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

2. 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

3. 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

4. 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

5. 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

6. 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:
* HSA account must be opened within 30 days from election to continue payroll contributions

7. 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

8. 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

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

10. 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

11. 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)

12. 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

13. 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

14. 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 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.