2022-2023 BENEFITS CHANDLER UNIFIED SCHOOL DISTRICT NO. 80
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2022-2023 BENEFITS CHANDLER UNIFIED SCHOOL DISTRICT NO. 80
PAGE 2 2022–2023 BENEFITS
WHO SHOULD YOU CALL?
Contact our plan providers directly if you have questions or would like more detailed information
about our plans. Then, if you need additional assistance regarding your benefits, contact Chandler’s
Benefits Department.
PLAN PROVIDER FOR QUESTIONS ABOUT… PHONE WEBSITE
UMR Medical eligibility and 844.212.6811 UMR.com
benefits; claims and appeals;
precertification; ID cards
MaxorPlus Prescription benefits 800.687.0707 MaxorPlus.com
Teladoc Virtual physician visits 800.835.2362 Teladoc.com
ComPsych Employee assistance 833.955.3386 GuidanceResources.com
program; counseling and
work-life services
BASIC COBRA administration 800.444.1922 BasicOnline.com
HealthEquity Health savings account; 866.346.5800 HealthEquity.com
flexible spending account
Delta Dental Delta Dental plan 602.938.3131 DeltaDentalAZ.com
800.352.6132
Total Dental TDA DHMO dental plan 888.422.1995 TDAdental.com
Administrators
VSP Vision benefits 800.877.7195 VSP.com
MetLife Basic and supplemental life 877.638.7868 MetLife.com
and AD&D plans; voluntary MyBenefits.MetLife.com
short-term disability; worksite
benefits
MetLife Hyatt Legal Prepaid legal coverage 800.821.6400 LegalPlans.com
Chandler USD All other benefit-related 480.812.7036 CUSD80.com
Benefits Department questions
PAGE 3 2022–2023 BENEFITS
WHAT’S NEW?
1. The CARE program (maternity, ongoing condition, and complex condition) is adding
new offerings including a mobile app, cash benefits for completion, and an expanded
list of covered conditions.
2. Delta Dental now covers virtual visits, which provide 24/7 access to emergency care.
3. Your Kairos team is growing! We’ve created a dedicated Participant Advocate Team
(PAT) that answers your phone calls at our 888-number. We also have onsite nurses to
help you navigate the health care system (see page 9 for more information).
4. Allowable HSA contributions are going up, so you can save more money this year. Now
you can contribute $3,650 for individual coverage and $7,300 for family coverage.
5. Dependent health care premiums have increased by 3%.
6. Vision premiums have decreased by 5%.
LISTEN UP!
It’s important to pay
close attention to the
changes in this
section, which take
effect at the start of
the plan year (July 1).
PAGE 4 2022–2023 BENEFITS
BEFORE WE BEGIN
TABLE OF CONTENTS ENROLLMENT CHECKLIST
5 PLAN RULES CHOOSE YOUR PLAN
Select a medical program option and
6 WHAT DOES IT ALL MEAN? decide who you're going to cover.
7 MEDICAL BENEFITS UPDATE YOUR INFORMATION
Is your address and contact
8 PRESCRIPTION BENEFITS information correct? Be sure to
confirm and update if needed.
9 CLINICAL ADVOCACY: EXPERTS
ON YOUR SIDE MAKE A CONTRIBUTION TO
YOURSELF
10 WELLBEING If you have the option to enroll in a
high deductible health plan
11 MORE BENEFITS (HDHP), don't miss out on making
health savings account (HSA)
contributions.
HOW TO USE THIS GUIDE
Our plan year runs from July 1 to June 30 of TAKE CARE OF YOUR LOVED ONES
each year. This guide provides a summary of Review and update beneficiary
benefit options to help you make the right designations for life insurance
decisions for you and your family. benefits as needed.
ARE YOUR DEPENDENTS STILL
Keep a copy of this guide handy throughout ELIGIBLE?
the year. It might be useful when you need it Confirm that any dependents up to
most. age 26 are still eligible to be enrolled.
PRO TIP: When you see a QR code CHOOSE YOUR OTHER COVERAGES
like this one, scan it with your cell If applicable, review and decide
phone to find more info. whether to elect any additional
employee-paid benefits.
DON’T MISS OUT!
Open enrollment is April 18–29, 2022.
Don’t miss this opportunity! It’s the one time each year you can make changes to
your benefit elections (unless you have a qualifying event; see p. 5 for more
information).
PAGE 5 2022–2023 BENEFITS
PLAN RULES
WHO’S ELIGIBLE?
Full-time employees working at least 30 hours per week or job share employees
Part-time employees working 20–29 hours (voluntary benefits only)
Active board members or council members
Dependents of enrolled employees, including:
— lawfully married spouses
— dependent children up to age 26
— unmarried children who are mentally or physically handicapped and fully dependent on the
enrolled employee for support and maintenance
THE ELECTIONS MADE DURING THIS ENROLLMENT PERIOD ARE EFFECTIVE FROM
July 1, 2022 to June 30, 2023
WHEN CAN I MAKE A CHANGE?
You can make changes or elect benefits once a year during open enrollment. Outside
of open enrollment, the IRS says a "qualified life event" must occur in order to make
changes.
If you experience a qualified life event and need to make a change to your benefits, you
must notify Chandler Benefits Department within 31 days of the event. Otherwise, you DAYS
will have to wait until the next open enrollment.
Below are examples of qualified life events that may make a mid-year change possible:
Marriage, divorce, legal separation, or Change in your spouse’s employment,
annulment or involuntary loss of health coverage
under another employer’s plan
Birth, adoption, placement for adoption, or
legal guardianship of a child Change in your dependent’s eligibility
status
Death of a dependent
Losing medical coverage through the Marketplace is not considered a qualifying
event and you cannot join the plan mid-year. You can, however, drop your medical
coverage to join a Marketplace plan mid-year.
i If you have questions about your eligibility or mid-year changes, contact Chandler
Benefits Department.
PAGE 6 2022–2023 BENEFITS
WHAT DOES IT ALL MEAN?
Let’s talk through some health
insurance terms and make this easy.
DEDUCTIBLE HIGH DEDUCTIBLE HEALTH
This is the amount of money you have to pay PLAN (HDHP) VS. PPO PLAN
each plan year (July to June) for covered services An HDHP is a type of medical plan that has a
before your health insurance benefits kick in. lower monthly premium but a higher annual
COINSURANCE deductible. It’s usually paired with a health
savings account (HSA) to help pay medical
This is a percentage of covered medical costs you expenses.
pay once you meet your deductible. The plan
pays the rest. A PPO is a plan that has a higher monthly
premium but a lower annual deductible. PPO
OUT-OF-POCKET MAXIMUM (OOP) plans sometimes have copays for services,
This is the most you’ll pay for covered services unlike HDHPs.
during the plan year. The out-of-pocket maximum INPATIENT VS. OUTPATIENT
puts a cap on health care costs if you ever have a
Inpatient services are those received when
major illness or injury.
you’re admitted to a hospital or facility and
EMBEDDED DEDUCTIBLE spend at least one night. Outpatient services
Individual family members have their own can vary, but they’re services received in a
deductibles AND there's a deductible for the facility that you’re not admitted to.
family as a whole. After an individual meets his PRIOR AUTHORIZATION
or her deductible, the plan begins to pay
This is pre-approval that is required for certain
benefits for that person. Once the family
services, prescriptions, and medical equipment
deductible is met, the plan pays benefits for all.
to be covered by the plan. It's sometimes called
IN-NETWORK VS. OUT-OF-NETWORK “preauthorization” or “precertification.”
In-network providers are contracted to provide
services at a discounted rate. Out-of-network
providers are not. Staying in-network is usually
the best way to save money on your health care.
How does my medical plan work?
YOU PAY YOU PAY, PLAN PAYS PLAN PAYS
DEDUCTIBLE COINSURANCE YOU COSTS OVER
The costs you cover The costs you REACH THE OOP MAX
on your own share with the YOUR Once you reach your
plan OOP MAX out-of-pocket limit, the
plan covers costs until
the end of the plan year
PAGE 7 2022–2023 BENEFITS
MEDICAL BENEFITS
UMR/UNITEDHEALTHCARE
UMR is the medical claims processor which uses the UnitedHealthcare (UHC)
Choice Plus network. This is a PPO network, which is a group of health care
providers who discount what they charge you for services. By staying in-
network, services will cost you less.
Where does UMR fit in?
CUSD UnitedHealthcare UMR
The Plan Medical Network Claims Handling
CUSD funds all of the CUSD medical plans use UMR processes your medical
health care plans and the UnitedHealthcare claims. When you see your
partners with Kairos to network. If your doctor doctor, he or she submits
administer your benefits. asks what network you the claim to UMR. For
have, you'll say, “United.” questions about your
medical coverage, call CUSD
or UMR (not United).
MANAGE YOUR BENEFITS FIND A DOCTOR
If you want to find a doctor, there’s no need
Create your mobile-friendly account at
to log in! Instead, follow these simple steps:
umr.com to take full advantage of your
medical benefits. You’ll need to have your ID Go to umr.com
card handy in order to register.
Select “Find a Provider”
Once you’re in, you can:
In the Provider Network search bar, type
View/print/order ID card(s) the network name: UnitedHealthcare
Choice Plus
View medical claims
Click search, then view providers
Monitor deductible and out-of-pocket
limits Type in your address or ZIP code
Shop for the best and most cost-efficient Now you’ll be able to search by provider
care name, locations, services, and more.
For questions, contact UMR at 844.212.6811 or visit umr.com.
PAGE 8 2022–2023 BENEFITS
PRESCRIPTION BENEFITS
MAXORPLUS
When you enroll in CUSD medical coverage, you automatically receive
prescription drug coverage through MaxorPlus. This benefit allows you to fill prescriptions
through any participating pharmacy listed in the MaxorPlus pharmacy network. To view
the most current formulary go to svc.kairoshealthaz.org.
Sign up for the MaxorPlus member portal to:
Locate the closest View the plan formulary Look up your
and most cost- (a list of prescription medications prescription history
efficient network that may be covered under the plan) and plan costs
pharmacy
TIPS FOR SAVING ON PRESCRIPTIONS
Depending on your medication type, dosage, and frequency, the dollars can add up quickly. But
you have options for lowering your out-of-pocket costs. Try these simple steps to help you save a
buck or two!
TAKE THE GENERIC USE MAIL ORDER
Generics have the same strength and Mail order delivers medications to your
active ingredients as the name brand doorstep for less than it costs to go to your
version of your medications. The only local pharmacy. For example, if a
difference is, they’re significantly prescription costs $180 for a three-month
cheaper. Talk to your prescriber to see if supply at retail, it could cost $120 through
generics are right for you. mail order. It’s like getting a month for free!
SHOP AROUND SIGN UP FOR MYMAXORLINK
Just like you might hunt for those great The myMaxorLink discount program does
Black Friday deals, you can do the work for you. Once enrolled, you’ll
comparison shopping for medications. automatically receive information on lower-
Log in to the MaxorPlus member portal cost prescriptions, reminders specific to
and use the copay calculator to find the your coverage, and other important health
most cost-effective pharmacy near you. updates. Call 888.596.0723 to enroll or go
(Believe it or not, not all pharmacies to mymaxorlink.com/maxorplus.
charge the same amount for the same
medication.)
For questions, contact Maxor at 800.687.0707 or visit maxorplus.com.
PAGE 9 2022–2023 BENEFITS
CLINICAL ADVOCACY:
EXPERTS ON YOUR SIDE
CLINICAL ADVOCACY PROGRAM
Navigating health care and insurance can be complicated and leave you feeling overwhelmed.
That’s where we come in. Through the Kairos Clinical Advocacy Program, our dedicated in-
house nurses help guide you through the health care system, choose the best treatment, and
keep your costs to a minimum.
With this program, you have:
• a champion in your corner who not only has a clinical background but understands your
insurance coverage and genuinely wants to help
• a concierge to compare costs for you and help you get the best value
Examples of how our clinical advocacy nurses help:
Acting as the liaison between you, Coordinating with your health care
your doctor, and your insurance providers when you need an alternative
site of care
Saving you money with
manufacturer’s medication programs Guiding you through the prior
or community assistance programs authorization (PA) process
OUR NURSES HAVE PEOPLE
EXCITEDLY SHOUTING:
“ Health care is so complicated. I’m
thankful you help us weed through it all.
”
“ You are a life saver! I hope you can hear
when I ring that cowbell after last treatment!
”
For questions, contact CUSD at 480.812.7036 or visit svc.kairoshealthaz.org.
PAGE 10 2022–2023 BENEFITS
WELLBEING
WHAT’S “WELLNESS” ALL ABOUT?
Wellness is more than skipping out on a donut for breakfast one day or trying to remember to de-
stress after a tough meeting. It’s a measure of both your mental and physical health, involving
nearly every aspect of your life. It’s about promoting a healthier and happier whole person.
We offer different wellness programs and activities for you to choose from. Participation is
optional unless stated otherwise.
Active&Fit fitness program Maternity care program
$25/month for access to 11,000+ fitness centers. For pregnant moms or those who are
Plus, online workout videos and life coaching. planning to be. Includes a $25 reward for
Online health center completion!
Online activities to promote healthy eating, Ongoing condition care program
weight management, and more. For those who need help when managing
Onsite events and workshops chronic conditions like diabetes, COPD, and
asthma.
Mammograms, flu shots, biometric screenings,
and financial workshops. Complex condition care program
For assistance with complex cases such as
transplants, oncology, and neonatal care.
PREVENTION IS PRICELESS
We want to help you stay healthy. So, the CUSD plan covers preventive care services for free,
with no age restrictions when you visit an in-network provider.
Examples of preventive benefits include:
Prostate screenings Colonoscopy screenings
Immunizations and flu shots Cancer screenings
Hearing exams Generic contraceptives
Mammogram screenings Blood pressure tests
Your doctor must use wellness codes when billing these services, or your service will not be
covered at 100%. To make sure wellness codes are billed correctly, inform your provider when
scheduling your appointment that you need a wellness visit.
You should also know that if, at the time of your appointment, any issues other than your
preventive screening are addressed, it’s likely that the billing codes will be changed from
wellness to diagnostic, and the fees will not be covered at 100%. If you’re having issues with a
wellness claim, contact the CUSD benefits department.
For questions, contact Kairos at 888.331.0222 or visit svc.kairoshealthaz.org.PAGE 11 2022–2023 BENEFITS
MORE BENEFITS
TELADOC COMPSYCH EAP
With Teladoc, you can use your phone or With ComPsych, you have 6 one-on-one
computer to conduct a live virtual visit with a counseling sessions per family member,
board-certified medical professional—any day, per issue, per year at no cost to you
anytime, anywhere.
Professional advisors are available 24/7
You'll get fast and 24/7 help for non- to help you and your family with:
emergency matters like:
Stress and Substance abuse
Cold and flu Headaches anxiety
symptoms Pink eye Minor depression
Relationship
management
Skin irritations Sinus infection matters
Stomach bugs Sore throat BONUS!
Online resources: Visit the website below
BONUS! to access family resources, legal and
Mental health benefits: Talk to a therapist financial consultations, on-demand
or psychiatrist by appointment via phone trainings, discounts, and more!
or video for things like anxiety,
depression, stress, and more.
For questions, contact ComPsych at
Dermatology benefits: Diagnose and 833.955.3386 or visit
treat skin conditions via the mobile app guidanceresources.com.
for things like eczema, rashes, and more. Web ID: Kairos EAP
For questions, contact Teladoc at
800.835.2362 or visit teladoc.com.PAGE 12 2022–2023 BENEFITS
AND NOW… THE MEDICAL
PLANS!PAGE 13 2022–2023 BENEFITS
PPO PLAN
IN-NETWORK4 OUT-OF-NETWORK4
BENEFIT OVERVIEW
$2,000/employee $4,000/employee
DEDUCTIBLE1
$4,000/employee +1 or more $8,000/employee +1 or more
$4,000/employee $8,000/employee
OUT-OF-POCKET MAXIMUM2
$8,000/employee + 1 or more $16,000/employee +1 or more
$25 copay primary care
OFFICE VISITS physician Deductible, then 50%
$50 copay specialist
URGENT CARE $50 copay Deductible, then 50%
EMERGENCY ROOM $500 access fee, then 20% $500 access fee, then 20%
WELLNESS SERVICES (ADULT/CHILD) $0 Deductible, then 50%
TELEHEALTH (TELADOC)3 $0 Not available
INPATIENT HOSPITAL
Deductible, then 20% Deductible, then 50%
OUTPATIENT HOSPITAL
OUTPATIENT BEHAVIORAL VISIT Office visit copay or 20% Deductible, then 50%
PRESCRIPTIONS
You must meet your prescription deductible first: $100 employee/$300 family
RETAIL • Generic: $10
(30-day supply) • Preferred: $70
• Non-preferred: $150
• Specialty: 50% (maximum of $180)
MAIL ORDER • Generic: $25
(90-day supply) • Preferred: $175
• Non-preferred: $375
¹This plan has an embedded individual deductible and an embedded out-of-pocket limit. This means that although a deductible and
out-of-pocket limit apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before
the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket limit. All
benefits are subject to the deductible, unless otherwise noted.
The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.
2
3Teladoc services are covered at 100% subject to the expiration of the CARES Act. Once the CARES Act expires, services will revert to
the pre-CARES cost structure with applicable copays/deductibles when stated.
4The in-network and out-of-network deductibles and out-of-pocket maximums are separate. This means that amounts applied toward
the in-network deductible and out-of-pocket maximum do not also apply toward the out-of-network deductible and out-of-pocket
maximum. Similarly, amounts applied toward the out-of-network deductible and out-of-pocket maximum do not also apply toward the
in-network deductible and out-of-pocket maximum.
Please note: Information provided above may be subject to change at any time.PAGE 14 2022–2023 BENEFITS
HDHP LOW
BENEFIT OVERVIEW IN-NETWORK4 OUT-OF-NETWORK4
$3,000 employee $6,000 employee
DEDUCTIBLE1
$6,000/employee +1 or more $12,000/employee +1 or more
$4,750 employee $9,500 employee
OUT-OF-POCKET MAXIMUM2
$9,500/employee +1 or more $19,000/employee +1 or more
OFFICE VISITS Deductible, then 20% Deductible, then 50%
URGENT CARE Deductible, then 20% Deductible, then 50%
EMERGENCY ROOM Deductible, then 20% Deductible, then 20%
WELLNESS SERVICES (ADULT/CHILD) $0 Deductible, then 50%
TELEHEALTH (TELADOC)3 $0 Not available
INPATIENT HOSPITAL
Deductible, then 20% Deductible, then 50%
OUTPATIENT HOSPITAL
OUTPATIENT BEHAVIORAL VISIT Deductible, then 20% Deductible, then 50%
PRESCRIPTIONS
You must meet your annual medical deductible first, except for preventive medications5
RETAIL • Generic: $10
(30-day supply) • Preferred: $70
• Non-preferred: $150
• Specialty: 50% (maximum of $180)
MAIL ORDER • Generic: $25
(90-day supply) • Preferred: $175
• Non-preferred: $375
¹This plan has an embedded individual deductible and an embedded out-of-pocket limit. This means that although a deductible and
out-of-pocket limit apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before
the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket limit. All
benefits are subject to the deductible, unless otherwise noted.
The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.
2
3Teladoc services are covered at 100% subject to the expiration of the CARES Act. Once the CARES Act expires, services will revert to
the pre-CARES cost structure with applicable copays/deductibles when stated.
4The in-network and out-of-network deductibles and out-of-pocket maximums are separate. This means that amounts applied toward the
in-network deductible and out-of-pocket maximum do not also apply toward the out-of-network deductible and out-of-pocket
maximum. Similarly, amounts applied toward the out-of-network deductible and out-of-pocket maximum do not also apply toward the
in-network deductible and out-of-pocket maximum.
5You must meet the annual medical plan deductible before the plan pays a prescription drug benefit, with the exception of certain
preventive medications not subject to the deductible. For a detailed list of medications that are exempt from this rule under the HDHP
plans, visit MaxorPlus.com.
Please note: Information provided above may be subject to change at any time.PAGE 15 2022–2023 BENEFITS
HDHP HIGH
BENEFIT OVERVIEW IN-NETWORK4 OUT-OF-NETWORK4
$5,000 employee $10,000 employee
DEDUCTIBLE1
$10,000/employee +1 or more $20,000/employee +1 or more
$6,450 employee 50% coinsurance with no
OUT-OF-POCKET MAXIMUM2
$12,900/employee +1 or more maximum
OFFICE VISITS Deductible, then 20% Deductible, then 50%
URGENT CARE Deductible, then 20% Deductible, then 50%
EMERGENCY ROOM Deductible, then 20% Deductible, then 20%
WELLNESS SERVICES (ADULT/CHILD) $0 Deductible, then 50%
TELEHEALTH (TELADOC)3 $0 Not available
INPATIENT HOSPITAL
Deductible, then 20% Deductible, then 50%
OUTPATIENT HOSPITAL
OUTPATIENT BEHAVIORAL VISIT Deductible, then 20% Deductible, then 50%
PRESCRIPTIONS
You must meet your annual medical deductible first, except for preventive medications5
RETAIL • Generic: $10
(30-day supply) • Preferred: $70
• Non-preferred: $150
• Specialty: 50% (maximum of $180)
MAIL ORDER • Generic: $25
(90-day supply) • Preferred: $175
• Non-preferred: $375
¹This plan has an embedded individual deductible and an embedded out-of-pocket limit. This means that although a deductible and
out-of-pocket limit apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before
the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket limit. All
benefits are subject to the deductible, unless otherwise noted.
The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.
2
3Teladoc services are covered at 100% subject to the expiration of the CARES Act. Once the CARES Act expires, services will revert to
the pre-CARES cost structure with applicable copays/deductibles when stated.
4The in-network and out-of-network deductibles and out-of-pocket maximums are separate. This means that amounts applied toward the
in-network deductible and out-of-pocket maximum do not also apply toward the out-of-network deductible and out-of-pocket
maximum. Similarly, amounts applied toward the out-of-network deductible and out-of-pocket maximum do not also apply toward the
in-network deductible and out-of-pocket maximum.
5You must meet the annual medical plan deductible before the plan pays a prescription drug benefit, with the exception of certain
preventive medications not subject to the deductible. For a detailed list of medications that are exempt from this rule under the HDHP
plans, visit MaxorPlus.com.
Please note: Information provided above may be subject to change at any time.PAGE 16 2022–2023 BENEFITS
MORE BENEFITS WITH YOUR
BENEFITSPAGE 17 2022–2023 BENEFITS
HEALTH SAVINGS ACCOUNT (HSA)
If you enroll in a high deductible health plan (HDHP), you are eligible to open a health savings
account with HealthEquity. An HSA is a personal savings account that lets you set aside pre-tax
money from your paycheck to use on qualified medical expenses. Some examples of qualified
expenses include deductibles and copays, doctor’s office visits, prescription drugs, vaccines and
screenings, and more! For a complete list, visit learn2.healthequity.com/kairos/qme.
Once you receive your debit card from HealthEquity, you’ll be able to use your account. New
cards are issued only to first-time enrollees (or if an existing card expires). Since it’s your personal
account, please contact HealthEquity if you need a replacement debit card.
To view CUSD’s annual contribution, turn to page 32.
HSA Advantages
Triple Tax Benefit It’s Yours Forever Grow and Save
Contributions are tax The money in your HSA You can invest the funds,
deductible; the funds grow rolls over every year and and your earnings grow tax-
with no tax liability; and is yours to keep, even if free. After age 65, you can
money used for health you leave your employer. use the HSA like a traditional
expenses is not taxed upon retirement account.
withdrawal.
YOU'RE ELIGIBLE FOR AN HSA IF:
You’re enrolled in a qualified high You aren’t enrolled in Medicare or another
deductible health plan. non-qualified health care plan.
You’re not also covered by a spouse’s You can’t be claimed as a dependent on
non-HDHP employer plan. someone else’s tax return.
HOW MUCH CAN YOU CONTRIBUTE?
TIER MAXIMUM AMOUNT
INDIVIDUAL $3,650
FAMILY $7,300
Learn how to
AGE 55+ Additional $1,000
maximize your HSA
You may contribute the maximum amount stated on a calendar year basis, or January 1 to December
31. This is a little different from the CUSD plan year, which runs from July to June. You are
responsible for calculating and verifying that your contributions, including any employer
contributions, don’t exceed the maximum annual amount.
For questions, contact HealthEquity at 866.346.5800 or visit healthequity.com.PAGE 18 2022–2023 BENEFITS
FLEXIBLE SPENDING ACCOUNT (FSA)
Set aside pre-tax dollars for eligible health care and dependent care expenses in a flexible
spending account (FSA) administered by HealthEquity. These accounts are also referred to as
consumer-driven accounts, or CDAs. You elect how much you want to contribute in equal
installments throughout the year.
MEDICAL REIMBURSEMENT FSA DEPENDENT CARE FSA
WHAT ARE THE ANNUAL Up to $2,850 (depending on your Up to $5,000 (tax filing status and
CONTRIBUTION LIMITS? employer's plan option) participation in other plans may
affect contribution limits)
WHAT MAY AN FSA BE USED Eligible medical, dental, and vision Eligible childcare expenses
FOR? expenses that are not already
covered or deducted on your income
taxes
HOW ARE REIMBURSEMENTS Claim form submitted via Claim form submitted via employee
MADE? employee portal, fax, or mail portal, fax, or mail
ANYTHING ELSE I NEED TO KNOW ABOUT FSAs?
Use it or Lose it—Any money set aside in the FSA must be used for eligible expenses during the
plan year. Claims for reimbursement may be submitted up to 90 days after the plan year ends on
June 30. After that, funds are forfeited.
Plan Carefully—Your election stays in effect for the entire plan year (July 1 through June 30). Once
you make your election, you may only change your contribution amount if you experience a
qualified status change (see page 5 for information about status changes).
Keep it Compliant—The IRS clearly defines eligible expenses, and only those that comply with the
Internal Revenue Code are eligible for reimbursement. In all cases, itemized documentation for
transactions should be retained.
If you enroll in an HDHP and want to contribute to an FSA, special rules
apply. You may only contribute to a Limited Purpose FSA to reimburse
yourself for eligible dental and vision expenses.
For questions, contact HealthEquity at 866.346.5800 or visit healthequity.com.PAGE 19 2022–2023 BENEFITS
DELTA DENTAL INSURANCE
The dental plan through Delta Dental allows you and your eligible dependents to visit any dentist
or specialist without a referral. The plan also travels with you anywhere in the country. Delta
Dental issues ID cards to new enrollees. If you ever need a replacement, please contact CUSD or
Delta Dental.
While both PPO and Premier dentists are in-network, you will save more money when using a PPO
dentist. Out-of-pocket costs increase by going out-of-network.
SELECT PLAN PPO AND PREMIER OUT-OF-NETWORK
BENEFIT OVERVIEW DENTIST DENTIST
ANNUAL MAXIMUM BENEFIT1 $1,500 $1,500
ANNUAL DEDUCTIBLE (EMPLOYEE/FAMILY)1 $50/$150 $50/$150
LIFETIME ORTHODONTIA MAXIMUM1 Child $1,500 Child $1,500
PREVENTIVE SERVICES (TWICE A YEAR)2 $0 $0
Exams
Routine cleanings
Fluoride: For children up to age 18
Sealants: For children up to age 19
X-rays
Space maintainers
BASIC SERVICES Deductible, then 20% Deductible, then 20%
Fillings
Stainless steel crowns
Emergency treatment
Endodontics: Root canal treatment
Periodontics: Gum disease treatment
Oral surgery: Simple and surgical extractions
MAJOR SERVICES3 Deductible, then 50% Deductible, then 50%
Prosthodontics: Bridges, partial dentures,
complete dentures
Bridge and denture repair
Implants
Restorative: Crowns and onlays
ORTHODONTIC SERVICES4 50% 50%
Benefit for children ages 8–19. Children must be
banded prior to age 17.
1Combination of in-network and out-of-network.
2Preventive services are deducted from the annual maximum benefit.
3Major services have a five-year waiting period.
4Orthodontia has a separate lifetime maximum. In order to receive the full maximum benefit, the
child must remain on the plan for 2 full years.
For questions, contact Delta Dental at 800.352.6132 or visit deltadentalaz.com.PAGE 20 2022–2023 BENEFITS
TDA DENTAL INSURANCE
Total Dental Administrators (TDA) provides comprehensive dental care on a predetermined fee
schedule. There are no deductibles, no claim forms, and no annual or lifetime benefit maximums.
Services are covered in the state of Arizona only.
NO ID CARD NECESSARY. TDA will issue an ID card to new enrollees. You don’t need your card,
though, to receive dental care—your dentist will have your name on file once covered.
DHMO PLAN IN-NETWORK COPAY
BENEFIT OVERVIEW
PREVENTIVE/DIAGNOSTIC
Initial exam $0
Adult cleaning $0
Office visits $0
RESTORATIVE
Amalgam (one surface) $13
Amalgam (two surfaces) $24
Resin (one surface) $29
Resin (two surfaces) $40
CROWN & BRIDGE
Crown porcelain $495*
Crown buildup $80
ENDODONTICS
Root canal therapy (anterior) $195
Root canal therapy (molar) $399
ORAL SURGERY
Extraction $40
Soft tissue impaction $90
PROSTHETICS
Complete denture $615*
Partial denture $550*
PERIODONTICS
Osseous surgery/quad $390
*Copay includes lab fee. Lab fees may vary; check with your provider for more details.
Refer to plan summary for a complete list of covered services.
HOW TO USE YOUR PLAN
STEP 1: Access the TDA website prior to making an appointment. Select the general dental office for
yourself and your dependents.
STEP 2: Select the DHMO dental plan network and enter your search criteria.
STEP 3: Make note of the provider code number listed to the right of the dental office. You’ll use this
code number to identify your selection when enrolling for benefits or calling customer service.
Contact TDA customer service at the number below if you need to change your provider mid-year.
For questions, contact TDA at 888.422.1995 or visit tdadental.com.PAGE 21 2022–2023 BENEFITS
VSP VISION INSURANCE
Using your VSP Choice benefit is easy. Simply create an account at VSP.com. Once your account is
activated, you can review your benefit information and find an eye doctor who’s right for you.
NO ID CARD NECESSARY. At your appointment, tell the office staff that you have VSP. They may
ask for additional personal information to verify your coverage. From there, you’re good to go.
You can also print out an ID card for reference through your online VSP account.
CHOICE PLAN IN-NETWORK
FREQUENCY1
BENEFIT OVERVIEW COPAY
VISION EXAM $10 Every 12 months
See Frames &
PRESCRIPTION GLASSES $25
Lenses
FRAMES
$200 featured frame brands allowance Included in Every 12 months
$180 frame allowance prescription
20% savings on your allowance glasses copay
$100 Walmart/Sam’s Club/Costco frame allowance
LENSES
Included in Every 12 months
Single vision, lined bifocal, and lined trifocal lenses
prescription
Impact-resistant lenses for children
glasses copay
LENS ENHANCEMENTS
Standard progressive lenses $0 Every 12 months
UV protection $0
Premium progressive lenses $95–$105
Custom progressive lenses $150–$175
Average savings of 30% on other lens enhancements
CONTACTS (INSTEAD OF GLASSES)
$150 allowance; no copay Up to $60 Every 12 months
Contact lens exam (fitting and evaluation)
ESSENTIAL EYECARE PROGRAM
Retinal screening for members with diabetes $0 As needed
Additional exams and services for members with diabetic $20 per exam
eye disease, glaucoma, or age-related macular
degeneration. Limitations and coordination with your
medical coverage may apply. Ask your VSP doctor for
details.
1Frequency is based on the last time the benefit was used, not on the plan year effective date.
ENJOY SHOPPING ONLINE?
Go to eyeconic.com and use your vision benefits to shop over 50 brands of contacts, eyeglasses, and
sunglasses. Brands include Bebe, Calvin Klein, Gucci, Ray-Ban, Nike, Nine West, and more!
For questions, contact VSP at 800.877.7195 or visit vsp.com.PAGE 22 2022–2023 BENEFITS
BASIC LIFE AND AD&D INSURANCE
Your employer provides eligible employees with basic life and AD&D in the amount of $50,000.
This benefit is at no cost to you, and enrollment is automatic. Administrators receive $200,000 of
basic life insurance and AD&D.
Once you reach age 65, the original amount reduces by 35% to $32,500, and then reduces again
once you hit age 70 by 50%, to $25,000.
You must designate a beneficiary at least 18 years of age for the basic life insurance benefit. To
update your beneficiary information, please log in to Employee Online iVisions, select Benefits,
then select HR employee beneficiaries.
SUPPLEMENTAL LIFE AND AD&D INSURANCE
If eligible, you have the opportunity to purchase additional life insurance coverage for yourself, your
eligible spouse, and your dependent children. You must elect supplemental life for yourself in order
to elect it for your spouse. You are responsible for paying the cost of this benefit as stated in the
plan summary.
Unlike basic life insurance, your supplemental life insurance amount will not reduce with age.
However, the amount you pay in premiums will increase as you age.
SUPPLEMENTAL COVERAGE AMOUNTS
YOU YOUR SPOUSE YOUR CHILDREN
AVAILABLE $10,000–$500,000 in $10,000–$250,000 in Up to 15 days old: $1,000
AMOUNTS increments of $10,000 increments of $10,000
15 days to 26 years:
Cannot exceed 5 times Cannot exceed the $2,000–$10,000 in
your annual salary combined amount of increments of $2,000
your basic life and
supplemental life
benefits
GUARANTEED $150,000 $100,000 $10,000
ISSUE AMOUNT
(only applies to
new hires or those
who are newly
eligible for
benefits)
GUARANTEED ISSUE AMOUNT
The guaranteed issue amount, sometimes referred to as “non-medical maximum,” is a set amount of voluntary
life insurance guaranteed for new hires or those who are newly eligible for benefits that does not require
evidence of insurability (EOI).
EOI is an application process that requires you to complete a statement of health (SOH) form on your medical
history in order to be approved for the life insurance amount requested. EOI is required for new enrollees
enrolling above the guaranteed issue amount and for existing enrollees increasing their life insurance.
Pay close attention during enrollment to determine if an SOH is needed.
For questions, contact Kairos at 888.331.0222 or visit metlife.com.PAGE 23 2022–2023 BENEFITS
SHORT-TERM DISABILITY INSURANCE
Eligible employees can elect to purchase voluntary short-term disability coverage through MetLife.
This benefit replaces a portion of your pre-disability earnings, less any income that was actually paid
to you during the same disability from other sources (e.g., Social Security benefits). Disability
insurance helps provide income protection for employees with unexpected health events, associated
expenses, and possible time away from work due to a non-occupational injury or sickness.
The plan provides weekly benefits in the amount of 40%, 50%, or not to exceed 66 2/3% of your
salary up to a $1,154 weekly maximum benefit.
Benefits begin following the plan’s 7-day elimination period and are paid for up to 25 weeks of
continuous disability. This plan includes maternity as part of the coverage and typically pays six
weeks of benefits for a normal pregnancy.
PRE-EXISTING CONDITION LIMITATIONS
The policy does not cover an illness or accidental injury that arose in the three months prior to your
plan effective date when enrolling for the first time. In addition, to be eligible for coverage during
pregnancy, your pregnancy must occur on or after the benefit effective date (e.g., July 1, 2022 if you
are enrolling during open enrollment).
IMPORTANT
You may sign up for this
coverage only during
open enrollment, or as a
new hire.
You may not drop
coverage until the next
open enrollment period.
For questions, contact MetLife at 877.638.7868 or visit metlife.com.PAGE 24 2022–2023 BENEFITS
HOSPITAL INDEMNITY (worksite benefit)
Chandler’s hospital indemnity plan through MetLife offers a cash benefit when you require
hospitalization and are admitted to the hospital. The policy provides one cash benefit per hospital
confinement, and cash benefits per day of hospitalization. There are no pregnancy or pre-existing
condition exclusions. Benefits reduce by 25% at age 65; and by 50% at age 70.
BENEFIT OVERVIEW PLAN PAYS YOU BENEFIT LIMITS
ADMISSION $500 One time per calendar year
$500 (ICU)
CONFINEMENT $200/day 15 days per calendar year
$200/day (ICU)
INPATIENT REHABILITATION $200/day 15 days per calendar year
HEALTH SCREENING BENEFIT $50 One time per calendar year,
per covered person
MetLife will pay you and your enrolled dependents $50 per calendar year for completing a
covered screening/test and submitting the information to MetLife.
Examples include a blood test to determine total cholesterol, an endoscopy, or colonoscopy.
When you’re ready to claim your $50:
1. Call 877.638.7868.
2. Provide a few details, including: your doctor’s contact information; the screening/test and
date it was completed; and address of where the screening/test was performed.
3. Receive your free $50.
HOW IT WORKS
On his way to work, Bill’s car is hit by a large truck on the highway. Bill is immediately taken
to the emergency room at a local hospital. Upon evaluation by the attending doctor, Bill
is admitted to the Intensive Care Unit for close observation of trauma to his head and a fractured
disk in his neck. After two days in the ICU, he is moved to a standard room and stays there for five
more days. Bill is then transferred for in-patient care at a rehabilitation facility. His stay there is
seven days. Bill would receive a lump-sum payment totaling $4,200.
COVERED EVENT BENEFIT AMOUNT
Hospital admission $500
Supplemental admission ICU $500
Confinement for 2 days ICU $800 ($400 per day)
Confinement for 5 days hospital $1,000 ($200 per day)
Inpatient rehab unit for 7 days $1,400 ($200 per day)
$4,200 Total
For questions, contact MetLife at 877.638.7868 or visit mybenefits.metlife.com.PAGE 25 2022–2023 BENEFITS
PREPAID LEGAL COVERAGE
Our legal plans through MetLife provide access to a national network of over 17,000 attorneys to
help navigate important life events. Through the program, you can participate in telephone and
office consultations with attorneys on a broad range of legal issues.
PREPAID LEGAL ADVANTAGES
Telephone advice and office consultation Money-back guarantee
on an unlimited number of legal matters No deductibles or copays
(exclusions may apply)
No claim forms
Access to attorneys in person or by phone,
email, or mobile app No usage limits
Prepaid legal is here to help you with:
Getting married Buying or selling your home Sending kids off to
and starting a college
family
Pick a plan that suits your needs.
HIGH PLAN
LOW PLAN
(In addition to Low Plan features)
COVERED SERVICES • Identity theft defense • Personal bankruptcy
• Tenant negotiations • Tax audit representation
• Foreclosures and mortgages • Refinancing and home equity
• Powers of attorney (health care, loan
financial, child care, immigration) • Revocable and irrevocable trusts
• Simple or complex wills • Civil litigation defense
• Disputes over consumer goods • Juvenile court defense
• Defense of traffic tickets • Adoption
Exclusions: DUI, divorce, felonies, work-related matters, pre-existing legal matters
For questions, contact MetLife at 877.638.7868 or visit legalplans.com.PAGE 26 2022–2023 BENEFITS
COMPLETING YOUR OPEN
ENROLLMENT
We encourage all employees to take an active role in their initial benefits enrollment process, in
monitoring any status changes during the year, and in benefits renewal.
OPEN ENROLLMENT
Your current benefit elections end on June 30, 2022. During the 2022–2023 open enrollment period,
you must renew your current elections or make any changes by April 29, 2022—possibly sooner if
required by your employer. If you miss this deadline, you will NOT have an opportunity to change
coverage until next year’s open enrollment period, unless you have a qualified life status change. (See
p. 5 for examples.)
NEW HIRE
You must elect or decline benefits within 10 calendar days of your date of hire. If you miss this
deadline, you will NOT have an opportunity to elect coverage until the following open enrollment
period.
LIFE EVENT
If you experience a qualified life status change, you must submit all necessary paperwork within 31
days of your benefit eligibility date. If you miss this 31-day deadline, you won’t have an opportunity
to make coverage or benefit changes until next year’s open enrollment period.
DURING OPEN ENROLLMENT,
ALL REQUIRED INFORMATION MUST
APRIL
29
BE COMPLETED BY APRIL 29, 2022
Note: If you have coverage elsewhere or through a spouse,
your employer plan will become your primary coverage.PAGE 27 2022–2023 BENEFITS
THIS GUIDE IS
INTENDED
ONLY AS A
BRIEF
DESCRIPTION
OF YOUR
PLAN BENEFITS
The guide attempts to describe
important details and changes to
the Chandler health plans in a clear,
simple, and concise manner. If there
is a conflict between this guide and
the wording of plan documents, the
plan documents will govern.
Chandler retains the right to
change, modify, suspend, interpret,
or cancel some or all of the benefits
or services at any time.PAGE 28 2022–2023 BENEFITS
MID-YEAR CHANGES TO YOUR HEALTH CARE BENEFIT ELECTIONS
IMPORTANT: After this open enrollment period is enrollment within 60 days after the Medicaid or S-CHIP
completed, generally you will not be permitted to coverage ends.
change your benefit elections or add/delete • become eligible for a premium assistance program
dependents until next year’s open enrollment, unless you through Medicaid or S-CHIP. However, you must request
have a special enrollment event or a mid-year change in enrollment within 60 days after you (or your dependents)
status event as outlined below: are determined to be eligible for such assistance.
Special enrollment event: If you are declining enrollment To request special enrollment or obtain more
for yourself or your dependents (including your spouse) information, contact Chandler at 480.812.7036.
because of other health insurance or group health plan
coverage, you may be able to enroll yourself and your Mid-year change in status event: Because Chandler
dependents in this plan if you or your dependents lose Unified School District pre-taxes benefits, we are
eligibility for that other coverage (or if your employer required to follow Internal Revenue Service (IRS)
stops contributing toward your or your dependents’ other regulations regarding whether and when benefits can be
coverage). However, you must request and make changed in the middle of a plan year. The following
enrollment changes within 31 days after you or your events may allow certain changes in benefits mid-year, if
dependents' other coverage ends permitted by the IRS and your employer’s respective
Section 125 plan, which provides final authority:
In addition, if you have a new dependent as a result of
marriage, birth, adoption, or placement for adoption, • change in legal marital status (e.g., marriage,
you may be able to enroll yourself and your divorce/legal separation, death);
dependents. However, you must request enrollment • coverage of the employee’s or spouse’s plan; and
within 31 days after the marriage, birth, adoption, or • changes consistent with special enrollment rights and
placement for adoption. FMLA leaves.
You and your dependents may also enroll in this plan if you
(or your dependents): You must notify the plan in writing within 31 days of the
mid-year change in status event by contacting Chandler
Unified School District. The plan will determine if your
• change in number or status of dependents (e.g., birth,
change request is permitted, and if so, changes will
adoption, death);
become effective the day of the event.
• change in employee’s/spouse’s/dependent’s
employment status, work schedule, or residence that
affects eligibility for benefits; Losing medical coverage through the Marketplace is not
• have a Qualified Medical Child Support Order considered a qualified life event with Chandler USD, and
(QMCSO); you will not be allowed to join the plan mid-year. However,
• have a change in entitlement to or loss of you can drop your Chandler USD medical coverage to join
eligibility for Medicare or Medicaid; a Marketplace plan mid-year. You will be required to
• experience certain changes in the cost of provide proof of coverage within 31 days of your
coverage, composition of coverage, or enrollment.
curtailment of coverage of the employee’s or
spouse’s plan; and
• have coverage through Medicaid or a State
Children’s Health Insurance Program (S-CHIP) and
you (or your dependents) lose eligibility for that
coverage. However, you must request
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub. does not display a currently valid OMB control number.
L. 104-13) (PRA), no persons are required to respond to a See 44 U.S.C. 3512.
collection of information unless such collection displays a
The public reporting burden for this collection of
valid Office of Management and Budget (OMB) control
information is estimated to average approximately seven
number. The Department of Labor notes that a federal
minutes per respondent. Interested parties are encouraged
agency cannot conduct or sponsor a collection of
to send comments regarding the burden estimate
information unless it is approved by OMB under the PRA
or any other aspect of this collection of information,
and displays a currently valid OMB control number, and
including suggestions for reducing this burden, to the
the public is not required to respond to a collection of
U.S. Department of Labor, Employee Benefits Security
information unless it displays a currently valid OMB
Administration, Office of Policy and Research, Attention:
control number. See 44 U.S.C. 3507. Also,
PRA Clearance Officer, 200 Constitution Avenue, N.W.,
notwithstanding any other provisions of law, no person
Room N-5718, Washington, DC 20210, or email
shall be subject to penalty for failing to comply with a
ebsa.opr@dol.gov and reference the OMB Control Number
collection of information if the collection of information
1210-0137.PAGE 29 2022–2023 BENEFITS
DIRECT ACCESS TO PRIMARY CARE PROVIDER (PCP) AND OB/GYN PROVIDER
The medical plans offered by CUSD do not require the obstetrical or gynecological care from a healthcare
selection or designation of a primary care provider professional who specializes in obstetrics or gynecology.
(PCP). You have the ability to visit any network or non- The healthcare professional, however, may be required to
network healthcare provider; however, payment by the comply with certain procedures, including obtaining prior
plan may be less for the use of a non-network provider. authorization for certain services, following a pre-
approved treatment plan, or procedures for making
You also do not need prior authorization from the referrals. For a list of participating healthcare
plan or from any other person (including a professionals who specialize in obstetrics or gynecology,
primary care provider) in order to obtain access to contact Kairos at 888.331.0222.
REQUIREMENT TO PROVIDE THE TAXPAYER IDENTIFICATION NUMBER (TIN) OR SOCIAL
SECURITY NUMBER (SSN) OF EACH HEALTH PLAN ENROLLEE
Employers are required by law to collect the taxpayer to request one: socialsecurity. gov/online/ss-5.pdf.
identification number (TIN) or social security number Applying for a social security number is FREE.
(SSN) for each medical plan participant and include
that number on reports that are provided to the IRS If you have not yet provided the social security number
each year. If you have a covered dependent who does (or other TIN) for each dependent enrolled in the health
not yet have a social security number, you can go to plan, please contact Chandler benefits department at
this website 480.812.7036.
COBRA COVERAGE REMINDER
In compliance with a provision of federal law referred to see what your premium, deductibles, and out-of-
as COBRA continuation coverage, this plan offers its pocket costs will be before you make a decision to
eligible employees and their covered dependents (known enroll. Being eligible for COBRA does not limit
as qualified beneficiaries) the opportunity to elect your eligibility for coverage for a tax credit through the
temporary continuation of their group health coverage Marketplace. Additionally, you may qualify for
when that coverage would otherwise end because of a special enrollment opportunity for another group health
certain events (called qualifying events). plan for which you are eligible (such as a spouse’s plan) if
you request enrollment within 30 days, even if the plan
Qualified beneficiaries are entitled to elect COBRA generally does not accept late enrollees.
coverage when qualifying events occur, and, as
a result of the qualifying event, coverage for that The maximum period of COBRA coverage is generally
qualified beneficiary ends. Qualified beneficiaries who either 18 months or 36 months, depending on which
elect COBRA continuation coverage must pay for it at qualifying event occurred.
their own expense.
In order to have the opportunity to elect COBRA
Qualifying event examples include termination of coverage following a divorce/legal separation or a
employment for any reasons other than gross child ceasing to be a dependent child under the
misconduct, reduction in hours of work making the plan, you and/or a family member must inform the plan
employee ineligible for coverage, death of in writing of that event no later than 31 days after the
the employee, divorce/legal separation, or a child event occurs. The employee should contact Chandler
ceasing to be an eligible dependent child. benefits department at 480.812.7036. They must also
provide the appropriate documentation in support of the
In addition to considering COBRA as a way to continue qualifying event (such as divorce documents)
coverage, there may be other coverage options for you
and your family. You may wish to seek coverage through If you have questions about COBRA, contact BASIC at
the Health Care Marketplace. (See healthcare.gov) In the 877.262.7202.
Marketplace, you could be eligible for a tax credit that
lowers your monthly premiums for Marketplace coverage,
and you canPAGE 30 2022–2023 BENEFITS
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or dependents might be eligible for either of these programs,
CHIP, and you’re eligible for health coverage from your contact your state Medicaid or CHIP office or dial
employer, your state may have a premium assistance 877.KIDSNOW or www.insurekidsnow.gov to find out how
program that can help pay for coverage using funds from to apply. If you qualify, ask your state if it has a program
the Medicaid or CHIP programs. If you or your children that might help you pay the premiums for an employer-
aren’t eligible for Medicaid or CHIP, you won’t be eligible sponsored plan.
for these premium assistance programs, but you may be
If you or your dependents are eligible for premium
able to buy individual insurance coverage through the
assistance under Medicaid or CHIP, as well as eligible
Health Insurance Marketplace. For more information, visit
under your employer plan, your employer must allow
www.healthcare.gov.
you to enroll in your employer plan if you aren’t already
If you or your dependents are already enrolled in Medicaid enrolled. This is called a “special enrollment” opportunity,
or CHIP, and you live in a state listed below, contact your and you must request coverage within 60 days of being
state Medicaid or CHIP office to find out if premium determined eligible for premium assistance.
assistance is available.
If you have questions about enrolling in your employer
If you or your dependents are NOT currently enrolled plan, contact the Department of Labor at www.askebsa.
in Medicaid or CHIP, and you think you or any of your dol.gov or call 866.444.EBSA (3272).
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 (WHCRA)
You or your dependents may be entitled to certain • surgery and reconstruction of the other breast to
benefits under the Women’s Health and Cancer Rights Act produce a symmetrical appearance;
of 1998 (WHCRA). For individuals receiving mastectomy-
• prostheses; and
related benefits, coverage will be provided in a manner
determined in consultation with the attending physician • treatment of physical complications of the mastectomy,
and the patient for: including lymphedema.
• all stages of reconstruction of the breast on which the Plan limits, deductibles, copayments, and coinsurance
mastectomy was performed; apply to these benefits. For more information on WHCRA
benefits, contact Chandler at 480.812.7036.
PRIVACY NOTICE REMINDER
The Health Insurance Portability and Accountability Act This plan’s HIPAA privacy notice explains how the group
(HIPAA) of 1996 requires health plans to comply with health plan uses and discloses your personal health
privacy rules. These rules are intended to protect your information. You are provided a copy of this notice when
personal health information from being inappropriately you enroll in the plan. You can also request another copy
used and disclosed. The rules also give you additional rights of the notice from Kairos.
concerning control of your own healthcare information.
MEDICARE NOTICE OF CREDITABLE COVERAGE REMINDER
If you or your eligible dependents are currently Kairos has determined that the prescription drug
Medicare-eligible, or will become Medicare-eligible coverage under the following prescription drug plan
during the next 12 months, be sure you understand options is “creditable”: PPO Plan; HDHP Low; and HDHP
whether the prescription drug coverage that you High.
elect through the pool is or is not creditable with(as
If you have questions about what this means for you,
valuable as) Medicare’s prescription drug coverage.
review the plan’s Medicare Part D Notice of Creditable
Coverage, which is available from Chandler at
480.812.7036.You can also read
