2019-2020 benefit plan highlights - edl · benefits are effective on the first day of the month...

2019-2020 Benefit Plan Highlights

Durango School District 9-R

Durango School District 9-R offers a comprehensivesuite of benefits to promote health and financial wellness for you and your family.

This booklet provides a summary of your benefits. Please review it carefully so you can choose the coverage that’s right for you.

Benefit Basics As a 9-R employee, licensed employees are eligible for half-time benefits at .25 FTE and full benefits at .51 FTE. Educational support staff are eligible for half-time benefits at .4375 FTE and full benefits at .625 FTE. Administrative, managerial and technical staff are eligible for half-time benefits at .4375 FTE and full benefits at .625 FTE.

Benefits are effective on the first day of the month following 30 days of eligibility.

You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include: • Your legal spouse• Civil union partner• Your children up to age 26.

Changes in Status / Life Events You can add or drop dependent(s) during your initial hire, open enrollment, and if a qualifying event occurs. When a qualifying event occurs, you have 30 days from the date of the qualifying event to notify Human Resources in an email. Below are considered qualifying events:

1. Change in marital status• Marriage• Death of spouse• Divorce• Legal separation

2. Change in number of dependents• Marriage• Birth• Death• Adoption of child• Placement of a child for adoption

3. Change in spouse coverage status• Commencement or termination of spouse’s health coverage on another health plan

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What is CEBT? Colorado Employers Benefit Trust (CEBT) is a self-funded, governmental multiple employer trust that provides employee benefits for over three hundred and forty (340) public entities, with over 33,000 employees and dependents covered in the state of Colorado. The CEBT plan offers health, dental, vision and life coverage to the participating groups.

Who is Willis Towers Watson? Willis Towers Watson is the broker / administrator for the CEBT. It provides customer service for plan participants to obtain answers on claims and benefits questions at (800) 332-1168 or (303) 773-1373.

What are the roles of UMR, CVS CAREMARK, Delta Dental and Vision Service Plan (VSP)? CEBT has contracted with these managed health care companies to provide claims processing and provider network access: UMR provides third party claim payment services and access to the UHC provider networks for CEBT members who have medical coverage. CVS Caremark provides the pharmacy payment and access to their provider network for CEBT members who have medical coverage using the United HealthCare provider network. Delta Dental of Colorado provides third party dental claim payment services and access to their Dental PPO and Premier networks. Vision Service Plan (VSP) provides the vision payment and access to their provider network for CEBT members who have vision coverage.

Much of your day to day correspondence, such as Explanations of Benefits (EOBs) and requests for further information, will come from UMR. Additionally, you will receive ID cards from UMR, CVS Caremark, and Delta Dental, but not from VSP.

Need help with a claim? CEBT has a customer service team of eight individuals to assist CEBT clients with a variety of benefit information. The Customer Service Representatives are housed right in Willis Towers Watson offices. Their hours of operation are Monday – Friday 7:30 – 4:30 (except Friday’s they close at 4:00). If you need assistance in any of the following areas, please call the customer service line at 1 800 332 1168:

Benefit information Claim resolution Claim status Explanation of Benefits Deductibles Order ID cards

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CEBT Medical Coverage Employees of 9R have the option to choose the Colorado Employer Benefit Trust (CEBT) / United HealthCare PPO4, PPO5, or HDHP 5000. Each plan includes comprehensive health care benefits, including free preventive care services and coverage for prescription drugs.

MEDICAL BASE PLAN PREFERRED PROVIDER ORGANIZATION (PPO)*

OPTION 4

PREFERRED PROVIDER ORGANIZATION (PPO)*

OPTION 5

PREFERRED PROVIDER ORGANIZATION (PPO)* HD

5000

Office Visits PPO $40 co-pay Non PPO subject to deductible then 60/40

PPO $45 co-pay Non PPO Subject to deductible then 60/40

PPO subject to deductible then 80/20 Non PPO subject to deductible then 60/40

Lab Charges PPO $40 co-pay Non PPO subject to deductible then 60/40

PPO $45 co-pay Non PPO Subject to deductible then 60/40

PPO subject to deductible then 80/20 Non PPO subject to deductible then 60/40

X-Ray Charges PPO $40 co-pay then 100% in office setting, outpatient subject to deductible 80/20, Non PPO subject to deductible 60/40

PPO $45 co-pay then 100% in office setting, outpatient subject to deductible 80/20, Non PPO subject to deductible 60/40

PPO subject to deductible then 80/20, Non PPO subject to deductible then 60/40

Prescription Drugs Retail - for 30 day supply:

Generic $20 Preferred Brand $40 Non-Preferred Brand $60

Generic $20 Preferred Brand $40 Non-Preferred Brand $60

Subject to deductible, then; $20 Generic $40 Preferred Brand $60 Non-Preferred Brand co-pays up to maximum out of pocket

Mail Order - for 90 day supply:

$40 Generic $80 Preferred Brand $120 Non-Preferred Brand

$40 Generic $80 Preferred Brand $120 Non-Preferred Brand

Subject to deductible, then; $40 Generic $80 Preferred Brand $120 Non-Preferred Brand co-pays up to maximum out of pocket

Deductible $1,500 individual $4,500 family

$2,500 individual $7,500 family

$5,000 individual $10,000 maximum for family

Co-insurance Subject to deductible then PPO 80/20, Non PPO 60/40

Subject to deductible then PPO 80/20, Non PPO 60/40

Subject to deductible then 80/20 PPO, Non PPO 60/40

Maximum out of Pocket

PPO $4,000 individual $8,000 family

Non PPO $8,000 individual $16,000 family





Hospital Charges Subject to deductible then PPO 80/20, Non PPO 60/40 Precertification is required for inpatient stays, and for surgeries, whether inpatient or outpatient

Subject to deductible then PPO 80/20, Non PPO 60/40 Precertification is required for inpatient stays, and for surgeries, whether inpatient or outpatient

Subject to deductible, then PPO 80/20, Non PPO 60/40, Precertification is required for inpatient stays and for surgeries, whether inpatient or outpatient

Emergency Care Subject to deductible then PPO 80/20, Non PPO 60/40



Urgent Care Services

PPO $50 co-pay, Non PPO Subject to deductible then 60/40

PPO $50 co-pay, Non PPO Subject to deductible then 60/40


Ambulance Subject to deductible then PPO 80/20 of “reasonable & customary”

Subject to deductible then PPO 80/20 of “reasonable & customary”

Subject to deductible then, 80/20 of reasonable & customary”

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Out Patient Surgery Subject to deductible then PPO 80/20, Non PPO 60/40



Maternity / Prenatal Care

PPO $40 co-pay (applies to the first prenatal care visit) Non PPO subject to deductible then 60/40

PPO $45 co-pay (applies to the first prenatal care visit) Non PPO subject to deductible then 60/40


MRI or CT Scan with or without Contrast



PPO subject to deductible then 80/20; Non PPO subject to deductible then 60/40

Pet Scans and SPECT Scans




Durable Medical Equipment




Physical, Occupational and Speech Therapy

PPO $40 co-pay; Non PPO subject to deductible then 60/40; pre-authorization required, 20 visit limit per injury or sickness

PPO $45 co-pay, Non PPO Subject to deductible then 60/40; pre-authorization required, 20 visit limit per injury or sickness

Subject to deductible then PPO 80/20, Non PPO 60/40; pre-authorization required,20 visit limit per injury or sickness

Chiropractor PPO / Non PPO $40 co-pay benefits subject “reasonable & customary” guidelines, 20 visits limit per year

PPO / Non PPO $45 co-pay benefits subject “reasonable & customary” guidelines, 20 visits limit per year

Subject to deductible then PPO/Non PPO 80/20, benefits subject to “reasonable & customary” guidelines, 20 visits limit per year

**Bold items are effective July 1, 2019

*Ambulance, chiropractic and out of network charges are all subject to reasonable and customary guidelines (R&C)

Routine Services – will be processed following the Federal Patient Protection and Affordable Care Act.

The Summary of Benefits and Coverage (SBC) is posted on the www.cebt.org website.

PPO Note: Combination of PPO and Non PPO out of pocket limit will never exceed the Non PPO out of pocket limit.

This comparison of coverages is intended only as a general description for the principle features of the benefit plans.

Please refer to the plan document for details.

Prescription Drug Coverage The vendor that manages your prescriptions is CVS Caremark. Please note that you do not need to access only a CVS pharmacy. You are able to use a pharmacy at City Market, King Soopers, Safeway, Walmart, Walgreens, etc. If you would like to access CVS 90 day mail order for your maintenance medications (blood pressure, cholesterol, etc.), you will need to do so by calling them directly at 866 885 4944.

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CEBT’s Covered Preventative Services—Adult Men and/or Women Eligible charges for the routine items below will be covered at 100% through an in-network provider. Through an out of network provider, charges are subject to the plan deductible and coinsurance.

General Screening Guidelines for Women & Men Alcohol Misuse – screening & counseling Aspirin – ages 55 – 79 – RX Plan Blood Pressure Tobacco Screening Cholesterol Screening Colonoscopy – over age 50 Depression Screening Cologuard Diabetes (Type 2) Screening Diabetes Test Hepatitis B & C Screening Diet Counseling Immunization Vaccines – see section below: “General Immunization/Vaccine for Women & Men”

HIV Screening – annually

Obesity Screening & Counseling Lung Cancer Screening - high risk Sexually Transmitted Infection (STI) – prevention counseling- provided annually

Routine Vision Exam

Syphilis Screening Generic Statins – age 40 – 75; with one or more CVD risk factors and have been calculated 10 years risk of cardiovascular event 10% or greater

General Screening Guidelines for Women Anemia Screening – for pregnant women Bacteruria Screening – for pregnant women Breast Cancer Chemoprevention Counseling Breastfeeding - comprehensive support and counseling BRCA Testing & Counseling Rental or Purchase of a breast pump – limited to one per

pregnancy Chlamydia Infection Screening Cervical Cancer Screening Domestic and Interpersonal Violence – screening and counseling- annually

Clinical Breast Exam

Folic Acid Supplements – RX Plan Expanded Tobacco – intervention and counseling for pregnant tobacco users

Gonorrhea Screening Gestational Diabetes Screening Osteoporosis Screening – over age 60 Routine Mammogram – a baseline age 35-39,

One every calendar year age 40-49, no frequency limitations for age 50 and older.

Oral contraceptives and sterilization procedures

Rh Incompatibility Screening Urinary Tract or Other Infection Screening HPV DNA testing Cov. 30 years and older Well-woman Visits

General Screening Guidelines for Men Abdominal Aortic Aneurysm One Screening – aged 65 - 79 Digital Rectal Exam (DRE)

Prostate Specific Antigen (PSA) General Immunization / Vaccine for Women & Men

Hepatitis A & B Human Papillomavirus (HPV) Influenza – flu shots Measles Meningococcal Mumps Pneumococcal (pneumonia) Rubella Zoster (shingles) – age 60 and over Shingrix (shingles) – age 50 and over

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CEBT’s Covered Preventative Services—Children

General Screening Guidelines for Children Alcohol & Drug Use – assessments for adolescents Autism – screening for children at 18 and 24 months Behavioral – assessments for children of all ages Blood Pressure Screening Cervical Dysplasia Screening – screening for sexually active females

Congenital Hypothyroidism – screening for newborns

Developmental – screening Dyslipidemia Screening – for children at higher risk of lipid disorders

Fluoride Chemoprevention Supplements Gonorrhea Prevention Medication- for the eyes of all newborns

Hearing Screening – newborns Height, Weight & Body Mass Index (BMI) measurements – for children

Hematocrit or Hemoglobin Screening Hemoglobinpathies or Sickle Cell Screening – for newborns

Hepatitis B Screening HIV Screening - for adolescents at high risk Hypothyroidism Screening – for newborns Immunization Vaccines – see section below: “General

Immunization/Vaccine for Children” Iron Supplements Lead Screening Medical History Obesity Screening and Counseling Oral Health – risk assessment Phenylketonuria (PKU) Screening Sexually Transmitted Infection (STI) – prevention counseling

Tuberculin Testing

Routine Vision Exam General Immunization / Vaccine for Children

Diphtheria, Tetanus, Pertussis Haemophilus Influenza Type B Hepatitis A & B Human Papillomavirus (HPV) Inactivated Poliovirus Influenza – flu shots Measles Meningococcal Pneumococcal (pneumonia) Rotavirus Varicella (chicken pox)

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Delta Dental Coverage Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower. MAXIMUM BENEFIT Calendar Year Maximum $1,750 per member, per calendar year

CALENDAR YEAR DEDUCTIBLE Applies to Basic and Major Services

Individual Deductible – $50.00 Combination of in and out-of-network Family Deductible – $150.00 Combination of in and out-of-network

PPO Dentist

PREMIER Dentist

NON-PAR

Dentist COVERED SERVICES BENEFIT INFORMATION (subject to Delta Dental

guidelines)

DIAGNOSTIC AND PREVENTIVE SERVICES

100% 100% 100%

Oral Exams and Cleanings

Twice each in a calendar year. Two additional cleanings may be covered for those with a documented EBD condition.

Sealants Once per tooth in a 36-month period for unrestored permanent molars, through age 15

Bitewing X-Rays Once in a calendar year

Full Mouth X-Rays Once in a 5-year period

Fluoride Twice in a calendar year, through age 15

Space Maintainers One per quadrant, per lifetime to maintain space for eruption of permanent posterior teeth, through age 13

BASIC SERVICES

80% 80% 80%

Fillings Once per tooth in a 12-month period; composite (white) fillings

Simple Extractions

Oral Surgery Endodontics / Periodontics

Occlusal Guards Limited to once per five calendar year period. Occlusal adjustments, limited to once per 24 months

MAJOR SERVICES

50% 50% 50%

Crowns Once per tooth in 5-year period. Not a benefit under age 12.

Implants Once per tooth in a 5-year period. Not a benefit under age 16.

Dentures, Bridges Once in a 5-year period, only when existing prosthesis cannot be made serviceable. Fixed bridges or removable partials are not a benefit under age 16.

ORTHODONTICS $2,000 lifetime maximum

50% 50% 50% For covered children to age 19

You are enrolled in a Delta Dental PPO plus Premier plan. You and your family members may visit any licensed dentist, but will enjoy the greatest out-of-pocket savings if you see a Delta Dental PPO dentist. There are three levels of dentists to choose from.

PPO Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less. Premier Dentist - Payment is based on the Premier Maximum Plan Allowance (MPA), or the fee actually charged, whichever is less. Non-Participating Dentist – Payment is based on the non-participating Maximum Plan Allowance. Members are responsible for the difference between the non-participating MPA and the full fee charged by the dentist. You will receive the best benefit by choosing a PPO dentist.

An employer must have at least 25% of the eligible employees enrolled in the plan in order to have the coverage offered. Members may add coverage once a year at Open Enrollment. Coverage may only be dropped by an employee or dependent with proof of qualifying event.

This is a brief description of services covered under your dental plan. Please refer to the Employee Benefit Booklet for full plan details. If differences exist between this summary and the Employee Benefit Booklet, the Employee Benefit Booklet will govern. 02/01/2019

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Vision Coverage—VSP 12/12/24 Under the Vision plan you have access to the VSP provider network. However, should you wish to see an out-of-network provider, VSP will reimburse you up to the amount allowed under your plan’s out-of-network reimbursement rates.

MEMBER DOCTOR BENEFITS 12/12/24 UP TO

Exam Co-pay $ 15.00 Once every 12 months

Material Co-pay $ 15.00 Once every 12 months

Corrective Contact Lenses Allowance $160.00 Once every 12 months

Frame Allowance (retail) $160.00 Once every 24 months

When contact lenses are obtained, the Covered Person shall not be eligible for lenses and frames again for 12 months.

NON-MEMBER DOCTOR BENEFITS

Exam $ 35.00

Single Lens $ 25.00

Bifocal Lens $ 40.00

Trifocal Lens $ 55.00

Elective Contact Lenses $120.00

Frame $ 45.00

Exclusions: Benefits covered under Worker's Compensation Act, surgery or medical treatment of eyes, replacement of lost, stolen or broken lenses and/or frames, services and supplies for which you or your dependent are not required to pay, services and supplies not listed.

An employer must have at least 25% of the eligible employees enrolled in the plan in order to offer coverage.

Enrollment Restrictions: If any employee or dependent drops coverage, he or she must have proof of a qualifying event in order to do so outside open enrollment. The employee or dependent will need to wait until the next open enrollment period to re-enroll or have proof of a qualifying event.

This is only intended to highlight some of the pertinent provisions of the Group Plan; such Plan will control in all instances.

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The Cost of Your Benefits Durango School District 9-R provides a tiered medical contribution to offset medical costs to employees with spouses and dependents on the plan. Per the DESPA and DEA Master Agreements, one medical plan (HD5000) is premium free for eligible employees. The employer pays 100% of basic life coverage. The district provides the cost of a single dental premium. Employees pay the entire portion of the vision plan.

PPO4

PPO 4 Monthly Cost Monthly District Contribution

Employee Pays

Annual District Contribution

EE $603.00 $461.00 $142.00 $5,532.00

EE + Spouse $1,206.00 $500.00 $706.00 $6,000.00

EE + Children $1,085.00 $550.00 $535.00 $6,600.00

Family $1,688.00 $650.00 $1,038.00 $7,800.00

2 EE + Spouse $1,206.00 $922.00 $284.00 $11,064.00

2 EE + Family $1,688.00 $922.00 $766.00 $11,064.00

PPO 5 Monthly Cost Monthly District Contribution Employee Pays Annual District

Contribution

EE $573.00 $461.00 $112.00 $5,532.00

EE + Spouse $1,146.00 $500.00 $646.00 $6,000.00

EE + Children $1,031.00 $550.00 $481.00 $6,600.00

Family $1,604.00 $650.00 $954.00 $7,800.00

2 EE + Spouse $1,146.00 $922.00 $224.00 $11,064.00

2 EE + Family $1,604.00 $922.00 $682.00 $11,064.00

HD 5000 Monthly Cost Monthly District Contribution Employee Pays Annual District

Contribution EE $461.00 $461.00 $0.00 $5,532.00 EE + Spouse $922.00 $500.00 $422.00 $6,000.00 EE + Children $830.00 $550.00 $280.00 $6,600.00 Family $1,291.00 $650.00 $641.00 $7,800.00 2 EE + Spouse $922.00 $922.00 $0.00 $11,064.00 2 EE + Family $1,291.00 $922.00 $369.00 $11,064.00

Vision B Dental A Employee Pays Employee Pays

EE $9.00 EE $0.00 EE + Spouse $14.00 EE + Spouse $34.00 EE + Children $13.00 EE + Children $52.00 Family $21.00 Family $86.00

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The Cost of Your Benefits (50% eligible employees)

PPO4

PPO 4 Monthly Cost Monthly District Contribution

Employee Pays

Annual District Contribution

EE $603.00 $230.50 $372.50 $2,766.00

EE + Spouse $1,206.00 $250.00 $956.00 $3,000.00

EE + Children $1,085.00 $275.00 $810.00 $3,300.00

Family $1,688.00 $325.00 $1,363.00 $3,900.00

2 EE + Spouse $1,206.00 $461.00 $745.00 $5,532.00

2 EE + Family $1,688.00 $461.00 $1,227.00 $5,532.00

PPO5

PPO 5 Monthly Cost Monthly District Contribution Employee Pays Annual District

Contribution EE $573.00 $230.50 $342.50 $2,766.00 EE + Spouse $1,146.00 $250.00 $896.00 $3,000.00 EE + Children $1,031.00 $275.00 $756.00 $3,300.00 Family $1,604.00 $325.00 $1,279.00 $3,900.00 2 EE + Spouse $1,146.00 $461.00 $685.00 $5,532.00 2 EE + Family $1,604.00 $461.00 $1,143.00 $5,532.00

HD 5000 Monthly Cost Monthly District Contribution Employee Pays Annual District

Contribution

EE $461.00 $230.50 $230.50 $2,766.00

EE + Spouse $922.00 $250.00 $672.00 $3,000.00

EE + Children $830.00 $275.00 $555.00 $3,300.00

Family $1,291.00 $325.00 $966.00 $3,900.00

2 EE + Spouse $922.00 $461.00 $461.00 $5,532.00

2 EE + Family $1,291.00 $461.00 $830.00 $5,532.00

Vision B Dental A

Employee Pays Employee Pays

EE $9.00 EE $17.50

EE + Spouse $14.00 EE + Spouse $51.50

EE + Children $13.00 EE + Children $69.50

Family $21.00 Family $103.50

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CEBT Life and Accidental Death & Dismemberment (AD&D) Insurance Coverage Life insurance is an important part of your financial security, especially if others depend on you for

support. Accidental Death & Dismemberment (AD&D) insurance is designed to provide a benefit in

the event of accidental death or dismemberment. Durango School District 9R provides Basic Life and

AD&D Insurance to all eligible employees at no cost to employees through The Standard.

Life - The Life insurance benefit is payable to the designated beneficiary upon the death of the insured.

AD&D Coverage - Accidental Death and Dismemberment insurance provides specified benefits for a

covered accidental bodily injury that directly causes dismemberment (i.e.; the loss of a hand, foot, or

eye). In the event that death occurs from an accident, both the Life and the AD&D benefit would be

payable

Life / AD&D $20,000

Benefit Reduction

Life and AD&D benefits will reduce

40% and at age 65, 65%

at age 70, 75% at age 75,

and 80% at age 80

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Benefits EnrollmentR E G I S T R A T I O N

Begin by going to www.cebt.org, and clicking on the Community/Online Enrollment Tab. Employees will click on the first “click here” option to register. Fill in the required fields on the registration page. Please use your work email address, or the email address you have on file with your employer. Press “create” and you will receive an email shortly after with a link to login.

Create a password, confirm and select change password

BEGIN ENROLLMENT

Select the New Hire Enrollment button in order to choose your benefits.

VERIFY INFORMATION

Review Profile Details and add in or correct any information that was not completed by your employer. Next, press Save and Select Benefits.

Please contact your HR Administrator or Benefits Specialist for any questions.

NEED TO ADD A DEPENDENT?

1.Click on “Add New Dependent”2.Fill in required information 3.Press “Save Dependent”

MAKE YOUR ELECTIONS

Review the benefit options available, and choose a plan.***Include dependents on coverage by checking the box next to the dependent you wish to add. You will need to do this as you move through each benefit tab.

WONDERING WHAT

PLAN TO CHOOSE?

Refer to the benefit descriptions for a comparison of the different plan designs.

ADD A BENEFICIARY

Add multiple beneficiaries by selecting the + sign, inputting their name, relationship, and percent. The total percentage of all primary or contingent beneficiaries should equal 100%.

PREVIEW AND SUBMIT

ENROLLMENT

Select Preview Benefits to review your benefits before submitting. Select Save & Finish to submit enrollment.

UPLOAD DEPENDENT VERIFICATION

Upload proof of dependent documentation for any new dependent being added to your benefits (ie. Birth certificate, marriage certificate, adoption papers, common law certificate, civil union certificate), and press upload. Dependent Verification is required within 30 days. If you do not have it at the time of enrollment press “Skip and Continue”, and submit to your HR administrator.

REVIEW AND PRINT ELECTIONS

Select “Summarize Coverages” in order to review your enrollment. Print your election summary for your records or future reference.

Please contact your HR Administrator or Benefits Specialist for any questions.

Teladoc

Teladoc provides 24/7/365 access to U.S. board certified doctors through the convenience of phone or video consults. It's an affordable alternative to costly urgent care and ER visits when you need care fast. Some of the common conditions that Teladoc doctors can treat are: cold and flu symptoms, allergies, sinus problems, and many more. CEBT pays for the full cost of the consult for those members on a PPO plan so there is no copay for those members. IRS regulations require the fee to be paid by members that choose a High Deductible Health Plan.

Imagine this... You wake up one morning with flu-like symptoms. You don't want to take time off from work, but you need care now. What can you do?

Teladoc.com/CEBT

Facebook.com/Teladoc

Then you a a

Turns out you have Problem solved.

*HDHP members pay $45 per consult.

1-800-Teladoc (835-2362)

Teladoc.com/mobile

15

Healthcare Bluebook

You’re probably overpaying for care and don’t even know it

Prices for the same procedure can vary up to 500% depending on where you go. It’s true!

With Healthcare Bluebook you can see price information on hundreds of procedures in your area with a simple search. Plus, you can earn rewards for using Fair Price™ (green) facilities. Get paid to save…It’s easy!

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SurgeryPlus is a comprehensive benefit that unlocks access to a premier network of high-

performing surgeons for each individualized need.

SurgeryPlus has identified the nation’s highest quality surgeons based on:

• Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State SanctionsCheck, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements(Hospital Only), Monthly Network Monitoring

You Can Save Money!

• When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e.

coinsurance and/or deductible on PPO plans, or copay on EPO plans). Rest easy knowing you can affordthe surgery you need

• HDHP plans will require the deductible to be met first

• Kaiser plans are not eligible

SurgeryPlus covers hundreds of planned surgeries including, but not limited to:

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Important Numbers

Medical, Dental, Vision, Life– Colorado Employer Benefit Trust (CEBT)

Member Services 303-773-1373 or 1-800-332-1168

Website Address www.cebt.org

Portal Access http://www.cebt.org/online-community

Teladoc

Member Services 1-800-835-2362

Website Address www.Teladoc.com/CEBT

Healthcare Bluebook

Member Services 1-800-341-0504

Website address https://www.healthcarebluebook.com/cc/cebt/

SurgeryPlus

Member Services 1-855.200.6675

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http://www.cebt.org/

http://www.cebt.org/online-community

http://www.teladoc.com/CEBT

https://www.healthcarebluebook.com/cc/cebt/

This benefit summary provides selected highlights of the Durango School District 9R employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the Company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of the policies, contracts and plan documents are governed by the terms of these policies, contracts and plan documents. Durango School District 9R reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The Plan Administrator has the authority to make these changes.

2019-2020 benefit plan highlights - edl · benefits are effective on the first day of the month...

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