champ and confidential open enrollment packet

April 16, 2019

Re: 2019/20 Health and Welfare Open Enrollment

Dear CHAMP Employees:

Open enrollment for benefit-eligible employees will be held Wednesday, May 1 through

Friday, May 17, 2019.

For more information please go to https://www.chino.k12.ca.us/Page/1002.

Enrollment Information:

• If you are NOT making changes to your medical coverage, NO ACTION IS REQUIRED

ON YOUR PART. Your current health and welfare benefits will continue through June 30,

2019. If no changes are made to your current health and welfare benefits, they will remain

in place for the 2019/20 fiscal year.

• If you are making a change for yourself and/or your dependent(s), you must log in during

open enrollment to access the BenefitFocus website at https://chinovalley.hrintouch.com.

BenefitFocus detailed instructions are provided in this packet.

• For BenefitFocus Website Technical questions, please call:

877.336.8082, Monday through Friday, 5:00 a.m. to 6:00 p.m., Pacific Standard Time.

• All newly added dependents will need proof of eligibility, (2018 tax return or marriage

certificate for spouse and birth certificates for children). These document(s) can be

uploaded on the website or submitted to the District Benefit Office no later than Friday,

May 17, 2019.

• If you are opting out of medical benefits, you MUST complete and sign a Waiver of

Participation and provide proof of other insurance coverage. The Waiver of Participation

form is included in this packet.

Questions on Medical Benefits?

• For Kaiser specific questions, please contact Kaiser customer service at 800.464.4000.

• For Blue Shield specific questions, please contact Blue Shield Concierge at 855.724.7698.

https://www.chino.k12.ca.us/Page/1002

https://chinovalley.hrintouch.com/

Need Assistance? We’re here to help!

• The Chino Valley Unified School District (CVUSD) Benefits staff and the *Representatives

listed below will be available to assist you.

Open Enrollment Information at PDC II:

• Location: Professional Development Center II (PDC II), 4545 Danito Ct., Chino, 91710

• Date/Time: Wednesday, May 15, 2019, 11:30 a.m. - 5:00 p.m.

• *Representatives: CSEBA, Kaiser, Blue Shield, Delta Dental, VSP, MES, VOYA,

Health Advocate (Employee Assistance Program), American Fidelity and SchoolsFirst

Credit Union.

CVUSD Benefits Staff:

Lisa Fjeldsted, [email protected] , services last names A-G, M-N, ext. 1244

David Valdivia, [email protected], services last names H-L, O-Z, ext. 1246

Denny Andrade, [email protected], ext. 1245

OPEN ENROLLMENT DEADLINE IS FRIDAY, May 17, 2019 AT 4:30 P.M.

Enclosure(s)

mailto:[email protected]



EMPLOYEE PLANS AND RATES

Type Provider Monthly (12) Annual

Single $618.32 $7,419.84

Employee + Spouse $1,342.36 $16,108.32

Employee + Children $1,221.68 $14,660.16

Family $1,825.05 $21,900.60

Single $530.68 $6,368.16

Employee + Spouse $1,149.56 $13,794.72


Family $1,562.14 $18,745.68

Single $628.93 $7,547.16

Employee + Spouse $1,320.74 $15,848.88


Family $1,855.34 $22,264.08

Single $553.70 $6,644.40

Employee + Spouse $1,162.76 $13,953.12

Employee + Children $996.64 $11,959.68

Family $1,633.42 $19,601.04

Single $1,346.20 $16,154.40

Employee + Spouse $2,827.00 $33,924.00


Family $3,971.28 $47,655.36

Single $820.96 $9,851.52

Employee + Spouse $1,724.02 $20,688.24


Family $2,421.83 $29,061.96

DELTA Delta Dental PPO Composite $124.39 $1,492.68

Single $29.02 $348.24

2-Party $52.17 $626.04

Family $69.56 $834.72

VSP Composite $22.63 $271.56

MES Composite $11.66 $139.92

LIFE VOYA Composite $5.45 $65.40

(1) Add the annual costs (from the chart above) of benefits you have chosen

example: Kaiser 20 (employee + children) + Delta + VSP + Life = $16,489.80

(2) Look on the chart below to determine District's annual share for the number of hours you work

example: A 8 hour/day employee works 100%, District contribution = $8,201.00

(3) Employee annual share:

(1) minus (2) = $8,288.80

(4) Monthly Out-of-Pocket:

(3) divided by 10 months = $828.88

Hours/Day % FTE

District's Annual

Contribution for 7/01/19

thru 6/30/20

4.00 0.50 $4,100.50

6.00 0.75 $6,150.75

8.00 1.00 $8,201.00

DENTALSAFEGUARD

Plan Closed To

New Enrollees

VISION

Instructions for Calculating Your Monthly Out-Of-Pocket Payroll Deductions:

CHINO VALLEY UNIFIED SCHOOL DISTRICT

PPO BLUE SHIELDBlue Shield

ASO PPO PLAN 2

HSA BLUE SHIELD

Blue Shield

HSA

(ASO PPO Savings Plan 1)

CHAMP / CONFIDENTIAL / PSYCHOLOGIST / BOARD MEMBERS 2019-2020

Plans

HMO

KAISER

Kaiser $20

CSEBA Plan 8

Kaiser DHMO $20

CSEBA Plan 11

BLUE SHIELD

Blue Shield

Access+ HMO $20 Plan 3

Blue Shield

Trio ACO HMO $20 Plan 3

CHINO VALLEY UNIFIED SCHOOL DISTRICT

IMPORTANT MEDICAL PLAN INFORMATION FOR 2019/2020

SHORT PLAN SUMMARY

Kaiser Permanente Plans

Kaiser HMO 20

(CSEBA Plan 8)

$20 Office Visit

Max Out of Pocket $1500 / $3000

$100 ER / 100% Hospitalization

Chiropractic Benefit

Acupuncture Benefit

$10 Rx 30 Day / $20 Rx 100 Day

EPIC Hearing Benefit to anyone enrolled in medical (See enclosed flyer)

Kaiser DHMO 20

(CSEBA Plan 11)

$20 Office Visit


20% Coinsurance Hospitalization

Chiropractic Benefit

Acupuncture Benefit added

$10 Rx 100 Day

$500 / $1000 Deductible


HMO Plans

Blue Shield Access +

HMO 20 Plan 3

$20 Office Visit


$50 ER (waived if admitted) / 100% Hospitalization

$0 / $30 / $60 Rx Copay with Blue Shield Prescription Network

Chiropractic and Acupuncture Benefits

Concierge 855.724.7698


Blue Shield Trio ACO

HMO 20 Plan 3

$20 Office Visit


$50 ER (waived if admitted) / 100% Hospitalization

$0 / $30 Rx with Blue Shield Prescription Network



EPIC Hearing Benefit added to anyone enrolled in medical (See enclosed flyer)

PPO Plan

Blue Shield ASO PPO

Plan 2


90% / 70% Coinsurance



100% Preventative Care




Health Savings Account

Blue Shield ASO PPO

Savings Plan 1 / HSA


90% / 70% Coinsurance



100% Preventative Care




Dental Plan

Delta Dental PPO SmileWay may be added with certain medical conditions (See enclosed flyer)

Vision Plans

VSP No plan design changes.

MES No plan design changes.

Addition Plans

Health Advocate

Solutions

Employee Assistance Program (EAP) services at 866.799.2728

• Confidential services included for all household and dependent family members

• Each person can receive 5 free visits, per issue

FOR FULL SUMMARY INFORMATION PLEASE VISIT OUR WEBSITE AT: https://www.chino.k12.ca.us/Page/1002

https://www.chino.k12.ca.us/Page/1002

WAIVER OF PARTICIPATION CERTIFICATED _____ CLASSIFIED _____ Employee Name: _____________________________________ Social Security # XXX-XX- _ _ _ _ Benefit Plan Year: _______________________________

• I am aware that the medical plans offered to me meet the Affordable Care Act (ACA) actuarial minimum value requirements of 60% or greater.

• I am also aware that my required contribution toward the cost of single coverage in the lowest cost plan offered, that meets the minimum value test, does not exceed 9.5% of my W-2 income with the District.

• I further understand that if I am waiving coverage to participate in the State or Federal Exchange I am not eligible for any cash in lieu benefits or any district contribution whatsoever.

At this time, after careful review, I elect not to enroll in the major medical coverage. Or I AM COORDINATING WITH CVUSD SPOUSE: _______________________________ (NAME) Employee Signature: ____________________________ Date: ________________ PLEASE PROVIDE PROOF OF OTHER COVERAGE IF WAIVING COVERAGE AT THIS TIME (i.e. copy of current medical card) NOTE: BY DECLINING THIS GROUP MEDICAL COVERAGE (UNLESS EMPLOYEE AND/OR DEPENDENTS HAVE GROUP MEDICAL COVERAGE ELSEWHERE) I ACKNOWLEDGE THAT MY DEPENDENTS AND I MAY HAVE TO WAIT UP TO TWELVE (12) MONTHS TO BE ENROLLED IN THIS GROUP MEDICAL UNLESS I HAVE A QUALIFYING EVENT THAT MEETS THE EMPLOYERS ELIGIBILITY REQUIREMENT.

Employee Benefit Online Enrollment Instructions

What is Benefitfocus?

Benefitfocus is CSEBA’s health benefits self-service website.

Benefitfocus Online Access

Benefitfocus provides you with secure and easy access to important benefit information.

Access Benefitfocus Online

1. First, access the portal at https://chinovalley.hrintouch.com to create your online account. 2. Select the Create an Account link to begin the account creation process. Enter the following required information into the

corresponding fields:

• Last Name

• Date of Birth

• Last 4 Digits of your SSN 3. Complete the Security Check and click Next

4. Create your Username and Password. All required fields are indicated by an asterisk. After you enter all required information,

please enter your email address and phone number (home/cell).

5. Create a Secret Question and Answer. You will be asked to provide multiple questions/answers. 6. Select Save.

Navigating the System

Once you log into the system, you can easily access your information from the Home Page.

Viewing the Home Page

The first time you log in, you will see benefit enrollment information. You can also access other information, such as your

Dependents and your Login information. You can explore the links on the Home page either before or after you enroll in benefits.

Guiding You Through the Process

1. The Home page shows you the information you need to complete. Select the Get Started button to begin. 2. Navigate from page to page by selecting the Next or Previous buttons. 3. Select Cancel on any screen to return to the Home page. 4. Save your elections on each benefit Summary page when you have entered all required information. Look over your

information closely. If you need to change any information, select the Edit links next to the corresponding section. Select Save once you have made all necessary changes.

5. Dependents: If adding a new dependent, you will be asked to upload a Proof of Eligibility document directly to the platform (if applicable).

6. Review your benefit election information. Select Complete Enrollment once you have finished with your benefit enrollment process.

Note: If you have not completed and saved your benefit elections, you will receive a warning message, which allows you to return to

your benefit elections to complete and save them before leaving the current screen.

You will be returned to the Home page and receive the Congratulations message at the top of the screen. Please review and print

your Employee Detail Report for your records. You may make any changes online anytime during the Enrollment period.

For Technical Questions: 1.877.336.8082 / Monday through Friday, 5:00am to 6:00pm / Pacific Standard Time.

https://chinovalley.hrintouch.com/

Understanding Your Employer’s Section 125 PlanIf there was a program available that could save you money on your taxes and help you proactively plan for out-of-pocket expenses, would you take advantage of it? That’s exactly what a Section 125 Plan does – reduces your tax and increases your spendable income. Under a Section 125 Plan, employers can offer eligible benefits to employees, through payroll deduction, on a pre-tax basis.

This employer-sponsored program is designed to help you save money on important expenses like eligible insurance premiums, health-related expenses, and dependent day care expenses.

See How Much You Could Save

This example shows what a sample employee’s bi-weekly paycheck could look like when using a Section 125 Plan. The sample is based on 24 pay periods.

Plan Today for Tomorrow’s Expenses

9000 Cameron Parkway • Oklahoma City, OK 73114 800-654-8489 • americanfidelity.com

1If you are subject to FICA taxes, there might be a slight reduction in your social security benefit due to the reduction of FICA contributions. Example is for illustrative purposes only. Please consult your tax advisor for actual tax savings.

With a Section 125 Plan Without a Section 125 Plan

Gross Bi-Weekly Income $2,000.00 Gross Bi-Weekly Income $2,000.00

Insurance Premiums- Medical insurance

- Dental insurance- Vision

- Cancer insurance- Accident insurance

- Healthcare Flexible Spending Acct

-$250.00-$30.00-$25.00-$20.00-$15.00-$50.00

Less Tax- Federal & State at 20%

- FICA at 7.65%-$400.00-$153.00

Taxable Bi-Weekly Income $1,610.00 Bi-Weekly Income Before Benefits $1,447.00

Less Tax- Federal & State at 20%

- FICA at 7.65%- $322.00- $123.17

Insurance Premiums- Medical insurance

- Dental insurance- Vision

- Cancer insurance- Accident insurance

- Healthcare Flexible Spending Acct

-$250.00-$30.00-$25.00-$20.00-$15.00-$50.00

Net Bi-Weekly Salary $1,164.83 Net Bi-Weekly Salary $1,057.00

E M P L O Y E R B E N E F I T S O L U T I O N S F O R E D U C A T I O N

Healthcare Flexible Spending AccountHow It Works

A Healthcare Flexible Spending Account (also known as a Healthcare FSA or HCFSA) may be used to pay for common medical expenses throughout the year. You determine how much money you may spend on eligible medical expenses and then set that amount aside pre-tax in a HCFSA. Throughout the year, when you purchase those items, you may reimburse yourself from the account.

Eligible and Ineligible Expenses

You may use your HCFSA to pay for a wide variety of common medical expenses for you, your spouse, and your eligible tax dependents. The Internal Revenue Service (IRS) determines which expenses are eligible for reimbursement. The following are common types of eligible and ineligible expenses.

Examples of Eligible Expenses:

• Medical expenses, including medical bills to coverdeductibles and copayments

• Prescriptions drugs and over-the-counter medicinesprescribed by your doctor

• Vision expenses, including eye exams, glasses,contact lenses, Lasik surgery

• Dental expenses, including dental exams, fillings, andorthodontia expenses1

• Transportation expenses relative to medical care,including mileage at the IRS allowable rate

Examples of Ineligible Expenses:

• Cosmetic procedures

• Toothbrushes

• Insurance premiums

• Vitamins for general wellness

• Any expenses reimbursed under other health plans

SB-15062-0

Visit with your American Fidelity Assurance Company account manager to learn

more.

“Use or Lose”It is important that you carefully choose your election amount each year. Under Internal Revenue Code (IRC) Section 125 regulations, if you don’t use your full election amount during the required timeframe, any remaining funds are forfeited. Check with your employer to see if your plan offers a Runoff Period, Carryover Provision, and/or Grace Period.

• Runoff Period - A period after the plan year endswhen you are able to submit claims that you incurredduring the previous plan year but have not yetsubmitted. The Runoff Period applies to both theHCFSA and the DCA.

• Carryover Provision - You are able to carry overup to $500 of unused Healthcare FSA contributionsfrom one plan year to the next, which may be usedto reimburse eligible medical expenses incurredanytime during the next plan year.

• Grace Period - An additional two and a half monthsfollowing the end of the plan year in which youare allowed to incur Healthcare FSA claims and stillreceive reimbursements.

Dependent Care AccountHow It Works

A Dependent Care Account (DCA) is used to reimburse yourself, with tax-free funds, for eligible dependent day care expenses incurred while you are working. Your contribution is withheld from your paycheck before tax, which in turn reduces your overall tax. You may allocate up to $5,000 pre-tax per calendar year for reimbursement of dependent day care expenses if you are married or $2,500 if filing separate tax returns.

Who May ParticipateAny employee who meets certain eligibility requirements and who has a qualifying dependent may participate in a DCA. If you are considering participating, you should be aware that you may be able to take a federal and/or state tax credit instead of participating in the DCA. Consult your tax advisor to review your options.

Southern California Branch Office36310 Inland Valley Dr., Ste. 100Wildomar, CA 92595800-365-9180 · 951-600-0122americanfidelity.com

1Members go to

www.listenhearlivewell.com and register with your name

and email address.

2Complete the 4 fun,

educational hearing healthactivities.

3Receive your reward couponfor additional savings off of

your purchase.

Welcome to the Listen Hear, Live Well

Hearing Health Wellness Program

Here’s How it Works:

Listen Hear, Live Well reward coupon savings are applied per each hearing device that is purchased--maximizing your value! Plus, these reward savings are applied on top of the 30% - 60% savings off of MSRP that is already available on an open selection of major brand hearing aids through the EPIC Hearing Service Plans. Simply complete the online wellness program on your desktop or mobile device and contact the EPIC Hearing Service Plan toll free at 1 866.956.5400 to redeem your reward, and start the process to better hearing!

Premium Devices: $200 offAdvanced Devices: $100 offStandard Devices: $50 off

Save

LISTENHEARLIVEWELL.COM [email protected]

ListenHear LiveWell

Benefits beyond smiles Enhanced coverage for enrollees with certain medical conditions

The health of gums and teeth is part of a bigger picture — overall body wellness. Gum disease is associated with a number of systemic conditions, and people with certain chronic conditions may benefit from additional periodontal (gum) cleanings and maintenance.

That’s why Delta Dental’s1 SmileWay® Wellness Benefits option offers expanded coverage for those diagnosed with diabetes, heart disease, HIV/AIDS, rheumatoid arthritis or stroke2.

How do groups get SmileWay Wellness Benefits?Talk to your Delta Dental representative to learn how to add Delta Dental’s SmileWay Wellness Benefits to a plan!

Four of the following (any combination) per calendar year• prophylaxis (teeth cleaning)

(D1110 or D1120), covered at 100%

• periodontal maintenance procedure (D4910), covered at 100%

100% coverage for one periodontal scaling and root planing procedure per quadrant (D4341 or D4342) per calendar year

What does expanded coverage look like?

deltadentalins.com

Some smiles need a little more support. SmileWay Wellness Benefits can provide extra coverage for enrollees who need it most.

It’s easy for enrollees to opt in!For groups with this benefit, enrollees simply sign up online at deltadentalins.com. After logging in to their Online Services account, they click on the Optional Benefits tab and then select Opt In.

Take a look for yourself

Copyright © 2017 Delta Dental. All rights reserved. GF15 #106496 (rev. 7/17)

1 Our Delta Dental enterprise includes Delta Dental of Pennsylvania, Delta Dental Insurance Company, Delta Dental of California, Delta Dental of New York, Inc. and our affiliated enterprise companies.

2 The SmileWay Wellness Benefits option is available for groups with a PPO plan only; specific coverage may vary by plan.

Employee Assistance Plan (EAP)

As a member of the California Schools Employee Benefits Association (CSEBA), you are eligible for the Employee Assistance Program (EAP). This program is designed to provide confidential support for life’s challenges or more serious problems. Help is available whenever you need it, 7 days a week, 24 hours a day, 365 days a year.

What Can My EAP Benefit Do For Me? You may be struggling with stress at work, seeking financial or legal advice, or coping with the death of a loved one. Maybe you just want to strengthen your relationships with your family. Your EAP Benefit offers assistance and support for all these concerns and more:

● Depression, anxiety and stress ● Substance abuse ● Relationship problems ● Workplace conflicts ● Parenting and family issues ● Living with chronic conditions ● Childcare and eldercare support

How Do I Get Started? The EAP is available to you toll-free, 24 hours a day, 7 days a week.

● All services are CONFIDENTIAL ● Services are available to all household and dependent family members ● You get 5 FREE visits per issue (not per member) with an EAP provider

Phone: 866.799.2728 Email: [email protected] Website: HealthAdvocate.com/members access code: CSEBA

What Will Happen When I Call? Once you call, our EAP counselors would walk you thru how the program will work when they do the clinical assessment and then (when appropriate) will facilitate the scheduling of in person visits with a participating provider. Remember, you have unlimited telephonic support. A specialist will ask you a few questions to help identify the nature of your problem and the appropriate resources needed to address it. If you need financial or legal services, the specialist will refer you to an expert in that field. If you want to see a clinician, the specialist will match you with one in the network who has the appropriate experience to help. They will work to satisfy your preferences with respect to gender and language/cultural requirements.

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Let us shrinkyour to-do list

©2016 Health Advocate HA-CEM-1509041-1.3FLY

Just call 866.799.2728

We'll do it for you Restaurant reservations Party/event planning Sporting events Ticketing Travel research and bookings…And more!

Start saving time now. Outsource your to-do list to us.Just Call Us. 866.799.2728

Introducing... Your Enhanced EAP+Work/Life Program

Health Advocate is not affiliated with any insurance or third party provider. Health Advocate complies with all government privacy standards. Health Advocate does not replace health insurance coverage, provide medical care or recommend treatment.

Welcome to your own Personal Concierge Service - a new enhancement to your Health Advocate EAP+Work/Life Program, provided at no cost to you. Now, in addition to licensed professional counseling and a range of work/life services, you can get help with travel booking, party planning, dinner reservations and other time-consuming, distracting tasks. It’s one more way we can help you better balance your work and life.

champ and confidential open enrollment packet

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