YES PREP PUBLIC SCHOOLSyesprepbenefits.org/wp-content/uploads/2015/07/Yes-Prep-2015... · ABOUT OPEN ENROLLMENT . ABOUT YOUR 2015-2016 BENEFITS PACKAGE. YES Prep Public Schools is

YES PREP PUBLIC SCHOOLS

2015/2016 BENEFIT PLAN YEAR

1. ABOUT THIS ENROLLMENT2. HEALTH & HSA/FSA/DCAP OPTIONS3. DENTAL4. VISION5. LIFE6. DISABILITY7. ACCIDENT CARE8. CRITICAL CARE WITH CANCER CARE9. EMPLOYEE ASSISTANCE PROGRAM10. 401(K) PLAN11. CONTACT INFORMATION

WHAT’S INSIDEBENEFITS FOR A HAPPIER HEALTHIER

L IFEWHO’S ELIGIBLE FOR COVERAGE Who’s Eligible for Coverage: Employees regularly working at least 20 hours per week are eligible to apply for all benefits. Employees regularly working at least 10 hours per week are eligible for health insurance.

ABOUT OPEN ENROLLMENT ABOUT YOUR 2015-2016 BENEFITS PACKAGE

YES Prep Public Schools is proud to offer you a benefits package that gives you the options to make the best decisions for your health and the health of your

family. Your benefits package is an important piece to help you and your loved ones not only stay physically well, but financially well, too. The benefits

offered to you are offered at a discounted group rate, so you can create a comprehensive package that fits within your budget.

START BY GOING TO YOUR YES PREP EMPLOYEE BENEFITS WEBSITE AT

WWW.YESPREPBENEFITS.ORG TO FIND ALL BENEFITS RELATED ITEMS.

IMPORTANT NOTES ABOUT THIS BENEFIT YEAR & ENROLLING ONLINE

YOUR ENROLLMENT OPTIONS:

You will be able to enroll three ways:

1. You can enroll online. You do this by going to www.yesprepbenefits.org

and clicking on the Enroll Now button.

2. You can meet with someone in person the week of August 17th. You

schedule an appointment with the benefit specialist by going to www.

yesprepbenefits.org and clicking on the Appointment button.

3. You can speak with a representative in our call center from 8:30 a.m. to

4:30 p.m. Monday through Friday. Just call 1-888-783-9653 and speak with

a representative today.

YOUR BENEFIT ENROLLMENT BEGINS ON AUGUST 3 AND ENDS ON

AUGUST 24.


ONLINE ENROLLMENT INSTRUCTIONS BENEFITSCONNECT - OUR NEW PLATFORM

TO START YOUR ONLINE ENROLLMENT GO TO WWW.YESPREPBENEFITS.ORG AND NAVIGATE TO

THE ENROLL NOW BUTTON.

ONCE YOU ARE AT THE ENROLL NOW BUTTON YOU WILL BE ABLE TO BEGIN YOUR ENROLLMENT.

WHEN YOU GET TO THE BENEFITSCONNECT WELCOME SITE YOU WILL DO THE FOLLOWING TO

LOGIN:

1. ENTER YOUR [YOUR USERNAME] FIRST 6 LETTERS OF YOUR LAST NAME + FIRST LETTER OF

YOUR FIRST NAME + LAST FOUR NUMBERS OF YOUR SOCIAL.

Example: Employee robert Smith with SSN 123-45-6789 will have the User Name smithr6789

2. ENTER IN YOUR [YOUR TEMP PASSWORD] Your full social security numberOnce you login, you’ll be required to reset your password.

FOLLOW THE INSTRUCTIONS AND ELECT YOUR BENEFITS.The site will include some important information about your benefit selections as well as the enrollment process, so be sure to slow down and read the instructions carefully.

If you have questions please contact the Call Center at 1-888-783-9653 or make an appointment with a representative for the week of August 17th by going to www.yesprepbenefits.org.


ABOUT THIS COVERAGEThese benefits are offered to you through your employer at discounted group rate. Certain restrictions and limitations apply. This benefit summary is not a certificate of insurance. For more information about the benefits presented to you, contact your benefits administrator or the carrier listed on this summary.

HERE’S TO LIVING A HAPPIER,

HEALTHIER LIFE.

ACTIVECARE 1 HD ACTIVECARE SELECT ACTIVECARE 2

EMPLOYEE

YOUR COST $10.75 $51.75 $122.25

PAID BY YES PREP $159.75 $184.75 $184.75

+CHILDREN

WHAT YOU PAY $95.25 $143.75 $258.75

PAID BY YES PREP $212.25 $237.25 $237.25

+SPOUSE

WHAT YOU PAY $218.50 $297.50 $475.50

PAID BY YES PREP $238.50 $263.50 $263.50

+FAMILY/TWO EMPLOYEE FAMILY

WHAT YOU PAY $324.50/$243.50 $349.50/$243.50 $444.50/$338.50

PAID BY YES PREP $291.00/$372.00 $316.00/$422.00 $316.00/$422.00

QUALIFYING ACCOUNT HSA [OR] FSA FSA FSA

YOU MAY EITHER ELECT A HEALTH SAVINGS ACCOUNT (HSA) OR A FLEXIBLE SPENDING ACCOUNT (FSA) BUT NOT BOTH.


HEALTH COVERAGE

HERE’S TO LIVING A HAPPIER,

HEALTHIER LIFE.

COSTS FOR COVERAGE Costs listed below are shown as per pay premiums.

WHAT’S COVERED? No matter which health option you choose, you’re covered. Below, we cover a few things included in your coverage options at no cost to you.

CHOOSE THE PLAN THAT WORKS BEST FOR YOUACTIVECARE 1 HD [OR] ACTIVECARE SELECT [OR] ACTIVECARE 2

YEARLY PHYSICALS [Like your yearly routine physical with your PCP]

IMMUNIZATIONS [Recommended by Advisory Committee of Immunization Practices of the CDC]

ANNUAL SCREENINGS [Cancer screening mammograms or colonoscopies; bone density tests, etc.]


YOUR OUT-OF-POCKET COSTS ACTIVECARE 1 HD ACTIVECARE SELECT ACTIVECARE 2

PLAN YEAR DEDUCTIBLE

EMPLOYEE ONLY/EMPLOYEE+ $2,500/$5,000 $1,200/$3,600 $1,000/$3,000

OUT-OF-POCKET MAX

EMPLOYEE ONLY/EMPLOYEE+ $6,400/$12,900 $6,600/$13,200 $6,600/$13,200

PHYSICIAN OFFICE VISITS

PRIMARY CARE 20% AFTER DEDUCTIBLE $30 COPAY $30 COPAY

SPECIALIST CARE 20% AFTER DEDUCTIBLE $60 COPAY $50 COPAY

EMERGENCY SERVICES

EMERGENCY ROOM 20% AFTER DEDUCTIBLE $150.001 + 20% AFTER DEDUCTIBLE $150.001 + 20% AFTER DEDUCTIBLE

HOSPITALIZATION & SURGICAL

INPATIENT PROCEDURE 20% AFTER DEDUCTIBLE $150.002 + 20% AFTER DEDUCTIBLE $150.002,3 + 20% AFTER DEDUCTIBLE

OUTPATIENT PROCEDURE 20% AFTER DEDUCTIBLE $150.00 + 20% AFTER DEDUCTIBLE $150.00 + 20% AFTER DEDUCTIBLE

OTHER SERVICES

HI-TECH RADIOLOGY 20% AFTER DEDUCTIBLE $100.00 + 20% AFTER DEDUCTIBLE $100.00 + 20% AFTER DEDUCTIBLE

TELEDOC® PHYSICIAN SERVICES $40 COPAY $0 COPAY $0 COPAY

PRESCRIPTIONS

GENERIC/BRAND-NAME SUBJECT TO DEDUCTIBLE $0/$200 $0/$200

1. WAIVED IF ADMITTED; 2. $750 COPAY MAX COPAY PER ADMISSION; 3. $2,250 COPAY MAX PER PLAN YEAR

YES PREP PUBLIC SCHOOLSHEALTH COVERAGE

ABOUT YOUR SAVINGS ACCOUNTS HSA: A HSA is like a 401(k) retirement account, but it’s for medical expenses. You can only have an HSA if you enroll in an HSA-compatible insurance plan. You can only spend the amount of funds you have already contributed to the account. Contributions to this account are pre-tax and you can invest the funds in your HSA.YES Prep Public Schools will contribute $50 per month to your employee HSA Plan, but does not cover admin costs. Your max yearly contribution $3,250 for individuals and $6,450 for family.

FSA: A FSA is set up by your employer. They own the account, but you get to decide which qualified medical expenses to pay for with your FSA. What makes it flexible? It works with most of our employer-sponsored health plans. With an FSA you can use amount of funds you have elected to contribute through the year before you’ve contributed the full amount. Contributions to this account are pre-tax.

DCAP: A DCAP is an employer-sponsored program that helps employees with the cost of dependent care expenses. It establishes an account from which an employee may seek reimbursement for eligible dependent care expenses. In most cases, a DCAP account is funded by employees with pretax dollars through payroll deductions. Your max yearly contribution for a DCAP (Dependant Care Assistance Program) for a married employee that files a joint tax return is $5,000. A married employee that files a separate tax return may only place up to $2,500 per calendar year in a DCAP.


HSA, FSA & DCAP

HEALTHY SMILES.HEALTHY HEARTS.

HAPPY LIVES.

HSA (HEALTH SAVINGS ACCOUNT)


AVAILABLE WITH ACTIVECARE 1HD

WHY CHOOSE A HSA• Contributions never expire• Acts like a 401(k) so you can withdraw funds at qualifying age• Contributions are pre-tax

ABOUT YES PREP’S HSA OPTION• YES Prep contributes $50 per month to your employee HSA plan• You cover administrative costs• Yearly max contribution for individuals is $3,250• Yearly max contribution for families is $6,450

FSA (FLEXIBLE SPENDING ACCOUNT)AVAILABLE WITH ACTIVECARE 1HD; ACTIVECARE SELECT; ACTIVECARE 2

WHY CHOOSE A FSA• Yearly funds amounts you choose to contribute are available immediately• Contributions are pre-tax up to $2,500 annually• You can use for multiple medical expenses

ABOUT YES PREP’S FSA OPTION• You can use funds beginning September 1st, 2015• Funds must be used by September 1st, 2016 (You can rollover $500 of unused funds)

DCAP (DEPENDENT CARE ASSISTANCE PROGRAM)AVAILABLE WITH ACTIVECARE HD 1; ACTIVECARE SELECT; ACTIVECARE 2

WHY CHOOSE A DCAP• Contributions may be pre-tax• You can use for qualifying care options for your dependents• ABOUT YES PREP’S DCAP OPTION• Employees married and filing jointly may contribute $5,000 annually • Employees married and filing separately may contribute up to $2,500

COVERAGE OPTIONS YOUR COST PER PAY ANNUAL DEDUCTIBLE

EMPLOYEE $12.17 $50.00

+CHILDREN $30.08 up to $150.00

+SPOUSE $23.89 up to $100.00

+FAMILY $41.94 up to $150.00


DENTAL COVERAGE

HEALTHY SMILES.HEALTHY HEARTS.

HAPPY LIVES.


YOUR OUT-OF-POCKET COSTS

DIAGNOSTIC/PREVENTIVE YOUR PORTION

Exams, Cleanings, Fluoride, Sealants, X-Rays, Space Maintainers 0%

BASIC RESTORATIVE

Fillings, Simple Extractions, Repairs, Periodontal Maintenance 20%

BASIC RESTORATIVE

Root Canals, Complex Extractions, Non-Surgical & Surgical Periodontics, Bridges, Dentures, Crowns, Inlays, Onlays, Implants 50%

ORTHODONTIA

Child Only ($1,500 Lifetime Max) 50%

ANNUAL BENEFIT MAX: $1,500


COVERAGE OPTIONS YOUR COST PER PAY

EMPLOYEE $3.25

+CHILDREN $5.86

+SPOUSE $5.52

+FAMILY $8.77


VISION COVERAGE

IT’S TIME TO SEE LIFE A LITTLE

MORE CLEARLY.


YOUR OUT-OF-POCKET COSTS

SERVICES IN-NETWORK ALLOWANCE OUT-OF-NETWORK ALLOWANCE

Eye Exam 100% of Cost $35

Frames $130 + 20% Discount1 $70

Single Vision Lenses 100% of Cost $25

Bifocal Lenses 100% of Cost $40

Trifocal Lenses 100% of Cost $45

Aspheric-Lenticular Lenses 100% of Cost $80

Contact Lenses - Medically Necessary/Elective

100% of Cost/up to $150 if elective $80

Lasik $200 + Discount1 $200


CHOOSE THE COVERAGE AMOUNT THAT WORKS FOR YOU, YOUR BUDGET, AND YOUR FAMILY.

COVERAGE IS PORTABLE & CAN BE CONVERTED.

[COVERAGE FOR YOU] Elect life and accidental death & dismemberment (AD&D) coverage for yourself (the employee) in increments of $10,000; from a minimum of $20,000 to a maximum of $250,000 without submitting a Medical Evidence of Insurability.

You may apply for coverage up to $500,000 by submitting a Medical Evidence of Insurability. Coverage can’t exceed five (5) times your annual salary.

[COVERAGE FOR YOUR SPOUSE] Elect life and AD&D coverage for your spouse in increments of $5,000; from a minimum of $10,000 to a maximum of $50,000 without submitting a Medical Evidence of Insurability.

You may apply for coverage up to $250,000 by submitting a Medical Evidence of Insurability. Coverage can’t exceed 50% of your (the employee’s) coverage amount.

[COVERAGE FOR YOUR CHILDREN] Elect life and AD&D coverage for your children age six (6) months to 26 years in the amount of $2,500; $5,000; or $10,000. Coverage for children age birth to six (6) months is $1,000.


LIFE COVERAGE


MORE CLEARLY.

UNDER 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$0.079 $0.099 $0.113 $0.142 $0.202 $0.311 $0.525 $0.720 $1.289 $2.238

Employee monthly costs are based upon employee’s age. Spouse cost per month are based upon spouse’s age.

MONTHLY COST FOR CHILD(REN) COVERAGE PER $1,000: $0.23

COSTS FOR COVERAGE Costs below are shown as monthly premiums for $1,000 increments.



DISABILITY COVERAGE

YOUR INCOME IS ONE OF YOUR

MOST IMPORTANT ASSETS.

MAKING THE DECISION TO INSURE YOUR INCOME COULD MAKE ALL THE DIFFERENCE IF YOU BECOME DISABLED.

UNDER 35 35-39 40-44 45-49 50-54 55-59 60+

$0.31 $0.225 $0.20 $0.22 $0.25 $0.29 $0.35

STD COST FOR COVERAGE Costs below are shown as per pay premiums for $10 increments.

[LONG TERM DISABILITY COVERAGE] Protect up to 66.67% of your monthly earnings up to a maximum of $10,000 per month. To calculate your premium you do the following Gross Salary/12/100 x rate = per pay premium.

Benefits start on the 90th day of disability caused by a covered illness or accident and may be payable up to 24 months if you’re disabled from your own occupation, or up to your Social Security Full Retirement Age. A 3/12 pre-existing condition limitation applies. For those currently on The Standard Disabillity Plan will be grandfathered and pre-existing condition clauses will be waived.

LTD COST FOR COVERAGE Costs below are shown as per pay premiums for $100 increments.


UNDER 19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

$0.04 $0.08 $0.11 $0.19 $0.26 $0.37 $.54 $.71 $.91 $.80 $0.38

[SHORT TERM DISABILITY COVERAGE] Protect up to 66.67% of your weekly earnings to a maximum of $1,250 per week. To calculate your premium you do the following Gross Salary x .67/52/10 x rate = per pay premium.

Benefits start on the 8th day of disability caused by a covered illness or accident and may be payable up to 12 weeks if you’re disabled from your own occupation due to an accident or illness. A 3/12 pre-existing condition limitation applies. For those currently on The Standard Disabillity Plan will be grandfathered and pre-existing condition clauses will be waived.

please note that the sytem will calculate the rates for you


ACCIDENT COVERAGE

ACCIDENTS HAPPEN. MAKE

SURE YOU’RE COVERED.

COVERAGE OPTIONS YOUR COST PER PAY

EMPLOYEE $6.76

+CHILDREN $9.93

+SPOUSE $13.02

+FAMILY $16.17


INJURY PAYABLE

FRACTURES (OPEN/CLOSED) up to $7,500/$3,750

DISLOCATION (OPEN/CLOSED) up to $4,000/$200

TENDONS/LIGAMENTS (REPAIR OF ONE/MORE THAN ONE) up to $800/ $1,200

BLOOD/PLASMA/PLATELETS $300

BURNS up to $10,000

RUPTURED DISC $600

KNEE CARTILAGE (TORN) up to $500

EYE INJURY (WITH SURGICAL REPAIR) up to $200

LACERATIONS (REQUIRING SUTURE) up to $800

ACCIDENT EMERGENCY TREATMENT BENEFIT $200

INITIAL HOSPITALIZATION FOR INJURY BENEFIT $600

HOSPITAL CONFINEMENT DAILY BENEFIT $600

ADDITIONAL INTENSIVE CARE UNIT BENEFIT $600

AMBULANCE BENEFIT (GROUND/AIR) $200/ $1,000

PHYSICAL THERAPY BENEFIT $50 up to 6 visits

FOLLOW-UP PHYSICIAN BENEFIT $100


COVERAGE IS PORTABLE & INCLUDES A $50 WELNESS BENEFIT AND AD&D BENEFITS.


CRITICAL CARE COVERAGE WITH CANCER CARE


MORE CLEARLY.


CONDITION COVERAGE

LUMP SUM BENEFIT $5,000-$100,000

HEART ATTACK 100%

STROKE 100%

MAJOR ORGAN TRANSPLANT 100%

PERMANENT PARALYSIS 100%

END STAGE RENAL FAILURE 100%

CORONARY ARTERY BYPASS SURGERY 25%

INVASIVE CANCER 100%

CARCINOMA IN SITU 25%

INSURED’S AGE YOUR COST PER MONTH

AGE 35 $9.90

AGE 45 $17.73

AGE 55 $30.68

*RATES SHOWN ARE NON-TOBACCO FOR EMPLOYEE ONLY COVERAGE

COSTS FOR COVERAGE Costs listed below are shown as per pay premiums per $20,000.*

COVERAGE IS PORTABLE & INCLUDES A $50 WELNESS BENEFIT. COVERAGE FOR THOSE PREVIOUSLY ENROLLED IN CRITICAL CARE COVERAGE WILL BE GRANDFATHERED.

COVERAGE BENEFIT DETAILS

GUARANTEED ISSUE (EMPLOYEE/SPOUSE/CHILD(REN) Up to $20,000/$10,000/$5,000

ADDITIONAL OCCURRENCE & RE-OCCURRENCE BENEFITS Included

RE-OCCURRENCE BENEFIT Included

SPOUSE COVERAGE 50% of Employee Amount

CHILD COVERAGE 10% of Employee Amount


EMPLOYEE ASSISTANCE PROGRAM

SOMETIMES, YOU JUST NEED A LITTLE

ASSISTANCE.

FOR TIMES WHEN THE GOING GETS TOUGH.

AWP is proud to serve as your EAP, offering you and your household valuable, confidential services, at no cost to you . Your benefits are designed to help you manage your daily life, work stress, major life events, or anything else that might affecting your quality of life.

Coverage is paid by YES PREP, is confidential, and you can reach AWP 24 hours a day, seven days a week.

WHAT’S INCLUDED?

• 1 TO 6 COUNSELING VISITS

• REIMBURSEMENT FOR EMERGENCY CAB FARE IF YOU BECOME IMPAIRED

• LEGAL ADVICE

• WELL-COACHI TO HELP YOU LIVE A HEALTHY LIFE

• SKILL-BUILDING

• & MORE!

BY PHONE:

TOLL FREE: 1-800-343-3822

AUSTIN AREA: 512-328-1144

ONLINE:ALLIANCEWP.COMLogin using the button in the top-right. From there, you can create a custom login.

Temporary Username: YESPREPmember



401(K) PLAN

PROTECT YOUR FUTURE.

YES PREP 401(K) PLAN SUMMARY

At YES Prep we are committed to your personal and professional success. Take action towards your financial future by participating and learning more about the 401 (k) plan, administered by AUL OneAmerica.

Start your enrollment now at www.yesprep401k.org.

WHAT YOU NEED TO KNOW:

• YOU MUST BE 21 YEARS OF AGE OR OLDER TO PARTICIPATE

• YES PREP DOES NOT MAKE EMPLOYER CONTRIBUTIONS AT THIS TIME

• ON SEPTEMBER 1ST, 2015 ALL EMPLOYEES WILL BE ENROLLED IN THE PLAN AT A 3%

DEFAULT CONTRIBUTION INTO A TRADITIONAL IRA

• ONCE A QUARTER YOU CAN CHANGE YOUR CONTRIBUTIONS

• YOU CAN CANCEL CONTRIBUTIONS AT ANYTIME

CONTACT INFORMATION:

PLAN NUMBER: G37501

CUSTOMER SERVICE: 1-800-249-6269

ONLINE PORTAL: WWW.YESPREP401K.ORG


CONTACT INFORMATION


MORE CLEARLY.

WHO TO CONTACT ABOUT YOUR BENEFITSCOVERAGE PROVIDER WEB ADDRESS TELEPHONE FAX

MEDICAL TRS Active Care www.trsactivecareaetna.com 800-222-9205 xxx-xxx-xxxx

HSA HSA Bank www.hsabank.com 800-357-6246 877-851-7041

FSA/DCA TASC www.tasconline.com 800-422-4661 608-441-3099

DENTAL Assurant Employee Benefits www.assurantemployeebenefits.com 800-442-7742 888-208-2323

VISION Superior Vision www.superiorvision.com 800-507-3800 xxx-xxx-xxxx

LIFE One America www.oneamerica.com 800-553-5318 888-285-1565

DISABILITY One America www.oneamerica.com 800-553-5318 888-285-1565

ACCIDENT Trustmark www.trustmarksolutions.com 877-201-9323 508-853-2867

CRITICAL CARE Trustmark www.trustmarksolutions.com 877-201-9323 508-853-2867

EAP AllianceWP www.alliancewp.com 800-343-3822 xxx-xxx-xxxx

401(K) AUL OneAmerica www.yesprep401k.org 800-249-6269 xxx-xxx-xxxx


BENEFIT PLAN YEAR 2015

NOTES

Documents

YES PREP PUBLIC SCHOOLSyesprepbenefits.org/wp-content/uploads/2015/07/Yes-Prep-2015... · ABOUT OPEN ENROLLMENT . ABOUT YOUR 2015-2016 BENEFITS PACKAGE. YES Prep Public Schools is