Agua Fria – 2017-2018 Benefits Overview HR BENEFITS COORDINATOR Carmen G. Ramirez

Choice Plus One –NO CHANGES Deductible: None Co-Payments: Virtual Visits – 0 PCP Visit - $30 Specialist copay – $40 Urgent Care – $50 Emergency Room – $200 Pharmacy - $10/$45/$70 Co-Insurance 100% Out of Pocket Limit IN-NETWORK Individual - $6,350 Family - $12,700 Out of Pocket Limit OUT-NETWORK Individual - $30,000 Family - $60,000

Choice Plus Two $350 – CHANGES Deductible: In-network – 350/$1050 Co-Payments: Virtual Visits – 0 PCP Visit - $30 Specialist Copay – $60 Urgent Care – $75 Emergency Room – $350 Pharmacy - $10/$45/$70 Co-Insurance 80% Out of Pocket Limit IN-NETWORK Individual - $6,350 Family - $12,700 Out of Pocket Limit OUT-NETWORK Individual - $30,000 Family - $60,000 Specialist Copay was 40; Urgent Care was 50 and Max Out of Pocket was 4500/9000

Choice Plus HDHP – CHANGES Deductible: $2,600/$5,200 Co-Payments: Virtual Visits – 0 PCP Visit – 80% Specialist copay – 80% Urgent Care – 80% Emergency Room – 80% Pharmacy – 80% Co-Insurance 80% Out of Pocket Limit IN-NETWORK Individual - $6,350 Family - $12,700 Out of Pocket Limit OUT-NETWORK Individual - $30,000 Family - $60,000

MEDICAL RATES FY17-18 Choice Plus HDHP Choice Plus II Choice Plus I Total Monthly (LESS) EE Monthly 22 Pays 26 Pays EE Only $420.39 ($400) $20.39 11 .12 9.41 EE + SP $840.79 $440.79 240.43 203.44 EE + CH $715.87 $315.87 172.29 145.79 EE + FAM $1,019.35 $619.35 337.83 285.85 MEDICAL RATES FY17-18 Choice Plus II Total Monthly (LESS) EE Monthly 22 Pays 26 Pays EE Only $531.47 ($400) $131.47 $71.71 $60.68 EE + SP $1,062.95 $662.95 $361.61 $305.98 EE + CH $905.03 $505.03 $275.47 $233.09 EE + FAM $1,288.70 $888.70 $484.75 $410.17 Choice Plus I Total Monthly (LESS) EE Monthly 22 Pays 26 Pays EE Only $592.98 ($400) $192.98 $105.26 $89.07 EE + SP $1,185.96 $785.96 $428.71 $362.75 EE + CH $1,009.76 $609.76 $332.60 $281.43 EE + FAM $1,437.84 $1,037.84 $566.09 $479.00

Health Savings Account (HSA) - OPTUM BANK Requires a qualifying High-Deductible Health Plan Annual contribution limits are set by the IRS and are income tax-free Used to Pay for qualified health care expenses ex: med; dental; vision; copays; deductible, etc. Funded by you, belongs to you, must be opened by you Account belongs to you, as it’s considered portable Grows over time and can be invested Register go to: www.optumbank.com * HSA account must be opened within 30 days from election to continue payroll contributions

Value Pharmacy Network Eliminates the following pharmacy’s: Costco CVS Safeway National Network Does not affect prescription cost 98% of current employees are within 2 miles of a network pharmacy Majority pharmacy’s include are: Walgreens, Walmart & Fry’s

DELTA DENTAL OF AZ PLAN I Plan III Benefit Max – 1,000 Deductible - $50/$150 Preventive Services – 100% Basic Services – 80% Major Services – 50% Ortho – N/A Life Ortho – N/A Plan III Benefit Max – 2,000 Deductible - $25/$75 Preventive Services – 100% Basic Services – 90% Major Services – 60% Ortho – 50% Life Ortho – $1,500

Employer Dental Services (EDS) 2% Rate Increase Prepaid Dental Insurance Dependents up to age 26 or younger

AVESIS – Vision Insurance Premiums – Rate PASS No Plan Changes Highlights Vision Exam: Every 12 Months Spectacle Lenses – Every 12 Months Frames – Every 24 Months Contact Lenses – Every 12 Months

LIFE INSURANCE – SYMETRA Basic Group Term Life District Paid (1x annual salary) Supplemental Life Insurance Employee (Guaranteed Issue: $100k ) Spouse (Guaranteed Issue: $25k) $300k Max Coverage Dependent Child ($10,000 Max benefit)

Other Voluntary Products Section 125 Cafeteria Plans Allstate Cancer Critical Illness Trustmark (Third Party Administrator) Accident Standard Universal Life with Long Term Care Universal Life (Employee, Spouse & Child) Sun Life Financial - Short Term Disability Guaranteed Issue: not to exceed 66.67% of salary Waiting Period – 8 days Maximum Benefit – 26 weeks Sick Leave offsets the benefit Optum Bank – Health Savings Account (HSA) BASIC – Flex Spending Account (FSA) & Dependent Care Account

TSA Consulting Group View List of Approved Vendors: AXA EQUITABLE Employees are eligible to participate in a voluntary, tax-deferred 403 (b)and 457 plan accounts that will provide supplemental income at retirement. Employees may initiate this program at any time with State Certified Providers that have been approved by the AFUHSD. View List of Approved Vendors: AXA EQUITABLE FIRST INVERSTORS CORP GF GALIC HORACE MANN METLIFE PLAN MEMBER SECURITY BENEFITS Plans to choose from: 403b Roth 403b 457

Frequently Asked Question: When is Open Enrollment? It will be April 24 – May 5th, 2017 When do Benefits begin? They are effective 7/1/2017 Who is eligible for Benefits? Classified employees who work 30 of more hours per week and Certified who are Full-Time Equivalent (FTE) of .67 or higher Will my changes be final? Yes, unless you have a Life Change Event How do I use the UHC app? Register online at www.myuhc.com then download the UHC app – HEALTH4ME How does the Appeal Process work? You have to send your written appeal to the insurance (UHC). If that gets denied, you send a second appeal to Valley Schools and work directly with them When do I review my Summary Plan Document? Review before any service If I go out of network will my insurance cover? Yes however, out-of- network providers can bill you for amounts higher than what you plan will cover.