planning tools
• We have a new mobile app to help you contact us at any time. You can download it at the AppStore or Google Play. Look for Matrix EAP.
• Common EAP problems include;o Alcoholismo Abuseo Anxietyo Attention deficit/learning
disabilitieso Caregiver issueso Child issueso Coping with medical conditionso Crisis interventiono Depressiono Domestic/family violenceo Drug abuseo Eating disorders and obesityo Eldercareo Employment stress
o Family issueso Financial problemso Grief and losso Interpersonal difficultieso Legal problemso Marital issueso Management issueso Mental or emotional illnesso Multicultural issueso Parenting issueso Sexual orientation issueso Stresso Work performance issueso Any other concern
( 8 0 0 ) 8 8 6 - 1 1 7 1 / ( 6 1 4 ) 4 7 5 - 9 5 0 0
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Medical Benefits
Administered by Anthem Blue Cross and Blue Shield
Dublin City Schools provides you with a High Deductible Health Plan (HDHP) that uses the Anthem Blue Access PPONetwork and their National Drug List (or Formulary). Comprehensive healthcare provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Dublin City Schools.
The plan allows you to select where you receive your medical services. However, when you use in-network providers your costs will be less. Out-of-network providers may balance bill you for the difference between their billed charges and what Anthem allows (the in-network contractual amount). Your cost share is illustrated below:
In-Network Benefits Out-of-Network Benefits
Deductible Single Family*
$1,400 $2,800
$2,800 $5,600
Out-of-Pocket Maximum Single Family
$2,600 $5,200
$5,200 $10,400
Coinsurance 10% 30%
Doctor's Office
Office Visits 10% after deductible 30% after deductible
Preventive Care Services (routine exams, x-rays/tests, immuniza-tions, well baby care, mammograms)
No Cost Share - the plan pays 100% 30% after deductible
Hospital Services
Emergency Room - True Emergency 10% after deductible 10% after deductible
Emergency Room - Non-Emergency 10% after deductible 30% after deductible
Urgent Care Center 10% after deductible 10% after deductible
Inpatient 10% after deductible 30% after deductible
Outpatient Surgery 10% after deductible 30% after deductible
Ambulance Services 10% after deductible 10% after deductible
Other Services
Maternity Services 10% after deductible 30% after deductible
Diagnostic Lab and X-ray 10% after deductible 30% after deductible
Diagnostic Scans (MRI, CT Scans, Nuclear Medicine) 10% after deductible 30% after deductible
Prescription Drugs Retail - Generic Drugs 31-day supply 10% after deductible 30% after deductible Mail Order 90-day supply 10% after deductible Not covered
If You also cover Dependents (other family members) under this Plan, only the “Family” amounts apply. The “Family” Deductible amounts can be satisfied by a family member or a combination of family members. Once the Family Deductible is met, it is considered met for all family members. The “Family” Out-of-Pocket amounts can be satisfied by a family member or a combination of family members. Once the Family Out-of-Pocket is met, it is considered met for all family members.*Dependent children up to age 26 regardless of f inancial dependence, student status, residence or mar ital status. Dependentsare automatically dropped from health insurance coverage at the end of the month in which the dependent turns 26.
Health Savings Accounts (HSA) Administered by CME Federal Credit Union
A HSA is a savings account ow ned by the employee designed to help them save for future, qualif ied medical expenses (QME) and retiree health expenses. Funds are contributed to the account on a pretax basis, and any unused funds roll over from year to year. Only “HSA Eligible” employees may contribute to an HSA. An individual is HSA Eligible if he or she
• Is covered by a Qualif ied High Deductible Health Plan (HDHP)• Is not enrolled in other disqualifying coverage such as
Medicare, Tricare, PPO, HRA, your or your spouse’s general
purpose FSA• Cannot be claimed as a tax dependent on another person ’s
tax returnAny contribution by the employee to his/her HSA up to the maximum limits provided by law may, at the members discretion, be made either by payroll deduction or in a lump-sum payment. The HSA shall be maintained by the employee for his/her exclus ive benefit and that of his/her dependents. Distribution of funds may be made at any time at the discretion of the employee. The employee is responsible for substantiating the distributions for qualif ied medical expenses.
2021 Contribution Limits
Single Coverage $3,600 Family Coverage $7,200 Catch-up Contributions (age 55 or older) $1,000
Excess contributions to the HSA are subject to a tax penalty and must be reported on the individual’s tax return as regular income.
Non -Qualified Expenses
In general, distributions for non-qualif ied medical expenses are subject to federal income tax and a 20% penalty if the individual is under age 65. If the individual is over age 65, non-qualif ied distributions are taxed as regular income.
Definition of Dependent for Health Savings Accounts is
Different than Group Health Plan
A Health Savings Account owner can use the funds to cover qualif ied medical expenses for themselves, their legal spouse and tax dependents. Under Healthcare Reform, an employee can cover his or her adult children up to age 26 regardless of student or marital status, f inancial dependence or residency. However,
medical expenses incurred by the adult child will not be a
qualified expense under the HSA unless the child can be
claimed as a tax dependent. If the adult child is not a tax dependent, any dis tr ibutions for them must be dec lared as regular income tax and will be subject to an additional 20% penalty.
12 | Dublin City Schools
Dublin City Schools partners w ith CME Federal Credit
Union to administer the Health Savings Account*
1. First step to establishing a Health Savings Account is
to open your CME account. Vis it www.cmefcu.org andclick on “Open an Account” to being the registrationprocess. Complete all screens selecting HSA on theAvail-able Products screen. You will receive a responseback from CME within 1-2 days.
2. Second step is to respond back to CME providing an
electronic signature via email.
3. If you have any questions about the process, please
contact the CME Call Center at 1.888.224.3108, ext. 6.
Following acceptance of your electronic signature, your HSA will be active and debit cards will be sent to you. Payrolldeductions will not start until the above steps are completed.
CME Federal Credit Union HSA Benefits:
Competit ively tiered interest rates
Investment Options
No set up or annual HSA fee
Online statements
Free Visa Debit Card
Free Online bill pay
Checks available upon request, at cost
LOCAL, personal, friendly customer service
CME w ill fund the $5 deposit to your Advantage Shareaccount. This amount is required to maintain your membeship stake in the credit union.
* If you currently have an HSA through another facility or bank,you can easily rollover your existing account to CME FederalCredit Union, if you choose. To begin the rollover process,please email [email protected] (Loraine Allison at CMEFederal Credit Union) using “Dublin City Schools HealthSavings Account Rollover” in the subject line. CME w ill sendthe appropriate application and rollover request form back toyou to init iate the rollover process. CME w ill notify Dublin CitySchools w hen the rollover is complete. At that point in t ime,Dublin City Schools will initiate requested payroll deductions toCME.
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With Sydney Health, you can find everything you need to know about your medical, pharmacy, dental, vision, life insurance, and disability insurance benefits all in one place. Sydney Health makes it easier to get things done, so you can spend more time focused on your health.
Life and Disability products underwritten by Anthem Life Insurance Company. In Georgia: Life and Disability products are underwritten by Greater Georgia Life Insurance Company using the trade name Anthem Life. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefi st underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affi iates only provide administrative services for self-funded plans and do not underwrite benefi s. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMOtl Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Sydney and Sydney Health are service marks of CareMarket, Inc.
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With just one click, you can:
Find care and check costs
See all benefits
View claims
View and use digital ID cards
Use the interactive chat featureto get answers quickly
Sync your favorite fitness tracker
S ecneirepxe elpmiOur simple experience makes it easy to find what you need — with one-click access to benefits info, Member Services, LiveHealth Online and wellness resources. And you can use the interactive chat to get answers quickly.
M draobhsaD htlaeH yMy Health Dashboard is your hub for personalized health and wellness. Find programs that interest you, build an action plan to help you meet your health goals, sync your fitness tracker and earn points for your progress.
P hctaM dezilanosre Personalized Match helps you find a doctor in your plan who’s right for you. You’ll get results carefully matched with your unique needs, preferences and plan details.
M droceR htlaeH ylimaF yMy Family Health Record gives you the full picture of your family’s health — all in one place. It includes health history and electronic medical records. View, download and share the info right from the app.
retal evas ,won erapmoc – trams pohSDid you know doctors and hospitals may charge different amounts for the same services? As an Anthem member, you can use the Estimate Your Cost tool on our app or website to compare costs based on your benef ts. You can also use the tooli to f nd and compare quality of care information, so you know you’re getting the best care available. i
Hospital 1 Hospital 2
Examples of procedures you can compare with the Estimate Your Cost tool
$4,500 Bronchoscopy
(Average cost $6,200)$7,900
$700 Chest CT scan
(Average cost $800) $1,000
$31,600 Hip replacement
(Average cost $34,700)$37,900
$31,700 Knee replacement
(Average cost $34,700)$37,700
Sample cost comparison*
Know your costs before you get care
For quick and easy cost comparison, use the Sydney app.
You can also go to anthem.com and log in to use the Estimate Your Cost tool.Search for the procedure you need and the tool will guide you.
* These rates are national averages for the services listed. Your experience may be different depending on your specif c plan, the services you receive and the health care provider.i Rates as of 2018.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain aff liates administer non-HMO benef ts underwritten by HALIC and HMO benef ts underwritten by HMOiii Missouri, Inc. RIT and certain aff liates only provide administrative services for self-funded plans and do not underwrite benef ts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthemii Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross andBlue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benef ts in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies.i Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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We understand that medical procedures can be costly and can sometimes seem unpredictable. In fact, the same test or procedure can vary by hundreds or even thousands of dollars, depending on where you go. SmartShopper makes it easy to compare cost information about common health procedures. You can even earn cash* rewards when you choose a health care provider known for high-quality outcomes.
Shop on your own or with a Personal Assistant
It’s easy to use SmartShopper. Shop online at smartshopper.com or call the SmartShopper Personal Assistant Team. Your Personal Assistant will help you understand your options and schedule your appointment. You can reach a Personal Assistant by calling 1-844-328-1582 Monday to Thursday, 8 a.m. to 8 p.m. Eastern andFriday 8 a.m. to 6 p.m. Eastern.
SmartShopper is easy to use
When your health care provider suggests a test or procedure, visit smartshopper.com or call the SmartShopper Personal Assistant Team at 1-844-328-1582.
Choose where you would like to have your test or procedure. All of the SmartShopper options are in your plan’s network.
After Anthem pays your claim, SmartShopper will mail you a reward check. Your check should arrive in about six weeks.
Save money on health tests and proceduresSmartShopper helps you find the best value for high-quality care
Earn cash rewards for choosing health care providers known for high-quality, lower-cost care.
Sample procedures and rewards
Test or procedure Reward up to:
ACL repair by arthroscopy $250
Colonoscopy $250
Mammogram $50
Ultrasound $50
Physical therapy $150
For a full list of procedures and rewards, call the Personal Assistant team at 1-844-328-1582 or visit smartshopper.com.
We are happy to offer you SmartShopper as part of your Anthem benefit plan. It’s one more way that we can help you to save money and receive high-quality health care. To sign up, go to smartshopper.com or call the Personal Assistant Team at 1-844-328-1582, Monday to Thursday, 8 a.m. to 8 p.m. Easternand Friday 8 a.m. to 6 p.m. Eastern.
1
3
2
* Reward payments may be taxable.
The SmartShopper program is provided by Sapphire Digital an independent company. Incentives available for select procedures only. Payments are a taxable form of income. Rewards may be delivered by check or an alternative form of payment. Members with coverage under Medicaid or Medicare are not eligible to receive incentive rewards under the SmartShopper program. Rewards are for select procedures only and reward payments may be taxable.
Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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When you’re not feeling well you can get the support you need easily using LiveHealth Online. Whether you have a cold, you’re feeling anxious or need help managing your medication, doctors and mental health professionals are right there, ready to help you feel your best. Using LiveHealth Online you can have a video visit with a board-certified doctor, psychiatrist or licensed therapist from your smartphone, tablet or computer from home or anywhere.
On LiveHealth Online, you can:
See a board-certified doctor 24/7. You don’t need anappointment to see a doctor. They’re always available toassess your condition and send a prescription to thepharmacy you choose, if needed.1 It’s a great option whenyou have pink eye, a cold, the flu, a fever, allergies, a sinusinfection or another common health issue.
Visit a licensed therapist in four days or less.2 Have a videovisit with a therapist to get help with anxiety, depression,grief, panic attacks and more. Schedule your appointmentonline or call 1-888-548-3432 from 8 a.m. to 8 p.m., sevendays a week.
Consult a board-certified psychiatrist within two weeks.3
If you’re over 18 years old, you can get medication support tohelp you manage a mental health condition. To schedule yourappointment call 1-888-548-3432 from 8 a.m. to 8 p.m.,seven days a week.
You’ve got access to affordable and convenient care
Your Anthem plan includes benefits for video visits using LiveHealth Online, so you’ll just pay your share of the costs — usually $59 or less for medical doctor visits, and a 45-minute therapy or psychiatry session usually costs the same as an office mental health visit.
A ,og eht no ro emoh t d latnem dna srotco h era slanoisseforp htlae h .uoy rof ereUse LiveHealth Online, anytime, for a private video visit with a doctor or mental health professional.
Sign up for LiveHealth Online today -- it’s quick and easy Go to livehealthonline.com or download the app and register on your phone or tablet.
1 Prescription availability is defined by physician judgment and state regulations. Visit the home page of livehealthonline.com to view the service map by state. 2 Appointments subject to availability of a therapist. 3 Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. Psychiatrists on LiveHealth Online will not offer counseling or talk therapy. Appointments subject to availability.
Online counseling is not appropriate for all kinds of problems. If you are in crisis or have suicidal thoughts, it’s important that you seek help immediately. Please call 1-800-784-2433 (National Suicide Prevention Lifeline) or 911 and ask for help. If your issue is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services.
If you’re a retiree or have coverage that complements your Medicare benefits, your employer sponsored health plan may not include coverage for online visits using LiveHealth Online. Check your plan documents for details. You can still use LiveHealth Online, but you may have to pay the full cost of a visit. Online visits using LiveHealth Online may not be a covered benefit for HRA and HIA+ members.
LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefi s underwritten by HALIC and HMO benefi s underwritten by HMOtt Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefi s. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthemt Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Got health questions? Answers are at your f ngertips. i
Add 800-337-4770 to your contacts today!
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain aff liates administer non-HMO benef ts underwritten by HALIC and HMO benef tsiii underwritten by HMO Missouri, Inc. RIT and certain aff liates only provide administrative services for self-funded plans and do not underwrite benef ts. In Nevada: Rockyii Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benef ts in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborativei Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
MANSH1301A VPOD Rev. 10/15
Whether it’s 3 a.m. or a lazy Sunday afternoon with the family, health issues can crop up at the most inconvenient times and places.
What if you had a nurse in your back pocket — someone knowledgeable you could talk to any time of the day or night, 365 days a year?
That’s why Anthem Blue Cross and Blue Shield (Anthem) offers 24/7 NurseLine, a resource you call when life throws you a curve ball.
While 24/7 NurseLine may be your f rst line of defense for the unexpected,i it’s also part of Anthem’s whole-health approach. The registered nurses can help you with your baby’s fever, give you allergy relief tips and advise you where to go for care.
Get round-the-clock
dnim fo ecaep24/7 NurseLine has you covered anytime, anywhere
*Prescription availability is def ned by physician judgment and state regulations. LiveHealth Online is available in most states andiis expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state.
LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
They can also: — Help you f nd providers and specialists in youri
area.
— Give you referrals to LiveHealth Online, a tool that allows you to have live video chats with board-certif ed doctors using a smartphone,i tablet or computer and webcam.*
— Enroll you and your dependents in valuable health management programs for certain health conditions.
— Remind you about scheduling important screenings and exams, including dental and vision checkups.
— Provide guidance during natural catastrophes and health outbreaks.
— Offer links to health-related educational videos or audio topics.
24/7 NurseLine can connect you to Anthem’s other health and wellness programs, so you have access to the best resources for the best health results.
19
20 | Dublin City Schools
21
2021 Insurance Rates & Contributions for Medical, Dental, Vision
Total Cost Per Month (Board + Employee Contribution)
Single Single + 1 Family Health $610.00 $1,220.00 $1,932.00 Dental $43.04 N/A $118.58
Vision $8.93 N/A $25.20
Dublin City Schools
Insurance Rates and Contributions (Per Pay)
Effective 1/1/2021
Benefit
Employee Cost 10%
BOE Cost 90%
Employee Cost 15%
BOE Cost 85%
Employee Cost 15%
BOE Cost 85%
Single Single Single + 1 Single + 1 Family Family
Medical $30.50 $274.50 $91.50 $518.50 $144.90 $821.10 Dental $2.15 $19.37 $8.89 $50.40 $8.89 $50.40 Vison $0.44 $4.02 $1.89 $10.71 $1.89 $10.71 Total Per Pay $33.09 $297.89 $102.28 $579.61 $155.68 $882.21
Rates for these and all other benefits will be shown on a per pay basis in the enrollment portal
SINGLE SINGLE + 1 FAMILY
Board Employee Total Board Employee Total Board Employee Total
Medical
Full-time $549.00 $61.00 $610.00 $1,037.00 $183.00 $1,220.00 $1,642.20 $289.80 $1,932.00
9 Tenths $494.10 $115.90 $610.00 $933.30 $286.70 $1,220.00 $1,477.98 $454.02 $1,932.00
8 Tenths $439.20 $170.80 $610.00 $829.60 $390.40 $1,220.00 $1,313.76 $618.24 $1,932.00
7 Tenths $384.30 $225.70 $610.00 $725.90 $494.10 $1,220.00 $1,149.54 $782.46 $1,932.00
6 Tenths $329.40 $280.60 $610.00 $622.20 $597.80 $1,220.00 $985.32 $946.68 $1,932.00
5 Tenths $274.50 $335.50 $610.00 $518.50 $701.50 $1,220.00 $821.10 $1,110.90 $1,932.00
4 Tenths $219.60 $390.40 $610.00 $414.80 $805.20 $1,220.00 $656.88 $1,275.12 $1,932.00
3 Tenths $164.70 $445.30 $610.00 $311.10 $908.90 $1,220.00 $492.66 $1,439.34 $1,932.00
2 Tenths $109.80 $500.20 $610.00 $207.40 $1,012.60 $1,220.00 $328.44 $1,603.56 $1,932.00
1 Tenth $54.90 $555.10 $610.00 $103.70 $1,116.30 $1,220.00 $164.22 $1,767.78 $1,932.00
22 | Dublin City Schools
Flexible Spending Accounts (FSA) Administered by Chard Snyder
FSA’s allow you to have pre-tax money deducted from your paycheck to pay for certain healthcare expenses. Since contributions are made through payroll deductions with pre-tax dollars, you decrease your taxable income and thereby increase your take-home pay.
There are two types of FSAs available:
Health Care Dependent Care
Substantiation Requirements
For medical expenses, the IRS requires you to substantiate: Date service was received or purchase made Description of service or item purchased Dollar amount Provider or store name In some cases, a Medical Necessity Form or physician
letter may be required
NOTE: In some cases, the plan’s design requires that your health insurer’s Explanation Of Benefits (EOB) is provided as substantiation for your expense. If you receive a receipt from your provider for a copay amount, make sure the receipt says “copay.” If not, ask your provider to write “copay” on your receipt before leaving the office. Vague or missing information causes your reimbursements to be held up or become ineligible. Keep your receipts and documentation.
For dependent care expenses, the IRS requires you to substantiate: Dates of service Dollar amount incurred Daycare provider name and Tax ID Daycare provider signature
NOTE: Daycare expenses must be incurred (not just paid) in order to receive reimbursement. Registration fees cannot be reimbursed until the services are actually incurred. You will be required to report your dependent care provider’s Tax ID (TIN) or SSN on IRS Form 2441 when you file your federal income tax return. Vague or missing information causes your reimbursements to be held up or become ineligible. Keep your receipts and documentation.
Health Care FSA
If you are enrolled in the HSA Plan and have a Health Savings Account, your FSA will be a limited purpose health care spending account. Under a limited purpose FSA account, you can receive tax-free reimbursement for dental and vision expenses only.
If you waive medical coverage or are not eligible to have a Health Savings Account, the FSA will reimburse qualified medical, prescription, dental and vision expenses.
NOTE: This is a “Use It or Lose it” account. The maximum annual amount that you can contribute to the health care FSA is $2,750. You may rollover up to $500 of unused funds at the end of the year.
Dependent Care Account
You can also set aside pre-tax money for daycare for eligible dependents through the Dependent Care FSA. You decide how much to contribute, up to $5,000 per year, per household.
Eligible dependents are children under the age of 13 or a dependent spouse or child who is physically or mentally incapable of caring for himself/herself and has the same principal residence as the Participant for more than one-half such taxable year.
Did You Know? The Chard Snyder debit card helps you stay within IRS rules by allowing purchases only at locations that provide
eligible services or merchandise. You’ll receive two cards, one for you and one for another family member.
Use the Chard Snyder Mobile App and stay up-to-date wherever you are! Access your account balance anywhere, see specific transaction details, submit healthcare claims and receipt images for substantiation, plus choose text alerts you want to receive. You’ll know when claims are confirmed or denied and when receipts are needed to support your reimbursement request.
Visit www.chard-snyder.com and click on the
Support Center link for A-to-Z FSA resources.
Examples of eligible healthcare account expenses are on the next page
23
24 | Dublin City Schools
Life and Accidental Death & Dismemberment (AD&D)
Optional Employee & Dependent Life and AD&D
Administered by Prudential Insurance Company of America
Dublin City Schools cares about your financial well-being and provides you with $50,000 of Basic Life and AD&D Insurance, at no cost to you. For full coverage details, please find the Certificate of Coverage on www.explainmybenefits.com/dublin under the Summaries link.
You may purchase additional Optional Life & ADD insurance on yourself and your dependents as well. Some highlights of the plan are listed below.
25
26 | Dublin City Schools
Universal Life with Long Term Care includes both a death benefit and a living benefit.
Universal Life with Long Term Care is permanent life insurance that is designed to match your needsthroughout your lifetime.
This policy is priced to remain the same cost to you until age 100.
The Living Benefit, or Long Term Care, is 4% of the death benefit per month for up to 25 months if confined in a nursing or assisted living facility or 2% of the death benefit per month of up to 50 months if receivinghome health or day care.
Monthly premiums are waived while using the Long Term Care benefit, and will reduce your death benefit.
Coverage is available for spouse and children.
Special Underwriting for Initial Offering
Guaranteed Issue
Up to $100,000 employee / up to $15,000 spouse
$25,000 children
Rates
This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system.
Universal Life Insurance with Long Term Care
Administered by Trustmark
Importance of Selecting a Beneficiary
Selecting a beneficiary is a very personal decision. Some people want to use a death benefit to replace income and maintain their family’s lifestyle, and others look at it as more of a financial umbrella to help pay off mortgages, debts or the cost of college. When you designate beneficiaries, you have the final say over who receives the proceeds. If you do not chose one, your state’s laws determine who received the benefit.
27
lf 4ou were to b ecome disabled how would 4ou ...
... continue 4our Ii f estl4e
What if 4ou couldnt work due to an injur4, illness, or preqnanc4? How
would 4ou earn income? OneAmerica has qot 4ou covered
lmportant
This is d tdx free benefit that pdljS ljOU in dddition to sick pdlj or STRS disdbilitlj. This DOES NOT OFFSET 4our sick pdlj or STRS disdbilitlj.
Special
Underwritinq
Gudrdnteed Issue coverdqe. That medns thdt reqdrdless of pdst medicdl condition 4ou qudliflj to receive coverdqe.
Preqnanc4
Preqndnc4 is covered dnd comes with d 3/o pre-existinq condition limitdtion prior to the effective ddte Refer to 4our benefits portdl for more information on pre-ex.
Coverage designed to help you receive up to your full pre
in jury or pre-illness income.
Disability Income
Short ct Lonq Term
Disabilit4 allows 4ou to:
•Palj LjOUr bills
•Bu4 4our qrocerires
•Pa4 4our rent/rnortqaqe
•Make 4our car pa4rnent
A Unique Solution
One of 4our biqqest assets is 4our abilit4 to earn income. Could LjOU and LjOUr famillj survive an income-interruptinq disabilit4?
28 | Dublin City Schools
• Part of the Ohio State Teachers Retirement
System . As a teacher or school employee you
have access based on the number of years
served.
• Existing members on June 30, 2013 must have
at least 5 years of qualifying service credit
• New members on or after July 1, 2013 must
have at least 10 years of qualifying service
credit
• If your disability is approved it pays a benefit
amount of 45% - 60% of your monthly salary
based on number of years served
• Actual net benefit would be 25% - 40% of your
monthly salary after taxes are withheld.
Why is Disability Insurance Important to You
• Regardless of the number of Sick Days you have, Short Term Disability will pay you a benefit amount that you choose from 40%
or 60% * of your monthly salary.
This benefit amount will be paid in addition to the income you receive from your sick pay!
• If you receive a STRS disability benefit, you will only NET 25% - 40%
of your monthly salary after taxes. Long Term Disability will pay you
a benefit amount you choose from 20%, 30% or 40%* of your monthly
salary. Providing you the opportunity to receive near your full
pre-disability income in the event you cannot work long-term Protect Your Paycheck
if You Cannot Work Due
to an Injury, Illness or
Pregnancy • Protect your income with either Short Term (benefits begin on 8th day
or 31st day and pays a benefit up to 180 days you cannot work) , Long Term (begins after 180 days and pays a benefit through normal retirement age) or choose both plans for ultimate Income Protection.
* Cost and benefit will be rounded to the nearest $100 benefit amount
• Part of the Ohio School Employee Retirement System . As school employee you have access based on the number of years served.
• Have at least five years of total service credit.
• There are two plans. Members who joined SERS after July, 29, 1992 are under the New plan. Under the old plan members cannot apply for disability once age 60 is reached.
• If your disability is approved it pays a benefit amount of 45% - 60% of your monthly salary based on number of years served
• Actual net benefit would be 25% - 40% of your monthly salary after taxes are withheld.
29
Short -Term Disability Insurance
Administered by One America
Your most important asset is your ability to earn a paycheck! Disability insurance is paycheck insurance. Disability insurance replaces a portion of your weekly income for 22 or 26 weeks, should you become sick or injured and unable to work. You can choose the right benefit option for you and your family.
The elimination period is the time you must wait from the start of your disability for benefits to start paying, if you are approved for claim. You will want to consider the Benefit Percentage, or Income Replacement amount, as well as the benefit duration.
A brief description is provided below. For complete details, please refer to the One America Short-Term Disability Plan Description under Summary Plan Description and Notices posted at www.explainmybenefits.com/dublin under the Summaries link.
Group Worksite Disability Insurance Options- Short Term Class Description All Eligible Full-Time Employees
Required Minimum Number
of Work Hours 17 hours weekly
Employee Premium
Contribution 100%
Features STD
Option 1 STD
Option 2 STD
Option 3 STD
Option 4
Injury Elimination Period 30 Days 7 Days 30 Days 7 Days
Sickness Elimination Period 30 Days 7 Days 30 Days 7 Days
Maximum Benefit Duration 22 Weeks 26 Weeks 22 Weeks 26 Weeks
Benefit Percentage 60% 60% 40% 40%
Maximum Weekly Benefit $2,500
Pre-Existing Condition
Exclusion 3/6
Total Disability Definition Regular Occupation
Partial Disability Definition Proportionate Loss
Residual Benefit Yes
An eligible employee is a full-time employee author-ized to work and reside in the United States. Eligible employees must work therequired minimum number of hours and cannot be considered a part-time, temporary or seasonal employee. If any eligible employee is not actively at work on the contract effective date, group insurance coverage for that employee will not exist until he/she returns to full-time active work.
30 | Dublin City Schools
Long -Term Disability Insurance
Administered by One America
If your disability lasts longer than anticipated, Long Term Disability will replace a portion of your monthly income. If your claim is approved, the benefit will continue until you are able to return to your regular occupation or you reach your full Social Security Full Retirement Age, whichever occurs first.
The elimination period is the time you must wait from the onset of your disability for benefits to start paying. You will want to consider the Benefit Percentage, or Income Replacement amount, described below.
A brief description is provided below. For complete details, please refer to the One America Long-Term Disability Plan Description under Summary Plan Description and Notices posted at www.explainmybenefits.com/dublin under the Summaries link.
An eligible employee is a full-time employee authorized to work and reside in the United States. Eligible employees must work the required minimum number of hours and cannot be considered a part-time, temporary or seasonal employee. If any eligible employee is not actively at work on the contract effective date, group insurance coverage for that em-ployee will not exist until he/she returns to full-time active work.
Group Worksite Disability Insurance Options- Long Term
Class Description All Eligible Full-Time Employees
Required Minimum Number of Work Hours 17 hours weekly
Employee Premium Contribution 100%
Features LTD
Option 1 LTD
Option 2 LTD
Option 3
Elimination Period 180 Days 180 Days 180 Days
Maximum Benefit Duration Social Security Full Retirement Age
Benefit Percentage 40% 30% 20%
Maximum Weekly Benefit $5,000
Pre-Existing Condition Exclusion 3/12
Total Disability Definition Regular Occupation - 2 years
Partial Disability Definition Proportionate Loss
Residual Benefit Yes
31
Voluntary Benefits
32 | Dublin City Schools
Accident Insurance
Administered by Trustmark
Trustmark Accident insurance is designed to cover unexpected expenses that result from all kinds of accidents, even sports-related and household ones. It provides a cash benefit per covered accident payable directly to you.
A brief description is provided below. Please refer to the brochure, FAQ, and Accident Plan—Health Screening Claim Form posted at www.explainmybenefits.com/dublin under the Summaries link. A Health Screening Benefit is payable every year and helps offset the affordable premium you pay for this benefit. Please refer to the Accident
Plan—Health Screening Claim Form for a list of specific screenings that are covered.
33
POD76984
Receiving a cancer diagnosis can be one of life’s most frightening events.Unfortunately, statistics show you probably know someone who has been in this situation.
With Cancer insurance from Allstate Benefits, you can rest a little easier. Our coverage pays you a cash benefit to help with the costs associated with treatments, to pay for daily living expenses, and more importantly, to empower you to seek the care you need.
Here’s How It WorksYou choose the coverage that’s right for you and your family. Our Cancer insurance pays cash benefits for cancer and 29 specified diseases to help with the cost of treatments and expenses as they happen. Benefits are paid directly to you unless otherwise assigned. With the cash benefits you can receive from this coverage, you may not need to use the funds from your Health Savings Account (HSA) for cancer or specified disease treatments and expenses.
Meeting Your Needs• Includes coverage for cancer and 29 specified diseases• Benefits are paid directly to you unless otherwise assigned
• Coverage available for dependents• Waiver of premium after 90 days of disability due to cancer for as long as your disability
lasts (employee only)• Coverage may be continued; refer to your certificate for details
• Additional benefits have been added to enhance your coverage
With Allstate Benefits, you can protect your finances if faced with an unexpected cancer or specified disease diagnosis. Practical benefits for everyday living.SM
Protection for the treatment of cancer and
29 specified diseases
Cancer Insurance
1Life After Cancer: Survivorship by the Numbers, American Cancer Society, 2017. 2Cancer Treatment & Survivorship Facts & Figures, 2016-2017
DID YOU KNOW
The number of cancer survivors in the U.S. is increasing, and is expected to jump to nearly 20.3 million by 20262
?Early detection, improved treatments and access to care are factors that influence cancer survival1
20.3 million
Dublin SchoolsOffered to the employees of:
Here’s how TJ’s story of diagnosis and treatment turned into a happy ending, because he had supplemental Cancer Insurance to help with expenses.
TJ undergoes his annual wellness test and is diagnosed for the first time with prostate cancer. His doctor reviews the results with him and recommends pre-op testing and surgery.
Here’s TJ’s treatment path:• TJ travels to a specialized hospital 400 miles
from where he lives and undergoes pre-op testing• He is admitted to the hospital for laparoscopic
prostate cancer surgery• TJ undergoes surgery and spends several hours
in the recovery waiting room• He is transferred to his room where he is visited
by his doctor during a 2-day hospital stay• TJ is released under doctor required treatment and
care during a 2-month recovery period
TJ continues to fight his cancer and follow his doctor recommended treatments.
CHOOSE CLAIMUSETJ chooses benefits to helpprotect himself and his wife if diagnosed with cancer or a specified disease
Meet TJTJ is like anyone else who has been diagnosed with cancer. He is concerned about his wife and how she will cope with his disease and its treatment. Most importantly, he worries about how he will pay for his treatment.
Here is what weighs heavily on his mind:• Major medical only pays a portion of the
expenses associated with my treatment
• I have copays I am responsible for untilI meet my deductible
• If I am not working due to treatments,I must cover my bills, rent/mortgage,groceries and other daily expenses
• If the right treatment is not availablelocally, I will have to travel to get thetreatment I need
TJ’s Cancer claim paid him cash benefits for the following:
WellnessCancer Initial DiagnosisContinuous Hospital ConfinementNon-Local TransportationSurgeryAnesthesiaMedical ImagingInpatient Drugs and MedicinePhysician’s AttendanceAnti-Nausea
For a listing of benefits and benefit amounts, see your company’s rate insert.
Benefits (subject to maximums as listed on the attached rate insert) Using your cash benefitsCash benefits provide you with options, because you decide how to use them.
FinancesCan help protect HSAs, savings, retirement plans and 401(k)s from being depleted.
TravelCan help pay for expenses
while receiving treatment in another city.
HomeCan help pay the mortgage, continue rental payments, or perform needed home repairs for after care.
ExpensesCan help pay your family’s living expenses such as bills, electricity, and gas.
An easy-to-use website that offers 24/7 access to important information about your benefits. Plus, you can submit and check your claims (including claim history), request your cash benefit to be direct deposited, make changes to personal information, and more.
MyBenefits: 24/7 Accessallstatebenefits.com/mybenefits
HOSPITAL CONFINEMENT AND RELATED BENEFITSContinuous Hospital Confinement -^ inpatient admission and confinement
Government or Charity Hospital -^ confinements in lieu of all other benefits, except Waiver of Premium
Private Duty Nursing Services -^ full-time nursing services authorized by attending physician
Extended Care Facility -^ within 14 days of a hospital stay; payable up to the number of days of the hospital stay
At Home Nursing -^ private nursing care must begin within 14 days of a covered hospital stay; payable up to the number of days of the previous hospital stay
Hospice Care Center or Team -^ terminal illness care in a facility or at home; one visit per day
RADIATION/CHEMOTHERAPY AND RELATED BENEFITSRadiation/Chemotherapy for Cancer -^ covered treatments to destroy or modify cancerous tissue
Blood, Plasma and Platelets -^ transfusions, administration, processing, procurement, cross matching
Hematological Drugs -^ boosts cell lines for white/red cell counts and platelets; payable when Radiation/Chemotherapy for Cancer benefit is paid
Medical Imaging -^ initial diagnosis or follow-up evaluation based on covered imaging exam
SURGERY AND RELATED BENEFITSSurgery* -^ based on Certificate Schedule of Surgical Procedures
Anesthesia -^ 25% of Surgery benefit for anesthesia received by an anesthetist
Bone Marrow or Stem Cell Transplant -^ autologous, non-autologous for treatment of cancer or specified disease other than Leukemia, or non-autologous for treatment of Leukemia
Ambulatory Surgical Center -^ payable only if Surgery benefit is paid
Second Opinion -^ second opinion for surgery or treatment by a doctor not in practice with your doctor
MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine -^ not including drugs/medicine covered under the Radiation/Chemotherapy for Cancer or Anti-Nausea benefits
Physician’s Attendance -^ one inpatient visit by one physician
Ambulance -^ transfer to or from hospital where confined by a licensed service or hospital-owned ambulance
Non-Local Transportation -^ obtaining treatment not available locally
Outpatient Lodging -^ more than 100 miles from home
Family Member Lodging and Transportation -^ adult family member travels with you during non-local hospital stays for specialized treatment. Transportation not paid if Non-Local Transportation benefit is paid
Physical or Speech Therapy -^ to restore normal body function
New or Experimental Treatment -^ payable if physician judges to be necessary and only for treatment not covered under other policy benefits
Prosthesis -^ surgical implantation of prosthetic device for each amputation
Hair Prosthesis -^ wig or hairpiece every two years due to hair loss
Nonsurgical External Breast Prosthesis -^ initial prosthesis after a covered mastectomy
Anti-Nausea Benefit -^ prescribed anti-nausea medication administered on outpatient basis
Waiver of Premium** -^ must be disabled 90 days in a row due to cancer, as long as disability lasts
OPTIONAL/ADDITIONAL BENEFITSCancer Initial Diagnosis -^ for first-time diagnosis of cancer other than skin cancer
Wellness Benefit -^ once per year for one of 23 exams. See left for list of wellness tests
SPECIFIED DISEASES29 Specified Diseases Covered -^ Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease), Muscular Dystrophy, Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis, Brucellosis, Sickle Cell Anemia, Thalassemia, Rocky Mountain Spotted Fever, Legionnaires’ Disease, Addison’s Disease, Hansen’s Disease, Tularemia, Hepatitis (Chronic B or C), Typhoid Fever, Myasthenia Gravis, Reye’s Syndrome, Primary Sclerosing Cholangitis (Walter Payton’s Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, and Primary Biliary Cirrhosis
*Two or more surgeries done at the same time are considered one operation. The operation with the largest benefit will be paid. Outpatient is paid at 150% of the amount listed in the Schedule of Surgical Procedures. Does not pay for other surgeries covered by other benefits **Premiums waived for employee only
Wellness Benefit Biopsy for skin cancer; Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer), PSA (prostate cancer); Bone Marrow Testing; Chest X-ray; Colonoscopy; Doppler screening for carotids or peripheral vascular disease; Echocardiogram; EKG; Flexible sigmoidoscopy; Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccina-tion; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap Smear, including ThinPrep Pap Test; Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening for abdominal aortic aneurysms.
ABJ30590-3 - Insert - 09259
This material is valid as long as information remains current, but in no event later than June 1, 2023. Allstate Benefits is the marketing name used by
American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2020 Allstate Insurance
Company. www.allstate.com or allstatebenefits.com.
For use in enrollments sitused in: OH. This rate insert is part of the approved brochure for Dublin Schools and is not to be used on its own.
Cancer Insurance (GVCP3)Includes coverage for 29 Specified Diseases from Allstate Benefits
BENEFIT AMOUNTS
HOSPITAL CONFINEMENT AND RELATED BENEFITS PLAN 1 PLAN 2Continuous Hospital Confinement (daily) $300 $100
Government or Charity Hospital (daily) $300 $100
Private Duty Nursing Services (daily) $300 $100
Extended Care Facility (daily) $300 $100
At Home Nursing (daily) $300 $100
Hospice Care Center (daily) or $300 $100
Hospice Care Team (per visit) $300 $100
RADIATION/CHEMOTHERAPY/RELATED BENEFITS PLAN 1 PLAN 2Radiation/Chemotherapy for Cancer1 (every 12 months) $12,800 $6,400
Blood, Plasma, and Platelets1 (every 12 months) $10,000 $5,000
Hematological Drugs1 (every 12 months) $200 $100
Medical Imaging1 (every 12 months) $500 $250
SURGERY AND RELATED BENEFITS PLAN 1 PLAN 2Surgery
2$3,000 $1,500
Anesthesia (% of surgery benefit) 25% 25%
Bone Marrow or Stem Cell Transplant (once/year)
1. Autologous $1,000 $500
2. Non-autologous (cancer or specified disease treatment) $2,500 $1,250
3. Non-autologous (Leukemia) $5,000 $2,500
Ambulatory Surgical Center (daily) $500 $250
Second Opinion $400 $200
MISCELLANEOUS BENEFITS PLAN 1 PLAN 2Inpatient Drugs and Medicine (daily) $25 $25
Physician’s Attendance (daily) $50 $50
Ambulance (per confinement) $100 $100
Non-Local Transportation1
(coach fare or amount shown per mile*) 0.40/Mile 0.40/Mile
Outpatient Lodging (daily; limit $2,000/12 mo. period) $50 $50
Family Member Lodging (daily per trip; max. 60 days) $50 $50
and Transportation (coach fare or amount shown per mile**) 0.40/Mile 0.40/Mile
Physical or Speech Therapy (daily) $50 $50
New or Experimental Treatment3 (every 12 months) $5,000 $5,000
Prosthesis3 (per amputation) $2,000 $2,000
Hair Prosthesis (every 2 years) $25 $25
Nonsurgical External Breast Prosthesis1
$50 $50
Anti-Nausea Benefit1
(once per calendar year) $200 $200
Waiver of Premium (employee only) Yes Yes
OPTIONAL/ADDITIONAL BENEFITS PLAN 1 PLAN 2
Cancer Initial Diagnosis (one-time benefit) $4,000 $0
Wellness Benefit $100 $01Pays actual cost up to amount listed. 2Pays actual charges up to amount listed in certificate
Schedule of Surgical Procedures. Amount paid depends on surgery. 3Pays actual charges up
to amount listed. *At least 70 miles away, up to 700 miles. **Transportation up to 700 miles
per continuous hospital confinement.
PLAN 1 PREMIUMSMODE EE EE + SP EE + CH F
Semi-Monthly $13.29 $20.68 $18.65 $26.03
Issue ages: 18 and over if actively at work
Opt 1-3Hosp; 4Rad; 2Surg; 1Misc; 4Init; 0ICU; 4Well; 0Prog
V.2020.06.01 FA Rate Insert Creation Date: 6/1/2020
FOR HOME OFFICE USE ONLY - GVCP3
EE=Employee; EE + SP = Employee + Spouse;
EE + CH = Employee + Child(ren); F = Family
Dublin Schools
Offered to the employees of:
Practical benefits for everyday living.sm
When you choose Allstate Benefits, you receive more than just coverage that helps you protect your finances when faced with life’s uncertainties; you also get the support of the Good Hands® promise.
We’ve been insuring and protecting families for over 50 years with the name that America knows and trusts. Our affordable and valuable coverage options help empower hard-working individuals and their families to make the best decisions for their care and finances.
After you’ve elected coverage, register with our website, MyBenefits, for anytime access to your coverage and benefit information. Plus, MyBenefits allows you to file fast and easy claims that we’ll deposit right into your bank account (direct deposit authorization required).
Allstate Benefits. We can help give you and your family financial peace of mind.Are you in good hands?®
This brochure is for use in enrollments sitused in OH and is incomplete without the accompanying rate insert.This material is valid as long as information remains current, but in no event later than June 1, 2023.Group Cancer benefits are provided under policy form GVCP3, or state variations thereof.The coverage provided is limited benefit supplemental cancer and specified disease insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer’s Guide available from Allstate Benefits. There may be instances when a law requires that benefits under this coverage be paid to a third party, rather than to you. If you or a dependent have coverage under Medicare, Medicaid, or a state variation, please refer to your health insurance documents to confirm whether assignments or liens may apply.This is a brief overview of the benefits available under the group policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the coverage, including exclusions and other limitations are included in the certificates issued. For additional information, you may contact your Allstate Benefits Representative.The coverage does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
CERTIFICATE SPECIFICATIONSEligibility ^Coverage may include you, your spouse or domestic partner, and children under age 26.
Termination of Coverage ^Coverage under the policy ends on the date the policy is canceled; the last day premium payments were made; the last day of active employment, unless coverage is continued due to Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence; the date you or your class is no longer eligible.
^Spouse/domestic partner coverage ends upon divorce/termination of partnership or your death. Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.
Portability Privilege ^Coverage may be continued under the Portability Provision when coverage under the policy ends. Refer to your Certificate of Insurance for details.
LIMITATIONS AND EXCLUSIONSPre-Existing Condition Limitation ^We do not pay benefits for a pre-existing condition during the 12-month period beginning on the date that person’s coverage starts. A pre-existing condition is a disease or condition for which symptoms existed within the 12-month period prior to the effective date, or medical advice or treatment was recommended or received from a medical professional within the 12-month period prior to the effective date. A pre-existing condition can exist even though a diagnosis has not yet been made.
Exclusions and Limitations ^We do not pay for any loss except for losses due to cancer or a specified disease. Benefits are not paid for conditions caused or aggravated by cancer or a specified disease. Treatment and services must be needed due to cancer or a specified disease and be received in the United States or its territories.
^Hospice Care Team Limitation:^ Services are not covered for food or meals, well-baby care, volunteers or support for the family after covered person’s death.
^Blood, Plasma and Platelets Limitation:^ Does not include immunoglobulins or blood replaced by donors.
For the ^Surgery, New or Experimental Treatment^ and ^Prosthesis ^benefits, we pay 50% of the applicable maximum when specific charges are not obtainable as proof of loss.
For the ^Radiation/Chemotherapy for Cancer^ benefit, we do not pay for: any other chemical substance which may be administered with or in conjunction with radiation/chemotherapy; treatment planning, consultation or management; the design and construction of treatment devices; basic radiation dosimetry calculation; any type of laboratory tests; X-ray or other imaging used for diagnosis or monitoring; the diagnostic tests related to these treatments; or any devices or supplies including intravenous solutions and needles related to these treatments.
Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2020 Allstate Insurance Company. www.allstate.com or allstatebenefits.com
DEFINITIONSActual Charges vs. Actual CostActual Charge – Amount billed for a treatment or service before any insurance discounts or payments.Actual Cost – Amount actually paid by or on behalf of you, accepted as full payment by the provider of goods or services.
40 | Dublin City Schools
Critical Illness Insurance Administered by Trustmark
If a critical illness strikes, how would recovery and living with critical illness affect you and your family? With earlier diagnosis and advancements in treatment protocols, heart attack and stroke are showing higher survival rates.
A brief description is provided below. Pre-existing condition exclusion may apply. For complete details, please refer to the Critical Life Events brochure posted at www.explainmybenefits.com/dublin under the Summaries link.
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Contact Information
If you have specific questions about any of the benefit plans, please contact the carrier listed below. They are best suited to answer specific benefit questions and explain how your claim was processed. If you need additional help, please contact your Benefits Department at 614.760.4307 or Gallagher Benefit Services at 614.761.2901.
Benefit Administrator Phone Website/Email Medical Anthem BCBS 833.234.0653 anthem.com
Dental Delta Dental 800.524.0149 deltadentaloh.com
Vision Vision Service Plan (VSP) 800.877.7195 Vsp.com
Health Sav ings Account CME Federal Credit Union, Sallie Cerrie
888.224.3108 Email: [email protected]
Flexible Spending Account Chard-Snyder 800.982.7715 Email: [email protected]
Basic & Supplemental Life, ADD Prudential 800.524.0542 prudential.com
For assistance with products administered by Allstate, LifeLock, OneAmerica or Trustmark, please contact
Explain My Benefits at 888.734.6937, Option 3
Short-Term Disability One America 800.553.5318 oneamerica.com Long-Term Disability One America 800.553.5318 oneamerica.com Cancer Insurance Allstate 800.521.3535 allstateatwork.com Accident Insurance Trustmark 800.918.8877 trustmarksolutions.com Critical Life Events Insurance Trustmark 800.918.8877 trustmarksolutions.com Universal Life with Long Term Care
Trustmark 800.918.8877 trustmarksolutions.com
Identity Theft Protection LifeLock 800.543.3562 lifelock.com
Employee Assistance Program
Matrix 800.886.1171 matrixpsych.com
Explain My Benefits Explain My Benefits 888.734.6937 [email protected]
School District Insurance Broker
Gallagher Benefit Services 614.761.2901
Your benefit resource website:
www.explainmybenefits.com/dublin
View
Current benefit elections
Benefit Guide
Forms dow nload
Benefit videos
Certif icates of Coverage and plan information
See Instructions for
New hire benefit enrollment
Qualifying Event rules & process
Update your personal information
Beneficiary changes
TIP: Use the carriers Mobile App to make managing your benefits a breeze.
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Notes
© 2019 Gallagher Benefit Services, Inc. All rights reserved. BrandGuidelines\GBS03\TK3
This benefit summary prepared by