JULY 1, 2015

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015

Table of Contents Section 1 – The Process

2

Section 2 – The Medical Plans

5

Section 3 – The Dental Plan

13

Section 4 – The Flexible Spending Accounts

15

Section 5 – Enrollment Instructions

15

Informational Meeting Times & Locations: DAY

DATE

LOCATION

TIME

MONDAY TUESDAY WEDNESDAY MONDAY MONDAY WEDNESDAY MONDAY

APRIL 13, 2015 APRIL 14, 2015 APRIL 15, 2015 APRIL 20, 2015 APRIL 20, 2015 APRIL 22, 2015 APRIL 27, 2015

GUILFORD, CAFETERIA EAST, AUDITORIUM ADMIN BLDG, BOARD ROOM STERLING HOLLEY, 2ND FLOOR AUBURN, CAFETERIA JEFFERSON, AUDITORIUM ADMINISTRATION, BOARD RM

4:30PM 4:30PM 4:30PM 9:00AM 4:30PM 4:30PM 5:00PM

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015

1.

The Process

Welcome to Open Enrollment for July 1, 2015! This booklet will guide you through the Open Enrollment process. This is a “Changes” only Open Enrollment for all benefits eligible employees, retirees and Cobra participants. All benefit eligible participants can enroll in the PPO500 Plan, PPO1000 Plan and the High Deductible Health Plan with eligibility for a Health Savings Account for medical insurance. Open enrollment begins April 13, 2015 at 8:00am, and ends on May 1, 2015 at 4:30pm, for benefit changes effective July 1, 2015. If you are making any type of change to either your dental or medical plan, you must always enroll in all medical and dental coverage you want for July 1, 2015.

For Bus Drivers, Nutrition Services, Paraprofessionals, Educational Interpreters (EIA), Office Professionals (EOPA) and all Administrators and Administrative Staff (non-bargaining):  A Second Network option is available through Humana. Humana has Rockford Memorial Hospital and OSF Hospital as in-network hospitals.  Rockford Memorial Hospital is Out-of-Network with BlueCross BlueShield as of 7-1-2014; however, SwedishAmerican Hospital and OSF Hospital will remain in-network. If you are a member of one of the above listed groups and wish to utilize Rockford Memorial Hospital for your in-patient and outpatient hospital care, you may want to enroll in one of the plans offered by Humana. All in-patient and out-patient hospital claims through Rockford Memorial Hospital are considered OUT-OF-NETWORK with BlueCross BlueShield of Illinois for all employee groups except the REA staff members. The District no longer offers the special arrangement with BlueCross to have Rockford Memorial Hospital claims paid as in-network. If you decide to stay with the BlueCross network and utilize Rockford Memorial Hospital, this could lead to higher out-of-pocket expenses for you. For all employee groups except the REA, only Swedish American Hospital and OSF are considered in-network with BlueCross BlueShield in Winnebago County.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Employee Group

Humana

BlueCross BlueShield

Bus Drivers Nutrition Services

PPO500, PPO1000, HDHP PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP PPO500, PPO1000, HDHP

Paraprofessionals

PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP

EIA

PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP

EOPA RBMA

PPO500, PPO1000, HDHP PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP PPO500, PPO1000, HDHP

Administrators

PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP

Administrative Staff

PPO500, PPO1000, HDHP

PPO500, PPO1000, HDHP

Not Available

PPO500, PPO1000, HDHP

REA

Express Scripts (formerly Medco) continues as the District’s pharmacy administrator for those employees enrolled in the PPO500 Plan and PPO1000 Plan. For those who enroll in the High Deductible Health Plan, your Medical Insurance Network will provide pharmacy coverage through their Pharmacy Benefit Manager.

NEW THIS YEAR FOR ALL DISTRICT EMPLOYEES Open Enrollment Requirements 

All Open Enrollment changes will be completed via an on-line Open Enrollment System through Employee Navigator. No paper enrollment forms will be available this year. (Please see Section 5 - Enrollment Instructions, for directions to access Employee Navigator)



You will only be required to complete a July 1, 2015 Medical/Dental Open Enrollment Benefit Election if you are a new enrollee in the medical and/or dental plan, if you want to add a new dependent or drop a dependent, elect a different coverage level (employee only, employee and spouse/civil union partner, employee and child(ren) or family) than you currently have, or want to utilize Rockford Memorial as the best savings option for you.



If you are happy with your current medical and dental coverage elections, the network you are currently in, and the dependents you have covered (if applicable), you do not need to do anything; your coverage will be carried over for July 1, 2015. -3-

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 If you do want to make changes to your coverage, this Open Enrollment Guide provides information to assist you in making choices with respect to enrollment in the medical and dental plans. This section of the guide describes the contents of the guide, eligibility, and other communications. July 1, 2015 Open Enrollment begins April 13, 2015 at 8:00am and ends on May 1, 2015 at 4:30pm, for changes effective July 1, 2015. All enrollments must be completed in the on-line Employee Navigator system by May 1, 2015 at 4:30pm. Please see instructions for accessing Employee Navigator under Section 5, page 15. Paper enrollment forms will not be made available. Eligibility The District’s Healthcare Program is available to: 

Active employees of the District who are not covered by a collective bargaining agreement and who are regularly scheduled to work 30 hours per week; or



All active employees of the District who are covered under a collective bargaining agreement and whose collective bargaining unit has approved their participation in this plan; or



Active employees who are normally scheduled to work at least 30 hours per week, but are in the first 12 weeks of an approved leave of absence; or



Retirees of the District who have a contractual agreement with the Plan Sponsor permitting him or her to continue to participate in the Plan, except for those retirees who participate in TRS-TRIP (who are covered by another plan); or



COBRA participants of the District.

Eligible Dependents – Any New Dependents added to your medical and/or dental insurance coverage, will require further documentation such as legal marriage/civil union certificates, legal birth certificates, the Child Eligibility Certification Statement and the Spouse/Civil Union Insurance Coverage Information Form, if applicable. 

Spouse/Civil Union Partner – If your spouse/civil union partner is employed and his/her employer is offering group health insurance, and if his/her employer pays 50% or more of the cost of single health coverage, the spouse/civil union partner can only be enrolled with secondary coverage under the District’s plan, regardless of whether or not the spouse/civil union partner enrolls in his/her plan. All employees enrolling their -4-

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 spouse/civil union partner must complete a Spouse/Civil Union Partner Insurance Coverage Form, available on the Employee Navigator website. Do not drop your spouse from his/her employer medical insurance coverage without discussing with Human Resources first as this could lead to serious financial repercussions for you. 

Further documentation may be required as proof to add a spouse, which may include tax documentation, regardless of being employed or not employed.



Children – Employees may cover their children, adopted children, stepchildren, or any other child for whom the Covered Employee has been appointed the permanent legal guardian on the District’s medical and dental insurance plans. These children will be covered until age 26. Proof of family relationship to the employee and a Child Eligibility Certification Form must be completed and other documentation may be required.



Employees may also cover their child who is a military veteran up to age 30, at full cost to the employee.

2.

The Medical Plans

Open enrollment begins April 13, 2015 at 8:00am, and ends on May 1, 2015 at 4:30pm. If you are currently a medical plan participant, and are happy with your medical elections, you do not need to do anything; your coverage will be carried over for July 1, 2015. If you are making any type of change to either your dental or medical plan, you must enroll in the medical and dental coverage you want for July 1, 2015. 

All Bus Drivers, Nutrition Services, Paraprofessionals, Educational Interpreters, Office Professionals, RBMA, Administrators and Administrative Staff eligible participants have three medical plans and two provider networks administrated by BlueCross BlueShield of Illinois and Humana: -

PPO500 Plan - a traditional preferred provider organization (PPO) plan that provides co-pays for office visits, immediate care, and emergency room care and co-insurance for services outside of the physician’s office as well as for in-patient services. BlueCross BlueShield utilizes SwedishAmerican and OSF Hospitals as in-network only in Winnebago County. Humana utilizes Rockford Memorial and OSF Hospital as in-network only in Winnebago County.

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PPO1000 Plan - a traditional preferred provider organization (PPO) plan that provides co-pays for office visits, immediate care, and emergency room care and co-insurance for services outside of the physician’s office as well as for in-patient -5-

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 services. This plan carries a higher deductible than the PPO500 Plan. BlueCross BlueShield utilizes SwedishAmerican and OSF Hospitals as in-network only in Winnebago County. Humana utilizes Rockford Memorial and OSF Hospital as innetwork only in Winnebago County. -



High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) - a high deductible plan that provides a Health Savings Account for all services. This plan has no copays, only a coinsurance once the deductible has been satisfied. Prescription benefits are administrated by the PPO network selected. BlueCross BlueShield utilizes SwedishAmerican and OSF Hospitals as innetwork only in Winnebago County. Humana utilizes Rockford Memorial and OSF Hospital as in-network only in Winnebago County.

All REA benefits eligible staff have three medical plans to choose from and one provider network which is administered by BlueCross BlueShield of Illinois: -

BlueCross BlueShield of Illinois PPO500 Plan - a traditional preferred provider organization (PPO) plan that provides co-pays for office visits, immediate care, and emergency room care and co-insurance for services outside of the physician’s office as well as for in-patient services.

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BlueCross BlueShield of Illinois PPO1000 Plan - a traditional preferred provider organization (PPO) plan that provides co-pays for office visits, immediate care, and emergency room care and co-insurance for services outside of the physician’s office as well as for in-patient services. This plan carries a higher deductible than the PPO500 Plan.

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BlueCross BlueShield of Illinois High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) - a high deductible plan that provides a Health Savings Account for all services. This plan has no copays, only a coinsurance once the deductible has been satisfied. Prescription benefits are administrated by BCBSIL.

Swedish American Hospital and OSF-St. Anthony Hospital are considered in-network with BlueCross BlueShield for REA participants only. Rockford Memorial Hospital will be listed as out-of-network with BCBSI; however, it will be treated as an innetwork hospital for in-patient and outpatient billing purposes for REA participants only. Cost sharing of out of pocket expenses could be higher for the REA staff member who utilizes Rockford Memorial Hospital.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 NETWORKS

MEDICAL PLANS

BLUECROSS BLUESHIELD OF ILLINOIS FOR ALL EMPLOYEE GROUPS HUMANA FOR ALL EMPLOYEE GROUPS EXCEPT REA PPO 500 PLAN PPO 1000 PLAN HDHP/HSA** INNETWORK

OUT-OFNETWORK

Individual Family

$500 $1,500

$1,000 $3,000

Individual Family

Co-Insurance Preventative Care

INNETWORK

OUT-OFNETWORK

INNETWORK

OUT-OFNETWORK

$2,500 $5,000

$5,000 $10,000

$3,000 $6,000

ANNUAL OUT-OF-POCKET CO-INSURANCE LIMITS $6,000 $3,000 $6,000 $1,000 $12,000 $6,000 $12,000 $2,000

$2,000 $4,000

20% $0

CO-INSURANCE 20% 50% $0 50%

20% $0

50% 50%

ANNUAL DEDUCTIBLE $1,000 $2,000 $2,000 $4,000

50% 50%

CO-PAYMENTS Primary Office Physician, Immediate Care

$15

50%

$15

50%

$0*

50%

Specialist Office Visits Emergency Room

$25 $75

50% $75

$25 $75

50% $75

$0* 20%

50% 20%

Retail $15 $40 $60

Mail Order $30 $80 $120

Retail $0* $0* $0*

Mail Order $0* $0* $0*

Generic Preferred Non-Preferred

PRESCRIPTIONS Retail Mail Order $15 $30 $40 $80 $60 $120 DISTRICT HSA CONTRIBUTION

Bus Drivers, Nutrition Services, Paraprofessionals, EIA, EOPA, RBMA, Administrators, Administrative Staff

Employee Employee/Child(ren) Employee/Spouse/CUP Employee/Family

$0 $0 $0 $0

$0 $0 $0 $0

Non Wellness/Wellness $400/$650 $600/$1,150 $700/1,200 $800/1,500 Continued…

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Employee Employee/Children Employee/Spouse/CUP Family

$0 $0 $0 $0

DISTRICT HSA CONTRIBUTION – REA ONLY*** $0 $0 $0 $0

$500 $1,000 $1,000 $1,500

*Cost included in deductible **High Deductible Health Plan with a Health Savings Account ***REA Part-time employees H.S.A contribution is pro-rated. See Part-Time Premium Rate Sheet.

MEDICAL PLAN HIGHLIGHTS Bus Drivers, Nutrition Services, Paraprofessionals, Educational Interpreters, Office Professionals, RBMA, Administrators and Administrative Staff 

Chiropractic visits are limited to 45 visits a plan period.



Physical Therapy, Occupational Therapy, Speech Therapy, visits are limited to a combination of 45 visits a plan period.



Rockford Memorial is out of network with BlueCross BlueShield.



Humana has Rockford Memorial and OSF in-network, Swedish American will be out of network with Humana.



All Coverage Management Programs of Express Scripts; safety programs, quantity limits, step therapy, prior authorization are in place.



Coordination of Benefits for dependents who are covered as secondary on the District’s plan will impose the same limits as set forth in the District’s plan (e.g., if the dependent is required to pay 20% co-insurance under the primary plan and the dependent is required to pay 20% under the District’s plan, the District’s plan would not pay any additional benefit).



A Health Risk Assessment and Biometric Screening must have been completed by March 31, 2015 and/or employees must have earned 100 points to receive the July 1, 2015 Wellness premiums for all six bargaining unions and administrative staff.



If the point total was not met during the 7-1-2014 Plan Year, higher premiums will be enacted at the beginning of the 7-1-2015 Plan Year. To maintain lower premiums continued participation in the Wellness Program is required.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Wellness Plans Administrators and Administrative Staff

PPO 500, PPO 1000, HDHP/HSA

Bus Drivers, Nutrition Services, Paraprofessionals

PPO 500, HDHP/HSA

EIA, Office Professionals, RBMA

PPO 500, HDHP/HSA

Health Savings Account (H.S.A.) – Associated Bank The Health Savings Account is only available to those benefits eligible employees who enroll in the High Deductible Health Plan (HDHP) effective 7-1-15. The HSA is a tax-preferred vehicle for funding uninsured medical expenses. Unlike FSA’s, HSA unused funds do rollover and are kept by the employee. There is no “use it or lose it” rule like associated with the FSA. If you are an active benefits eligible employee enrolled in the HDHP as of 7-1-15, the District will front load its contribution to your HSA in the increments listed in the Medical Plan Comparison Chart. These HSA funds then belong to you as the employee. You may also elect to make pretax contributions in to your HSA, just as you would have for a FSA. However, unlike the FSA, you can change your HSA contribution amount at any time during the year. The maximum HSA contribution for 2015 is limited to $3,350 for single coverage and $6,650 for family coverage. You would then use these HSA dollars for any medical and prescription services that you incur on the HDHP. Like an FSA, the HSA is governed by the Internal Revenue Service. Unlike the FSA, neither the District nor Associated Bank will audit the HSA account. The IRS is the only one that can ask for documentation for proof of the correct HSA use. We do recommend keeping a file each year of your expenses. Do remember that you can only spend what you have in your HSA account. If you incur a large bill under the HDHP, you can ask your provider if you can make monthly payments as your HSA contributions are applied to your account. Please refer to the Employee Guide on the Associated Bank link on the 7-1-2015 Open Enrollment page in Employee Navigator for further information regarding how the HSA account can work for you. Mental Health/Substance Abuse All Mental Health and Substance Abuse in-patient hospitalization benefits must have PreAuthorization through our administrators, BlueCross BlueShield and Humana, prior to receiving care. Pre-Authorization is required prior to receiving care regardless of whether you choose to seek care with a BlueCross BlueShield or Humana in-network or an out-ofnetwork provider.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Not all other Mental Health/Substance Abuse services require pre-authorizations for benefit coverage. You will utilize the BlueCross BlueShield or Humana PPO network for therapists, counselors and all other related Mental Health/Substance Abuse providers. You will maximize your benefits by utilizing your BlueCross BlueShield and Humana PPO networks. Mental Health/Substance Abuse benefits are treated in the same way as any other medical condition, and these services shall be considered in calculating deductibles and maximum annual out-of-pocket limits. The phone number for you to call BlueCross BlueShield or Humana for pre-authorization of your in-patient hospital care will be on your identification card. Employee Assistance Plan (EAP) Members will also have access to 8 visits per mental health or substance abuse issue per calendar year through an Employee Assistance Program (EAP) administrated by Mutual of Omaha. Members are encouraged to use the EAP benefit prior to utilizing the Medical Program. There is no co-payment or additional cost to the member to utilize the EAP benefit. For further information regarding EAP, visit their website at www.mutualofomaha.com/eap . You may also call toll-free at 1-800-316-2796. Rockford Public Schools group number is G000SXZ.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Pharmacy Benefits Express Scripts Inc (ESI) is our Pharmacy Benefit Manager. Listed in the below chart are the co-payments for the District’s prescription plan associated with the PPO 500 Plan and the PPO 1000 Plan. There are no prescription co-payments with the High Deductible Health Plan as all prescription costs are paid toward the deductible. BlueCross BlueShield’s and Humana’s Pharmacy Benefit Managers will administrate pharmacy benefits for those enrolled in the HDHP Plan. PPO-500 Plan & PPO-1000 Plan

Retail Co-Pay

Mail Order Co-Pay

Retail Penalty Co-Pay (4)

Tier 1

Generic

$15

$30

$30

Tier 2

Preferred

$40

$80

$80

Tier 3

Non-Preferred

$60

$120

$120

Note that the co-payment amounts listed in the chart above represent the maximum amounts that a member will pay. A member will pay the lesser of the co-pay or the actual price of the prescription drug. Notes: 1. Tier 1 drugs are generally generic drugs. 2. Tier 2 drugs are generally preferred brand drugs with no generic equivalent. 3. Tier 3 drugs are generally non-preferred brand drugs, which typically also have a preferred brand and/or a generic drug equivalent. 4. In addition, after a member has filled the same maintenance prescription at a retail establishment three times, the member will have to pay the higher mail order co-pay amount for a fourth refill of the same prescription at a retail establishment . Please ask your provider for a Mail Order Prescription, which is usually a 90-day prescription with three refills so you will not receive the above penalties as listed in Note 4. You can obtain Mail Order Prescription forms from www.expressscripts.com or the District’s website at www.rps205.com / About Us / Human Resources / Medical Insurance / Forms. We also recommend that you phone ESI at 1-800-818-0093 to verify that your prescription can be processed as a 90-day mail order prescription before sending the mail order prescription to ESI, as some prescriptions are government regulated and may have dispensing limitations.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 How to determine if My Physician is in the BCBSI or Humana Network? There are three options for you to determine if your provider is in the BCBSI or Humana network: 1. Call the provider. 2. Call BlueCross BlueShield, 1-800-810-2583 or Humana at 1-866-427-7478 3. Consult the BlueCross BlueShield website or Humana website through the directions listed below. For BlueCross BlueShield of Illinois: 1. Visit www.bcbsil.com 2. Click on “Find A Doctor” 3. Select network type, and then select “PPO” (Participating Provider Option) 4. Select provider type, provider’s name or location to refine your search. For Humana; 1. Visit www.humana.com 2. Click on “Find a Healthcare Provider” 3. Select, Start your search 4. Select, Search Type – Medical 5. Select, Just Looking 1. Coverage Type – Insurance through your employer 2. Zip Code 3. Network – National POS-Open Access 6. Select one of the criteria listed; All, Name, Specialty, or Condition to locate the provider In Rockford, both Swedish American Hospital and OSF-St. Anthony Hospital are considered innetwork with BlueCross BlueShield for REA participants only. Rockford Memorial Hospital will be considered out-of-network effective for all other employee groups. Rockford Memorial Hospital will be listed as out-of-network with BCBS; however, it will be treated as an in-network hospital for in-patient and outpatient billing purposes for REA participants only. Cost sharing of out of pocket expenses could be higher for the REA staff member who utilizes Rockford Memorial Hospital. Call & Ask Your Providers Physicians and other Providers can change their affiliation with a network at anytime. You should call your provider or BlueCross BlueShield or Humana before utilizing each provider’s services and ask if they participate in the BlueCross BlueShield’s or Humana network. By taking this extra step, you will maximize your benefits paid by the District, and decrease your cost sharing by using in-network providers.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015

3.

The Dental Plan

Open Enrollment begins April 13, 2015 at 8:00am and ends on May 1, 2015 at 4:30pm. If you are happy with your dental elections, you do not need to do anything; your coverage will be carried over for July 1, 2015. However, if you are making any type of changes to either your dental and/or medical plan, you must always enroll in all dental and medical coverage you want for July 1, 2015. All enrollment changes must be done on-line through the Employee Navigator enrollment site. Summary of the plan: The District offers one dental program, which BlueCross BlueShield of Illinois is the administrator. The product name is Blue Care DPPO and it is like a medical PPO plan, in that it offers a large national network of more than 60,500 contracting general and specialty dentists. The plan gives you the freedom to choose a dentist from within the network or outside the network. Benefit coinsurance levels are the same for network and non-network dentists. Network dentists have agreed to accept a pre-determined fee (Maximum Allowance) for their services, so when you select a Blue Care DPPO dentist your out-of-pocket cost is less, and you will not be balanced billed. You can also see any dental specialist within the Blue Care DPPO network without a referral. Network dentists have also agreed to submit the claim to BlueCross for you. As stated previously, you may see any dental provider you wish; however if you utilize an out-ofnetwork provider, the plan will pay the provider the lesser of the fee charged or between 50100% of the usual and customary fee charged depending upon the service for that zip code. In most instances, you will be obligated to pay the “balanced billed” amount, which is the difference between the amount charged and the amount paid by the plan. To locate a Blue Care DPPO provider visit the BlueCross BlueShield of Illinois web site at www.bcbsil.com. Select Find A Doctor, Select Group Health Plan, Select Dental, and then select Blue Care Dental DPPO, or call Customer Service at 1-800-367-6401.

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 The following is a listing of common dental services.

Dental Benefits Benefits

In-Network Provider*

Out-of-Network Provider*

Benefit Period Maximum

$1,500 per person

Deductible

$ 50 per person per benefit period $150 maximum per family

Dependent Coverage

Spouse/Civil Union Partner and unmarried dependent up to age 19 or Adult Child(ren) up to age 26

Diagnostic & Preventive Services** Dental Exams, cleanings, X-rays Restorative, Endodontic Periodontal Services Major (Crowns, Inlays/Onlays Services) Orthodontics Coverage for dependent children to age 19

100% of Maximum Allowance

100% of Usual & Customary

80% of Maximum Allowance

80% of Usual & Customary

50% of Maximum Allowance

50% of Usual & Customary

50% of Maximum Allowance (Lifetime Maximum of $1,500)

50% of Usual & Customary (Lifetime Maximum of $1,500)

Please note: This information only provides highlights of this program. * Schedule of Maximum Allowances - Contracting providers have agreed to accept the Schedule of Maximum Allowances as payment in full for covered services. For services received from an out-of-network provider, member will be liable for the difference between the dentist's charge and covered benefits. ** Deductible does not apply

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015

4.

The Flexible Spending Accounts

Open Enrollment for the Flexible Spending Account for a plan period of 7-1-15 through 6-30-16 runs concurrent with the Medical/Dental Insurance Open Enrollment. You must complete your enrollment on-line through Employee Navigator for each period to participate in any of the FSA Plans:   

Medical/Dental Flexible Spending Account, $2,500 period maximum contribution. Limited Flexible Spending Account, dental/vision expenses only, for use for those who enroll in a HDHP with a HSA, $2,500 period maximum contribution. DayCare Flexible Spending Account, $5,000 period maximum contribution.

Enrollment is required each plan period for eligibility. No elections roll over between plan periods. Please see the Guide To Employee Benefits FSA Open Enrollment for further information.

5.

Enrollment Instructions

Open Enrollment begins April 13, 2015 at 8:00am and ends on May 1, 2015, at 4:30pm. This year the District is utilizing an On-Line Open Enrollment system through Employee Navigator, no paper enrollment forms will be available. The July 1, 2015 Open Enrollment is for all benefits eligible employees, Retirees and COBRA participants on the District’s PPO500 Plan, PPO1000 Plan, or the High Deductible Health Plan (HDHP) with a Health Savings Account (HSA). If you are eligible and not currently enrolled in a medical plan or dental plan, you will need to utilize the On-Line Open Enrollment system through Employee Navigator to complete your enrollment. You may enroll in only a medical plan and choose not to enroll in the dental plan. You may also choose not to enroll in a medical plan, but choose to enroll in the dental plan. If you do enroll in the medical plan, and you are enrolling a spouse/civil union partner, please be sure to complete the Spouse/Civil Union Partner Insurance Coverage Information Form, which is available on Employee Navigator. If you are adding a new dependent to your existing coverage, you must enroll all eligible dependents you want covered, not just the new dependent(s). In addition, you must provide all requested paperwork, legal birth certificates, etc for the new enrollee(s). Only

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 the selected plan and coverage tiers and dependents listed on your On-Line Open Enrollment will be enrolled on July 1, 2015. Deadline for Enrollment All On-Line Open Enrollment elections must be completed through Employee Navigator by 4:30pm on May 1, 2015. Remember, you are responsible for making sure your enrollment is complete and all required documents are received by Human Resources by 4:30pm, May 1, 2015. Confirmation Receipts All employees will receive an email confirmation from Employee Navigator to the e-mail address they used to register their enrollment for 7-1-2015. How to Register for Employee Navigator With Employee Navigator, benefit eligible employees enjoy convenient online access to their benefits coverage 24 hours a day, seven days a week during Open Enrollment. On this site, you will be able to enroll in medical/dental/FSA benefits, change plans, add or remove dependents and access a complete document library. You may access Employee Navigator by going to www.employeenavigator.com/benefits/login.axsp on the internet, or by accessing their web page through Employee On-Line or the District’s website at www.rps205.com / About Us / Human Resources, or through the District’s Employee Intranet. Once you are at the site, follow the below directions; 1. Click Login

2. First time users will select “New User Registration” to create a Username & Password. Your company identifier is rps205 3. Existing users will proceed by entering their existing Username & Password

Key features for employees Employee Announcements - Located on the Employee Home Page, this feature allows employees to view important news, articles, and information provided by their employer. Online Enrollment – The Open Enrollment start button located on the Employee Home Page, allows employees to enroll, change plans, and update dependent coverage during open enrollment. Open enrollment is from 8:00 AM April 13, 2015 to 4:30 PM May 1, 2015. Enrollment Summary - Upon completion of enrollment, the employee will be prompted to agree to their benefits, and will be e-mailed a copy of their enrollment summary. - 16 -

GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Document Library - Under the "Documents" tab, employees can access a range of plan and HR specific documents. A few examples include benefit summaries, forms, and company policies or procedures.

Service

Web Site

Phone

Blue Cross Blue Shield of Illinois Medical Plan

www.bcbsil.com

888-979-4516

www.humana.com

866-427-7478

www.bcbsil.com

800-367-6401

Express Scripts Customer Service

www.medco.com

800-818-0093

Mail Order Pharmacy Refills

www.medco.com

800-473-3455

Specialty Pharmacy

www.medco.com

800-501-7260

www.mypayflex.com

800-284-4885

Customer Service Humana Medical Plan Customer Service Blue Cross Blue Shield of Illinois Dental Plan Customer Service Express Scripts

Flexible Spending Account Pay Flex Customer Service Employee Assistance Plan

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GUIDE TO EMPLOYEE BENEFITS OPEN ENROLLMENT JULY 1, 2015 Mutual of Omaha Mental Health/Substance Abuse Inpatient Benefits Mental Health/Substance Abuse Outpatient Benefits Human Resources

www.mutualofomaha.com/eap

800-316-2796

www.bcbsil.com

800-523-5668

www.bcbsil.com

888-979-4516

[email protected]

815-966-3145

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