2020-2021 BENEFITS - Scottsdale Unified School District
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2020-2021 BENEFITS
PA G E 2 2020–2021 BENEFITS
LET'S BEGIN!
BCBSAZ has facilities listed as Blue Distinction® facilities in their network. You are required to use a
Blue Distinction facility for certain procedures. This now includes gene therapy and transplants.
Diabetics can get up to six nutritional counseling sessions per year at no cost!
EAP now offers video counseling, online support groups, and artificial intelligence chatbots.
Please do not discard your old card(s) as you will not receive new medical ID cards unless you are
newly enrolling or lost your card.
Health savings account (HSA) cards and dental benefit cards will be issued to new members only.
You can save more this year. HSA allowable contributions are going up! See the HSA section for
more info.
Got vision coverage? Your frame allowance just increased to $180 every 12 months.
Vision Service Plan (VSP) does not issue cards. Instead, you will need to provide the employee’s
social security number when receiving services.
See page 7 for instructions on how to enroll online through the IVisions Portal. Please contact your
benefits representative for more details.
KAIROS MEMBER WEBSITE
Check out the member page on the Kairos website for specific information regarding the
Kairos benefits offered by your employer. SVC.KAIROSHEALTHAZ.ORG
PLEASE REVIEW THIS
GUIDE CAREFULLY, AND
CONTACT YOUR BENEFITS
DEPARTMENT IF YOU HAVE
QUESTIONS.
This guide presents benefit options and costs for the period from July 1, 2020 through
June 30, 2021. It also outlines the steps you need to take to select and enroll in appropriate
benefits for you and your dependents.
PA G E 3 2020–2021 BENEFITS
WHO SHOULD YOU CALL?
Contact our plan providers directly if you have questions or would like more detailed information
about our plans. If you need further assistance regarding your benefits, contact your Benefit
Department.
PLAN PROVIDERS For Questions About... Phone Website
Eligibility; benefits
information; medical
Blue Cross Blue Shield 844-817-4116 www.azblue.com
plan claims and appeals;
precertification
BlueCare Anywhere Virtual physician visits 844-606-1612 www.bluecareanywhereaz.com
Prescription drugs
MaxorPlus Pharmacy Plan 800-687-0707 www.maxorplus.com
(retail and mail)
BASIC COBRA administration 800-372-3539 www.basiconline.com
EAP Preferred Employee assistance program 800-327-3517 www.eappreferred.com
Health Equity Health savings accounts 866-346-5800 www.healthequity.com
602-938-3131
Delta Dental Delta Dental plans www.deltadentalaz.com
800-352-6132
Total Dental Administrators Dental DHMO 888-422-1995 www.tdadental.com
VSP Vision 800-877-7195 www.vsp.com
Basic and supplemental life
and AD&D plans; voluntary
MetLife 877-638-7868 www.metlife.com
short-term disability;
worksite benefits
Hyatt Legal Prepaid legal coverage 800-821-6400 www.legalplans.com
United Pet Care Pet Insurance 602-266-5303 www.unitedpetcare.com/kairos
Nationwide Pet Insurance 877-738-7874 www.petinsurance.com
Kairos Health Arizona, Inc. Plan administration and
888-331-0222 www.svc.kairoshealthaz.org
(Kairos) member services
PA G E 4 2020–2021 BENEFITS
ARE YOU READY FOR THIS?
During the open enrollment period, it's important that you complete the following items:
CHOOSE YOUR PLAN
Select a medical program option and decide who you're going to cover. Your choices for
coverage are:
• employee;
• employee plus spouse;
• employee plus child(ren); or
• employee plus family.
MAKE A CONTRIBUTION TO YOURSELF
If you enroll in a high deductible health plan (HDHP), determine if you wish to contribute to
a health savings account (HSA). Refer to the health savings account section of this guide for
more information.
TAKE CARE OF YOUR LOVED ONES
Review and update beneficiary designations for life insurance benefits as needed.
ARE YOUR DEPENDENTS STILL ELIGIBLE?
Confirm that any dependents up to age 26 are still eligible to be enrolled.
CHOOSE YOUR VOLUNTARY PRODUCTS
If applicable, review and decide whether or not to elect any voluntary products, and submit
required information.
NOTE: Please refer to your Benefits Department for your
enrollment date.
Do not miss the enrollment period. It’s the one time each year
you can make changes (unless you have a qualifying event;
see p.6 for more information).
PA G E 5 2020–2021 BENEFITS
WHO'S ELIGIBLE FOR BENEFITS
• Full-time employees working at least 30 hours per week are eligible.
• Employees hired prior to 2009 working less than 30 hours per week may be eligible for benefits at a
cost subsidy commensurate with their full-time equivalent.
• Employees hired after 2009 must work a 30-hour contract (or greater) to be eligible for insurance benefits.
• Dependents of enrolled employees are eligible, including:
a. lawfully married spouse;
b. dependent children up to age 26, such as a natural child, stepchild, legally adopted child, child
placed for adoption, child for whom you have legal guardianship, and a child for whom health
coverage is required through a Qualified Medical Child Support Order; and
c. an unmarried child who is mentally or physically handicapped and dependent chiefly on the
enrolled employee for support and maintenance.
NOTE: Duplicative coverage is prohibited. A husband and wife who are both active district employees
may not enroll as both an employee and as a dependent spouse. This is duplicate coverage and is not
permitted. It is the employee's responsibility to make sure that they and their dependents do not have
duplicate district coverage, as duplicate benefits will not be paid.
WHEN CAN YOU MAKE A CHANGE?
Benefit plans are administered on a “policy year basis”—from July 1 through June 30 of the following year.
This means that elections you make during annual open enrollment are effective from July 1, 2020 through
June 30, 2021.
Because some of the benefits you elect are offered on a pre-tax basis, the Internal Revenue Service (IRS)
does not allow changes to these benefit elections outside of the annual open enrollment period, unless
you have a qualified mid-year “change in status event.” (See p. 6.)
Changes must be made within 31 days of the change in status event. If you don't make changes within this
timeframe, your next opportunity to make changes to your coverage will be during the subsequent open
enrollment period.
WHEN COVERAGE BEGINS
• New hires—Insurance elections are effective the first day of the month. Hire dates in the first half of the
month result in a benefits effective date of the first of the month immediately following the hire date.
Hire dates in the second half of the month result in a benefits effective date of the first of the month
following 30 days.
• Open enrollment—Insurance elections and changes are effective on July 1.
• Permissible mid-year changes—Insurance elections and coverage changes are effective on the first day
of the month following the event date or date of birth for a newborn IF required enrollments have been
completed and all required supporting documentation has been received by the Benefit Department.
• Short term disability—Elections made on or after the first day of a month will be effective the first of the
next month. This is for new hires only.
• For insurance coverage requiring an Statement of Health (SOH) form—The effective date may be
delayed according to SOH form completion, submission to the insurance carrier, and approval by the
insurance carrier.
PA G E 6 2020–2021 BENEFITS
WHAT EVENTS QUALIFY
Some common mid-year change in status events include:
• marriage, divorce, legal separation, or annulment;
• birth, adoption, placement for adoption, or legal guardianship of a child;
• the death of a dependent;
• a change in your spouse’s employment, or involuntary loss of health coverage under another
employer’s plan;
• a loss of coverage under the Medicare or Medicaid programs;
• loss of coverage due to the exhaustion of another employer’s COBRA benefits, provided you
were paying premiums on a timely basis; and
• cessation of your dependent child’s qualification as an eligible dependent.
NOTE: This list is not inclusive of all mid-year or special enrollment changes. For more information, please
visit the Kairos website or contact your Benefit Department.
HELPFUL TIPS:
Losing medical coverage through the Marketplace is not considered a qualified change in
status event with Scottsdale Unified School District, and you will not be allowed to join the plan
mid-year. However, you can drop your Scottsdale Unified School District medical coverage to
join a Marketplace plan mid-year. You will be required to provide proof of coverage within 31
days of your enrollment.
31
Expecting a baby?
Congratulations! If you
want medical coverage
for your child, please
remember to complete
the appropriate DAYS
documentation within 31 Dependent children up to age
days following the birth. 26 may be covered under a
Coverage for newborns parent’s plan, regardless of
is not automatic, so you student or marital status.
must notify your Benefit
Department within this Participants may not be double
time period and pay covered under any Kairos plan,
the full premium for the including Scottsdale Unified
month the child is added School District employer's plan
(if necessary). for any benefits.
PA G E 7 2020–2021 BENEFITS
ONLINE ENROLLMENT INSTRUCTIONS
Ivisions is your on-line enrollment tool.
The site is accessible via your single sign-on in the Ivisions portal.
Scottsdale Unified School District Benefits Department
NAME EMAIL TELEPHONE FAX
SUSD Benefits Department benefits@susd.org 480-484-6104 480-484-6268
Benefits Overview
All plan information and rates can be found in the idrive/Benefits Folder/2020-21 Open Enrollment
Information (Use SUSD Single Sign-On, then My Drives, then the "i" drive). If you receive a "Stoneware"
error you will need to right click on the document and hit download to read the document. You may also
view idrive on a work computer desktop by going to This PC.
TO ENROLL THROUGH THE IVISIONS BENEFITS PORTAL
1. Log on to Ivisions portal.
2. Click on Benefits, then “HR Benefits Enrollment.”
3. Read through the Welcome Screen instructions. Please note do not use the “Back” button on
your browser.
4. If you need to make changes to your address or phone number, you will do that in your Profile
under the self-service tab and not on the benefits enrollment portal.
5. To add/edit dependents or beneficiaries and/or update information, you will click the
magnifying glass to activate the screen. Save your edits by clicking “Update” when finished.
6. You will move through the screens with the “Next” or “Previous” button on the bottom of the
page; do not hit the back button on your browser.
7. To elect benefits click on the radio button to make your election. If you choose any
dependents, make
sure you scroll to the bottom to select the corresponding dependent.
8. You may waive out of any benefit by scrolling to the bottom of the screen and clicking the
“Waive” radio button.
9. When you come to the end of the portal, make sure you hit “Submit” to complete your
enrollment.
10. You may print your enrollment after you have submitted to keep a copy for your records.
PA G E 8 2020–2021 BENEFITS
YOU HAVE CHOICES!
Scottsdale Unified School District offers a flexible benefits program that lets you choose from
different medical plan option(s) using the Blue Cross Blue Shield of Arizona (BCBSAZ) network.
As you review the plan information, keep in mind the following key terms:
Amount of covered medical expenses you pay each fiscal year
PLAN YEAR DEDUCTIBLE (from July 1 to June 30) before the plan pays any benefits.
You can use any qualified provider you choose. However, in-
network providers have agreed to accept specific, contracted fee
IN-NETWORK VERSUS amounts as payment in full for services rendered. The plan also
places a lower limit on your out-of-pocket expenses when you stay
OUT-OF-NETWORK within the network.
SERVICES
When you use an out-of-network provider, your out-of-pocket
costs will likely be considerably higher.
A percentage of covered medical costs you pay once you meet
the deductible; the plan pays the balance. Example: You might be
required to pay 30% for a specific service, while the plan
COINSURANCE pays 70%.
There are different coinsurance requirements for in-network and
out-of-network services.
This is the maximum amount you and your family could be
OUT-OF-POCKET required to pay for services under your plan during the course of a
year. Once your deductible plus coinsurance reaches the out-of-
MAXIMUM pocket maximum for in-network services, the plan pays 100% of
your covered costs for the rest of the plan year.
With embedded deductible plans, each family member has an individual deductible. When an individual
family member reaches his or her deductible, the plan will begin to pay benefits for that individual,
regardless of whether the family deductible has been met. Once the family deductible is met, the plan
pays benefits for all.
With non-embedded plans, there are no individual deductibles. The total family deductible must be met
before the plan begins to pay benefits for any individual family member.
i TIP: To gain the best savings, use in-network providers.
(To find an in-network provider, visit azblue.com and click on Find a Doctor.)
PA G E 9 2020–2021 BENEFITS
BENEFITS TO KEEP YOU HEALTHY
PRESCRIPTION DRUGS
When you enroll for medical coverage, you automatically receive prescription drug coverage
through MaxorPlus. This benefit allows you to obtain prescriptions from any participating
pharmacy listed on the MaxorPlus pharmacy network.
If you choose an HDHP, you’ll need to meet the annual deductible before your benefit plan starts
paying its share, except for certain preventive medications and medical services not subject to
the deductible.
Important Tip!
Get the most from your pharmacy benefits and register now for myMaxorLink. Once you enroll
in myMaxorLink, you’ll automatically receive information on lower-cost prescriptions, reminders
specific to your own coverage, and other important health updates.
Sign up today at mymaxorlink.com/maxorplus or call 800-687-0707. You’ll be glad you did!
Make sure you hang onto your
all-in-one medical and prescription
ID card. Existing members will not
receive a new card in the mail.
Keep me!
To manage your plan benefits, log into the MaxorPlus Member Portal.
Once there, you can do things like:
View the plan formulary Locate the closest Order replacement
(a list of prescription medications network pharmacy medical/Rx ID cards
that may be covered under the plan)
PA G E 1 0 2020–2021 BENEFITS
BENEFITS TO KEEP YOU HEALTHY
PREVENTIVE BENEFITS BLUECARE ANYWHERE™
We want to keep you healthy. So, your plan TELEHEALTH
covers preventive care services for free when With BlueCare Anywhere, you can use your
you visit an in-network provider. computer or mobile device to conduct a live
Examples of preventive benefits include: virtual visit with a board-certified medical
professional—any day, anytime, anywhere.
Annual wellness Well child visits
visits You'll get fast help for non-emergency
Mammogram matters like:
Blood pressure screenings
tests Cold and flu Headache
Prostate
symptoms
Cancer screenings Pink eye
screenings Skin irritations
Annual flu shot Sinus infection
Cholesterol Sprains and
Colonoscopy Sore throat
screenings strains
screenings
Hearing exams (once every 10 Stomach bugs
years starting
Contraceptives
at age 50)
(generic) for
women
Log in to your BCBSAZ member portal or download
BlueCare Anywhere at the Apple App Store® or on Google Play.™
You can see a full list of preventive and telehealth services on the
AZBlue website: bit.ly/azblue-healthresources
Blue Cross, Blue Shield, and the Cross and Shield Symbols are registered service marks, and BlueCare Anywhere is a
service mark, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.PA G E 1 1 2020–2021 BENEFITS
TOTAL WELLBEING
Staying healthy is about more than just your annual checkups. That's why your plan offers programs
that focus on your total wellbeing.
Healthy Blue® is a set of wellness tools, The Kairos Employee Assistance Program
The Kairos Employee Assistance Program
resources, and services to help you and (EAP) offers 24-hour
(EAP) offers 24-houraccess
telephone to confidential
access to
your family live a healthier, more productive counseling services
confidential thatservices
counseling can help
that canwith a
help with a variety of everyday issues and
lifestyle. With Healthy Blue, you can measure variety of everyday
challenges. issues
Professional andarechallenges.
advisors available
to help you and your family with:
your progress and get the support you need Professional advisors are available to help
to stay focused on reaching your health goals. you and•yourstress, anxiety, and minor depression
family with:
management;
Healthy Blue programs include: • family and relationship matters;
tress,
S anxiety, and minor depression
Online wellness assessment tool management
• alcohol and substance abuse;
• personal, emotional, and work-related
24/7 Nurse On Call Family and relationship matters
difficulties;
• child and day care resources;
One-on-one health and lifestyle coaching Substance abuse
• financial information and resources;
by phone or email
Childcare and elder care resources
• legal information and resources;
Blue365®, a discount program for savings
egal• and
L financialservices;
will preparation information
and and
on products and services that keep you
resources
• elder care (most services).
healthy
Coverage includes up to six one-on-one
Will preparation services
ondition and care management for
C counseling sessions (per family member, per
issue, per year) at no cost to you. If applicable,
complex and unexpected events Coveragefor includes up12 to
first responders, six one-on-one
one-on-one counseling
sessions are included for a traumatic on-the-
counseling sessions
job event.
per family member, per
issue, per year at no cost to you.
Blue 365 and Healthy Blue are registered service marks
of the Blue Cross Blue Shield Association, an association
of independent Blue Cross and Blue Shield Plans.
TO SPEAK TO A PROFESSIONAL ADVISOR, CALL 1-
OR VISIT THE EAP WEBSITE USING THE USERNAM
ions? Questio
Website: www.eappreferred.com
Quest Username: kairos
Password: eappreferred
ns?
Call 1-877-MY-HBLUE Call 1-800-327-3517
(1-877-694-2583) or visit
or visit eappreferred.com
bit.ly/live-healthy-Kairos Username kairos
Password eappreferredPA G E 1 2 2020–2021 BENEFITS
PPO PLAN IN-NETWORK33
IN-NETWORK OUT-OF-NETWORK33
OUT-OF-NETWORK
BENEFIT OVERVIEW
$1,000/employee $2,000/employee
PLAN YEAR DEDUCTIBLE1
DEDUCTIBLE1
$2,000/employee +1 or more $4,000/employee +1 or more
$5,000/employee $10,000/employee
OUT-OF-POCKET MAXIMUM2
MAXIMUM2
$10,000/employee +1 or more $20,000/employee +1 or more
$40 copay primary care physician;
OFFICE VISIT Plan pays 25%, after deductible
$50 copay specialist
WELL ADULT CARE
Plan pays 100%, no deductible Plan pays 25%, no deductible
WELL CHILD CARE
TELEHEALTH Plan pays 100%, no deductible N/A
OUTPATIENT LAB AND X-RAY
Plan pays 70%, after deductible Plan pays 25%, after deductible
(INCLUDING MRI, PET, AND CT)
EMERGENCY ROOM3
ROOM3 $250, then plan pays 70% $250, then plan pays 70%
URGENT CARE $75 copay
INPATIENT HOSPITAL
Plan pays 70%, after deductible Plan pays 25%, after deductible
OUTPATIENT HOSPITAL
OUTPATIENT BEHAVIORAL VISIT $40 copay
RETAIL PRESCRIPTION DRUGS You pay:
After deductible is met • Generic: $10
(30-day supply)4 • Preferred: $35
• Non-preferred: $50
• Specialty: 20% (maximum of $60)
MAIL ORDER DRUGS You pay:
After deductible is met • Generic: $20 copay
(90-day supply)4 • Preferred: $70 copay
• Non-preferred: $120 copay
*This plan has an embedded individual deductible and an embedded out-of-pocket maximum. This means that although a deductible
and out-of-pocket maximum 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
maximum.
The deductible must be met before the plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.
1
2
The deductible applies toward the annual out-of-pocket maximum.
3
You pay one access fee per member, per day, per facility, plus in-network deductible and coinsurance. The fee is waived if you are
admitted to the hospital as an inpatient.
4
The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.
Disclaimer: Information may be subject to change.PA G E 1 3 2020–2021 BENEFITS
$1,500 HDHP
($3,000 FAMILY*) IN-NETWORK3 OUT-OF-NETWORK3
BENEFIT OVERVIEW
$1,500/employee $3,000/employee
PLAN YEAR DEDUCTIBLE1
$3,000/employee +1 or more $6,000/employee +1 or more
$3,000/employee $6,000/employee
OUT-OF-POCKET MAXIMUM2
$6,000/employee +1 or more $12,000/employee +1 or more
OFFICE VISIT Plan pays 70%, after deductible Plan pays 25%, after deductible
WELL ADULT CARE
Plan pays 100%, no deductible Plan pays 25%, after deductible
WELL CHILD CARE
TELEHEALTH N/A
EMERGENCY ROOM Plan pays 70%, after deductible
URGENT CARE
INPATIENT HOSPITAL
Plan pays 70%, after deductible
OUTPATIENT HOSPITAL
Plan pays 25%, after deductible
OUTPATIENT LAB AND X-RAY
(INCLUDING MRI, PET, AND CT)
OUTPATIENT BEHAVIORAL VISIT
RETAIL PRESCRIPTION DRUGS You pay:
After deductible is met • Generic: $10
(30-day supply)4
supply)4 • Preferred: $35
• Non-preferred: $60
• Specialty: 20% (maximum of $60)
MAIL ORDER DRUGS You pay:
After deductible is met • Generic: $20
(90-day supply)4
supply)4 • Preferred: $70
• Non-preferred: $120
*This plan has a non-embedded deductible and out-of-pocket maximum. This means that families enrolling in the plan will need to meet
the entire family deductible before the plan pays benefits for any member of the family (other than for preventive/wellness care).
1The deductible must be met before the HDHP plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.
2The deductible applies toward the annual out-of-pocket maximum on the HDHP plans.
3The 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.
4The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive
medications. For a detailed list of these medications, visit maxorplus.com.
Disclaimer: Information provided above may be subject to change.PA G E 1 4 2020–2021 BENEFITS
$2,800 HDHP
($5,000 FAMILY*) IN-NETWORK3 OUT-OF-NETWORK3
BENEFIT OVERVIEW
$2,800/employee $5,000/employee
PLAN YEAR DEDUCTIBLE1
$5,600/employee +1 or more $10,000/employee +1 or more
$5,000/employee $10,000/employee
OUT-OF-POCKET MAXIMUM2
$10,000/employee +1 or more $20,000/employee +1 or more
OFFICE VISIT Plan pays 70%, after deductible Plan pays 25%, after deductible
WELL ADULT CARE
Plan pays 100%, no deductible Plan pays 25%, after deductible
WELL CHILD CARE
TELEHEALTH Plan pays 70%, after deductible N/A
EMERGENCY ROOM Plan pays 70%, after deductible
URGENT CARE
INPATIENT HOSPITAL
Plan pays 70%, after deductible
OUTPATIENT HOSPITAL
Plan pays 25%, after deductible
OUTPATIENT LAB AND X-RAY
(INCLUDING MRI, PET, AND CT)
OUTPATIENT BEHAVIORAL VISIT
RETAIL PRESCRIPTION DRUGS You pay:
After deductible is met • Generic: $10
(30-day supply)4
supply)4 • Preferred: $35
• Non-preferred: $60
• Specialty: 20% (maximum of $60)
MAIL ORDER DRUGS You pay:
After deductible is met • Generic: $20
(90-day supply)4
supply)4 • Preferred: $70
• Non-preferred: $120
*This plan has an embedded deductible and out-of-pocket maximum. This means that although a deductible and out-of-pocket
maximum 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 maximum.
1
The deductible must be met before the HDHP plan pays benefits. All benefits are subject to the deductible, unless otherwise noted. The
family deductible must be met before claims are paid for any member of the family..
The deductible applies toward the annual out-of-pocket maximum on the HDHP plans.
2
3
The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate
toward one another.
The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive
4
medications. For a detailed list of these medications, visit maxorplus.com.
Disclaimer: Information may be subject to change.PA G E 1 5 2020–2021 BENEFITS
$5,000 HDHP IN-NETWORK3 OUT-OF-NETWORK3
BENEFIT OVERVIEW
$5,000/employee $10,000/employee
PLAN YEAR DEDUCTIBLE1
$10,000/employee +1 or more $20,000/employee +1 or more
$6,750/employee $13,500/employee
OUT-OF-POCKET MAXIMUM2
$13,500/employee +1 or more $27,000/employee +1 or more
OFFICE VISIT Plan pays 70%, after deductible Plan pays 25%, after deductible
WELL ADULT CARE
Plan pays 100%, no deductible Plan pays 25%, after deductible
WELL CHILD CARE
TELEHEALTH N/A
EMERGENCY ROOM Plan pays 70%, after deductible
URGENT CARE
INPATIENT HOSPITAL
Plan pays 70%, after deductible
OUTPATIENT HOSPITAL
Plan pays 25%, after deductible
OUTPATIENT LAB AND X-RAY
(INCLUDING MRI, PET, AND CT)
OUTPATIENT BEHAVIORAL VISIT
RETAIL PRESCRIPTION DRUGS You pay:
After deductible is met • Generic: $10
(30-day supply)4
supply)4 • Preferred: $35
• Non-preferred: $60
• Specialty: 20% (maximum of $60)
MAIL ORDER DRUGS You pay:
After deductible is met • Generic: $20
(90-day supply)4
supply)4 • Preferred: $70
• Non-preferred: $120
*This plan has an embedded individual deductible and an embedded out-of-pocket maximum. This means that
although a deductible and out-of-pocket maximum 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 maximum.
The deductible must be met before the HDHP plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.
1
2
The deductible applies toward the annual out-of-pocket maximum on the HDHP plans.
3
The 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.
4
You must meet the annual medical plan deductible before the HDHP plan pays a prescription drug benefit, with the exception of
certain preventive medications and medical services not subject to the deductible. For a detailed list of medications that are exempt
from this rule under the HDHP plans, visit maxorplus.com.
Disclaimer: Information may be subject to change.PA G E 1 6 2020–2021 BENEFITS
PLAN FEATURES PPO HDHP $1,500 HDHP $2,800 HDHP $5,000
In- Out-of- In- Out-of- In- Out-of- In- Out-of-
Network Network Network Network Network Network Network Network
ANNUAL DEDUCTIBLE
Individual $1,000 $2,000 $1,500 $3,000 $2,800 $5,000 $5,000 $10,000
Family $2,000 $4,000 $3,000 $6,000 $5,600 $10,000 $10,000 $20,000
OUT-OF-POCKET MAXIMUM (OOP)
Individual $5,000 $10,000 $3,000 $6,000 $5,000 $10,000 $6.750 $13,500
Family $10,000 $20,000 $6,000 $12,000 $10,000 $20,000 $13,500 $27,000
PREVENTIVE CARE
Well-child visits 100% 25% 100% 25% 100% 25% 100% 25%
Mammogram 100% 25% 100% 25% 100% 25% 100% 25%
DOCTOR AND SPECIALIST
Doctor Visit $40 25% 70%* 25%* 70%* 25%* 70%* 25%*
Specialist Visit $50 25% 70%* 25%* 70%* 25%* 70%* 0%*
URGENT & EMERGENCY CARE
Urgent Care Visit $75 25% 70%* 25%* 70%* 25%* 70%* 25%*
$250 $250
Emergency Room then then 70%* 70%* 70%* 70%* 70%* 70%*
70% 70%
Ambulance 70%* 70%* 70%* 25%* 70%* 25%* 70%* 25%*
HOSPITAL CARE
Outpatient Surgery 70%* 25%* 70%* 25%* 70%* 25%* 70%* 25%*
Lab and X-ray 70%* 25%* 70%* 25%* 70%* 25%* 70%* 25%*
Hospital Stay 70%* 25%* 70%* 25%* 70%* 25%* 70%* 25%*
Maternity Stay 70%* 25%* 70%* 25%* 70%* 25%* 70%* 25%*
ADDITIONAL SERVICES
Embedded Deductible
Yes Yes No No Yes Yes Yes Yes
& OOP Max
Combined Med &
No No Yes Yes Yes Yes Yes Yes
Pharmacy Deductible
OOP Max includes
Yes Yes Yes Yes Yes Yes Yes Yes
Deductible
PHARMACY
$100
Retail
Individual/$200 Must meet deductible before plan pays
(Up to a 31-day supply)
Family deductible
Generic $10* $10* $10* $10* $10* $10* $10* $10*
Preferred $35* $35* $35* $35* $35* $35* $35* $35*
Non-Preferred $60* $60* $60* $60* $60* $60* $60* $60*
max max max max max max max max
Specialty
$60 $60 $60 $60 $60 $60 $60 $60
MAIL ORDER
(up to a 90-day supply)
Not Not Not
Generic $20* $20* $20* $20* $20*
covered covered covered
Not Not Not
Preferred $70* $70* $70* $70* $70*
covered covered covered
Not Not Not
Non-Preferred $120* $120* $120* $120* $120*
covered covered covered
*After the deductiblePA G E 1 7 2020–2021 BENEFITS
HSA WHAT? SAVINGS!
If you enroll in a high deductible health plan,
you have the option of opening a health savings
account (HSA) with HealthEquity.
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; qualified rolls over every year and and your earnings grow tax-
medical expenses are is yours to keep, even if free. After age 65, you can
tax-free; and, funds grow you leave your employer. use the HSA like a traditional
with no tax liability. retirement account.
YOU'RE ELIGIBLE FOR A HSA IF:
You’re enrolled in a qualified high Y
ou aren’t enrolled in Medicare or another
deductible health plan (HDHP). non-qualified healthcare plan.
You are 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?
COVERAGE TYPE
2020–2021 MAXIMUM
CONTRIBUTION LIMIT HSA increases
INDIVIDUAL $3,550 for 2020
FAMILY $7,100 If enrolling in an HSA, you may need to complete
additional forms. If applicable, these will be provided
during your open enrollment meeting, and should also
AGE 55+ CATCH-UP CONTRIBUTION Additional $1,000
be available from your Benefits Department.
i Refer to IRS Publication 969 for complete HSA rules.
Learn how to maximize your HSA savings by visiting: www.healthequity.com/learn/hsa/
ions?
Quest Call 866-346-5800 or visit healthequity.comPA G E 1 8 2020–2021 BENEFITS
FLEX THOSE DOLLARS!
FLEXIBLE SPENDING ACCOUNTS
The Medical Expense Reimbursement Account and the
Dependent Care Account are flexible spending accounts (FSAs)
that can save you money on taxes by allowing you to pay for
certain expenses with pre-tax dollars.
IF YOU ENROLL IN AN HDHP PLAN WITH A HEALTH SAVINGS ACCOUNT, YOU ARE NOT
ELIGIBLE FOR A MEDICAL EXPENSE REIMBURSEMENT ACCOUNT, HOWEVER, YOU ARE
STILL ELIGIBLE TO ENROLL IN THE DEPENDENT CARE ACCOUNT.
HOW FLEXIBLE SPENDING ACCOUNTS WORK
• The Scottsdale Unified School District FSA plans are administered by BASIC.
• You decide how much you want to contribute on an annual basis into one or both of the FSAs.
• Your FSA contributions are deducted from your paychecks on a pre-tax basis, in equal amounts
each pay period.
• Your election stays in effect for the entire plan year (July 1 through June 30). You may not
increase, decrease, or cancel your contributions outside of the plan’s enrollment period, unless
you have a qualified life status change (see p. 6 for information about status changes).
• You use your FSA contributions to pay for eligible expenses under the Medical Expense
Reimbursement Account or Dependent Care Account. The IRS clearly defines eligible expenses,
and only those that comply with the Internal Revenue Code are eligible for reimbursement.
• You may not use the contributions you make to the Medical Expense Reimbursement Account to
reimburse yourself for eligible expenses under the Dependent Care Account, or vice versa.
ions?
Quest Call 800-372-3539 or visit basiconline.comPA G E 1 9 2020–2021 BENEFITS
USING YOUR MEDICAL REIMBURSEMENT ACCOUNT
In general, you can use the money in a Medical Expense Reimbursement Account to pay for
eligible healthcare expenses that are not: (1) covered by your or your spouse’s healthcare plans; or
(2) used as healthcare deductions on your income tax return. Depending on your employer’s plan
option, you may contribute up to $2,750 for 2020/2021.
You can use the plan’s Flex Convenience debit card to pay most eligible expenses through your
Medical Expense Reimbursement Account. Alternatively, you can submit your expenses for
reimbursement.
When you use your FSA debit card, you'll be required to substantiate your spending.
Documentation must include the following information: provider name, service provided, date of
service, and amount charged. Failure to substantiate your purchase within 30 days may result in
deactivation of your FSA debit card.
USING YOUR DEPENDENT CARE ACCOUNT
The Dependent Care Account lets you set aside pre-tax dollars to
help you pay the cost of care for your eligible dependents so that
you (and your spouse) can work outside your home. You may
contribute up to $5,000 annually. However, your contributions
may be limited by your tax-filing status, by your spouse’s
participation in a similar plan, by a spousal disability or status as a full-time student, or if you use
the federal dependent care tax credit. Consult your tax or financial advisor to determine how much
to contribute to the Dependent Care Account.
The Dependent Care Account is strictly monitored by the IRS, and only those expenses that
comply with the Internal Revenue Code are considered covered expenses. More information is
available through the IRS website at: www.irs.gov/pub/irs-pdf/p503.pdf.
FLEXIBLE SPENDING ACCOUNT: USE
IT OR LOSE IT
The IRS governs the administration of
flexible spending account plans. Once you
elect to set aside money in an FSA, you
must use it for eligible expenses during
the plan year. You should make every
effort to file your FSA claims as you incur
expenses. However, you have 90 days after
the plan year-end (June 30) to file claims
for reimbursement. After that point, you
forfeit, or lose, any unused funds. Because
of this IRS “use it or lose it” rule, you should
carefully estimate the amount you want to
contribute to your FSA(s) before making
your elections.PA G E 2 0 2020–2021 BENEFITS
io ns?
Quest
Delta’s dental plan allows you and your eligible dependents
Call 800-352-6132
to visit any dentist or specialist without a referral. The or visit
plan also travels with you anywhere in the country. All you deltadentalaz.com
have to do is log on to the Delta Dental website at
www.deltadentalaz.com to find an in-network provider, or
call 1-800-352-6132.
You must meet the plan year deductible before benefit coverage applies. The deductible is waived
for preventive services. However, these services apply toward your annual maximum benefit (see
the table below).
You can save money on out-of-pocket costs and maximize your annual benefit by making sure
to choose a PPO provider. Remember to always verify that your dentist is a PPO provider when
making an appointment.
DENTAL PLAN—CORE PLAN
PPO
BENEFIT COVERAGE
DENTIST/PREMIER
ANNUAL MAXIMUM BENEFIT $1,000
ANNUAL DEDUCTIBLE (individual/family) $50/$150
PREVENTIVE SERVICES
Exams, evaluations, or consultations
Full mouth/Panorex or vertical bitewings X-rays
Bitewing X-rays 100%
Periapical X-rays
Routine cleanings
Space maintainers
BASIC SERVICES 80%*
Fillings
Stainless steel crowns
Emergency treatment
MAJOR SERVICES
Endodontics: Root canal treatment
Periodontics: Treatment of gum disease
Prosthodontics: Bridges, partial dentures, complete dentures
Bridge and denture repair 50%*
Implants
Restorative: Crowns and onlays
Oral surgery: Simple extractions
Oral surgery: Surgical extractions
Deductible applies to these services.
*
Members may incur higher out-of-pocket costs when seeing a premier or out-of-network dentist.PA G E 2 1 2020–2021 BENEFITS
io ns?
Quest
Call 800-352-6132
or visit
deltadentalaz.com
DENTAL PLAN—PREMIER PLAN
PPO
BENEFIT COVERAGE
DENTIST/PREMIER
ANNUAL MAXIMUM BENEFIT $2,000
ANNUAL DEDUCTIBLE (individual/family) $50/$150
LIFETIME ORTHODONTIC MAXIMUM—Adult and Child
$1,500
(combination of in and out-of-network)
PREVENTIVE SERVICES (twice in a benefit year)
Exams
Routine cleanings
Flouride: For children to age 18 100%
Sealants: For children up to age 19
X-rays
Space maintainers
BASIC SERVICES
Fillings
Stainless steel crowns
Emergency treatment
90%*
Endodontics: Root canal treatment
Periodontics: Treatment of gum disease
Oral surgery: Simple extractions
Oral surgery: Surgical extractions
MAJOR SERVICES
Prosthodontics: Bridges, partial dentures, complete dentures
Bridge and denture repair 60%*
Implants
Restorative: Crowns and onlays
Orthodontic Services
50%
Benefit for adults and children age 8 or older.
Deductible applies to these services.
*
Members may incur higher out-of-pocket costs when seeing a premier or out-of-network dentist.PA G E 2 2 2020–2021 BENEFITS
io ns?
Quest
Call 888-422-1995
or visit
TDADental.com
SUMMIT CARE PLUS DHMO: TOTAL CARE PLAN
Total Dental Administrators (TDA) provides comprehensive dental care on a pre-determined 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.
WHAT SORT OF THINGS ARE COVERED?
reventive, diagnostic, and
P TMJ
restorative care
ndodontics, periodontics, and
E
Orthodontics for children and adults prosthodontics
Oral surgery
For a more detailed list of services, visit tdadental.com.
How Do I Use My Plan?
STEP 1 STEP 3
Access the TDA website prior to making an Make note of the Dental Office Code number
appointment. Select the general dental office listed to the right of the dental office. You’ll use
for yourself and your dependents. this code number to identify your selection when
enrolling for benefits or calling customer service.
STEP 2
Select the DHMO dental plan network and Contact TDA customer service at 1-888-422-1995 if
enter your search criteria. you need to change your provider mid-year.
You can also use the TDA website to:
Order an ID card
Search past claims
Review your benefitsPA G E 2 3 2020–2021 BENEFITS
io ns?
Quest
Call 800-877-7195
or visit
VSP.com
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.
At your appointment, tell the office staff that you have VSP.
You may visit any vision care provider, but know that benefits are provided at significantly higher
levels when you visit an in-network doctor.
i There’s no ID card necessary. If you’d like a card for reference, you can print one at vsp.com.
VISION DESCRIPTION COPAY` FREQUENCY
BENEFIT COVERAGE
Focuses on your eyes and overall $10 Every 12
WELL VISION EXAM wellness months
$25 See Frames
PRESCRIPTION GLASSES
& Lenses
$180 allowance for a wide selection Included in Every 12
of frames prescription months
$200 allowance for featured frame glasses
brands copay
FRAMES
20% savings on the amount over
your allowance
$100 Costco and Walmart frame
allowance
Single vision, lined bifocal, and Included in Every 12
lined trifocal lenses prescription months
LENSES
Polycarbonate lenses for glasses
dependent children copay
Standard progressive lenses Covered Every 12
Premium progressive lenses $95–$105 months
Custom progressive lenses $150–$175
LENS ENHANCEMENTS
Ultraviolet lenses Covered
Average savings of 20–25% on
other lens enhancements
$150 allowance for contacts; the Up to $60 Every 12
copay (fitting and evaluation exam) months
CONTACTS (INSTEAD OF GLASSES)
does not apply toward the cost of
contact lensesPA G E 2 4 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
metlife.com
BASIC LIFE INSURANCE
The district provides eligible employees with basic term life and accidental death and
dismemberment insurance coverage for each eligible employee who works a .75 or greater contract.
Employees hired prior to 2009 who work between .5 and .74 receive a prorated level, commensurate
with their contract. Eligible classified and certified employees are provided basic life coverage in the
amount of $50,000. Administrative employees are provided their annual salary plus $50,000 to a
maximum of $250,000.
After you reach age 65, the policy amount is reduced by 35%, and then reduced again at age 70
by 50%. An accelerated death benefit is also available in the event of your terminal illness.
You must designate a beneficiary at least 18 years of age for the basic life insurance benefit. To
update your beneficiary information, please contact your Benefit Department.
SUPPLEMENTAL LIFE INSURANCE
If eligible, you have the opportunity to purchase supplemental life insurance coverage for yourself
and your eligible spouse and dependent children. The covered employee must elect supplemental
life for him/herself to be eligible for supplemental dependent coverage. Note: The amount of
coverage, once elected, will not automatically reduce with age. However, your premium will
increase as you age.
SCOTTSDALE UNIFIED SCHOOL DISTRICT OFFERS THE FOLLOWING COVERAGE AMOUNTS:
EMPLOYEE $10,000–$500,000, not to exceed five times annual earnings
(NOTE: Initial member enrollment provides up to $150,000, and is guaranteed issue.)
SPOUSE $10,000–$250,000, not to exceed 100% of employee voluntary and basic & life
combined
(NOTE: Initial member enrollment provides up to $30,000, and is guaranteed issue.)
Spousal rates are based on age of employee.
CHILD (0–14 days) $1,000
CHILD $10,000
(15 days up to age 26)PA G E 2 5 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
metlife.com
SHORT-TERM DISABILITY INSURANCE
Voluntary short-term disability coverage 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.
Eligible employees can elect to purchase voluntary short-term disability coverage. The plan
provides benefits in the amounts of 40%, 50%, and 66 2/3% of your salary, up to a $1,154
weekly maximum benefit. Benefits are paid in the event you cannot work due to a covered non-
occupational sickness or injury, for up to 25 weeks of continuous disability. This plan covers
maternity the same as a sickness.
Benefits begin following the plan’s 7-day elimination period. Benefits are paid in addition to
accumulated sick leave and are paid even when school is not in session, if unable to work. Your
benefit will be offset by other sources as defined by MetLife group policies. These sources include,
but are not limited to, Social Security and state retirement systems. However, the minimum weekly
benefit amount payable under the voluntary short-term disability policy cannot be lower than a
$20 weekly benefit, regardless of the amount of income you receive from other sources. Income
received from salary continuation or accumulated sick leave plans will not be deducted from your
gross disability benefit.
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. In addition, to be eligible for coverage during pregnancy, your pregnancy
must occur on or after the benefit effective date (e.g., July 1, 2020 if you are enrolling during
open enrollment).
IMPORTANT:
If you receive a salary increase,
your short-term disability does not
increase automatically.
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.PA G E 2 6 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
legalplans.com
LEGAL SUPPORT SERVICES
MetLaw provides access to a national network of over 14,000 attorneys to help navigate important
life events, such as buying a home or creating a will. Through the program, you can participate in
telephone and office consultations with attorneys on a broad range of legal services.
The MetLaw advantage
• 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
LOW PLAN HIGH PLAN
(IN ADDITION TO LOW PLAN FEATURES)
Identity theft defense Personal bankruptcy
Tenant negotiations/foreclosures Tax audit representation
Powers of attorney, guardianship, Purchase or sale of a home/property
conservatorship, demand letters, school
hearings Revocable and irrevocable trusts
Disputes over consumer goods Civil litigation defense and pet liability
Defense of traffic tickets Juvenile court defense
Elder care law Adoption
For a full list of services, contact your Benefits Department.PA G E 2 7 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
metlife.com
HOSPITAL INDEMNITY
The hospital indemnity plan offers a cash benefit when an employee requires hospitalization and is
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.
MetLife Hospital Indemnity
BENEFIT TYPE Insurance Pays YOU
HOSPITAL COVERAGE (SICKNESS OR ACCIDENT)
ADMISSION $500 (non-ICU)
(Payable once per calendar year) $500 (ICU)
CONFINEMENT $200 a day (non-ICU) for up to 15 days
(Paid per sickness) $200 a day (ICU) for up to 15 days
OTHER BENEFITS
HEALTH SCREENING (WELLNESS) BENEFIT PROVIDED IF THE
COVERED INDIVIDUAL TAKES ONE OF THE COVERED SCREENING/
$50
PREVENTION TESTS
(Payable once per calendar year)
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
ICU Supplemental Admission $500
ICU Confinement for 2 Days $800 ($400 per day)
Hospital Confinement for 5 Days $1,000 ($200 per day)
In-Patient Rehab Unit $1,400
$4,200 TotalPA G E 2 8 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
metlife.com
CRITICAL ILLNESS
Critical illness insurance can provide financial protection to help lessen the burden of large out-of-
pocket costs for employees who suffer a critical illness.
CRITICAL ILLNESS INSURANCE
COVERED PERSON INITIAL BENEFIT REQUIREMENT
Coverage is guaranteed, provided the
EMPLOYEE $10,000, $20,000, or $30,000
employee is actively at work.*
Coverage is guaranteed, provided the
employee is actively at work and the spouse/
50% of the employee’s initial
SPOUSE/DOMESTIC PARTNER domestic partner is not subject to a medical
benefit
restriction as set forth on the enrollment
form and in the coverage certificate.
Coverage is guaranteed, provided the
employee is actively at work and the
50% of the employee’s initial
DEPENDENT CHILD(REN) dependent is not subject to a medical
benefit
restriction as set forth on the enrollment
form and in the coverage certificate.
OTHER BENEFITS
HEALTH SCREENING (WELLNESS) BENEFIT PROVIDED IF THE
COVERED INSURED TAKES ONE OF THE COVERED SCREENING/
$50
PREVENTION TESTS
(Payable once per calendar year)
*Coverage is guaranteed subject to terms and conditions, including pre-existing condition limitations.
HOW IT WORKS
John suffers a heart attack. Upon further examination, it is revealed that John also has a
blocked coronary artery and needs to undergo heart surgery. He is diagnosed a year later
with lung cancer. John had elected $10K in critical illness insurance, so he would receive:
COVERED EVENT BENEFIT AMOUNT
Heart Attack $10,000
CABG $10,000
Lung Cancer $10,000
The total benefit payout over the life of the policy would be $30K, which is the maximum
benefit (300% of elected amount).PA G E 2 9 2020–2021 BENEFITS
io ns?
Quest
Call or 877-638-7868
or visit
metlife.com
ACCIDENT INSURANCE
Accident insurance provides a financial cushion to absorb expenses like copays and deductibles.
Benefits are paid regardless of medical insurance coverage, and benefit dollars can be spent as
participants choose.
BENEFIT TYPE PLAN PAYS
INJURIES
FRACTURES AND DISLOCATIONS $100–$6,000
SECOND- & THIRD-DEGREE BURNS $100–$10,000
CONCUSSION $400
CUTS/LACERATIONS $50–$400
EYE INJURIES $300
MEDICAL SERVICES & TREATMENT
AMBULANCE $300–$1,000
EMERGENCY CARE $50–$100
NON-EMERGENCY CARE $50
PHYSICIAN FOLLOW-UP $75
THERAPY SERVICES (INCLUDING PHYSICAL THERAPY) $25
MEDICAL TESTING BENEFIT $200
MEDICAL APPLIANCES $100–$1,000
INPATIENT SURGERY $200–$2,000
HOSPITAL COVERAGE (ACCIDENT)
ADMISSION $1,000 (non-ICU)–$2,000 (ICU) per accident
$200 a day (non-ICU)—up to 31 days
CONFINEMENT
$400 a day (ICU)—up to 31 days
$200 a day, up to 15 days per accident, not to exceed
INPATIENT REHAB
30 days per calendar yearPA G E 3 0 2020–2021 BENEFITS
io ns?
Quest
Call 877-638-7868
or visit
metlife.com
ACCIDENT INSURANCE CONTINUED
BENEFIT TYPE PLAN PAYS
ACCIDENTAL DEATH
Employee receives 100% of amount shown, spouse $50,000
receives 50%, and children receive 20%. $150,000 for common carrier
DISMEMBERMENT, LOSS & PARALYSIS
$500–$50,000 per injury
OTHER BENEFITS
LODGING: Pays for lodging for companion up to 30 $200 per night, up to 30 nights; up to $6,000 in total
nights per calendar year lodging benefits available per calendar year
HEALTH SCREENING BENEFIT (wellness): Benefit $50, payable once per calendar year
provided if the covered insured takes one of the covered
screening/prevention tests
HOW IT WORKS
Kathy’s daughter, Molly, plays soccer. During a recent game, Molly collided with an opposing player,
was knocked unconscious, and was taken to the emergency room by ambulance. The ER doctor
diagnosed a concussion and a broken tooth. He also ordered a CT scan. After thorough evaluation,
Molly was released to her primary care physician for follow-up treatment, and her dentist repaired
her broken tooth with a crown.
COVERED EVENT1 BENEFIT AMOUNT
Ambulance (ground) $300
Emergency Room $100
Physical Follow-Up ($75 x 2) $150
Medical Testing $200
Concussion $400
Broken Tooth (repaired by crown) $200
Kathy would get a lump-sum payment totaling $1,350.
1
Covered services/treatments must be the result of a covered accident or sickness as defined in the group policy/certificate.PA G E 3 1 2020–2021 BENEFITS
io ns?
Quest
Call 877-738-7874
or visit
petinsurance.com
PET INSURANCE
Pet insurance pays, partly or in total, the cost of veterinary treatment for the employee’s ill or
injured pet. The My Pet Protection plans from Nationwide help you provide your pets with the best
care possible:
• 90% cash back: Use any vet and get 90% reimbursement on the bill.
• Open to all ages: No age limits or age-based premium increases.
• More than just accident & illness coverage: Spay/neuter, hereditary issues, Rx therapeutic diets,
dental care, and more.
• Exclusive: Available only for employees, not to the general public.
• Easy enrollment: Just a few simple questions to get coverage.
• Bigger savings: Save an average of 40% over similar plans from other pet insurers.
To enroll in this benefit, please visit:
petinsurance.com/kairoshealthaz
IMPORTANT:
This benefit is not payroll-deductible. You
will be responsible for paying the monthly
premium directly to the carrier.
PET INSURANCE—UNITED PET CARE
United Pet Care—United Pet Care offers a unique and affordable pet healthcare program that
saves you 20–50% at the veterinarian. All pets are eligible. Savings are immediate, with no claim
forms or deductibles. A selection of veterinary clinic is required at enrollment time.
You will enroll through the Ivisions benefits portal, and coverage is eligible for payroll deduction.
After you enroll through the portal, visit www.unitedpetcare.com/susd to register your pet.PA G E 3 2 2020–2021 BENEFITS
THIS OPEN ENROLLMENT GUIDE IS INTENDED ONLY AS A
BRIEF DESCRIPTION OF YOUR PLAN BENEFITS.
This guide attempts to describe important details and changes to the Scottsdale Unified School District
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. Scottsdale Unified School District retains the
right to change, modify, suspend, interpret, or cancel some or all of the benefits or services at any time.
MID-YEAR CHANGES TO YOUR HEALTH CARE BENEFIT ELECTIONS
IMPORTANT: After this open enrollment period enrollment within 60 days after the Medicaid or
is completed, generally you will not be permitted S-CHIP coverage ends.
to change your benefit elections or add/delete • become eligible for a premium assistance
dependents until next year’s open enrollment, unless program through Medicaid or S-CHIP. However,
you have a special enrollment event or a mid-year you must request enrollment within 60 days after
change in status event as outlined below: you (or your dependents) are determined to be
Special enrollment event: If you are declining eligible for such assistance.
enrollment for yourself or your dependents To request special enrollment or obtain more
(including your spouse) because of other health information, contact Scottsdale Unified School
insurance or group health plan coverage, you may District at 480-484-6104.
be able to enroll yourself and your dependents in
this plan if you or your dependents lose eligibility Mid-year change in status event: Because Scottsdale
for that other coverage (or if your employer stops Unified School District pre-taxes benefits, we are
contributing toward your or your dependents’ other required to follow Internal Revenue Service (IRS)
coverage). However, you must request enrollment regulations regarding whether and when benefits
within 31 days after your or your dependents’ can be changed in the middle of a plan year. The
other coverage ends (or after the employer stops following events may allow certain changes in
contributing toward the other coverage). benefits mid-year, if permitted by the IRS and your
employer’s respective Section 125 plan, which
In addition, if you have a new dependent as a provides final authority:
result of marriage, birth, adoption, or placement
for adoption, you may be able to enroll yourself • change in legal marital status (e.g., marriage,
and your dependents. However, you must request divorce/legal separation, death);
enrollment within 31 days after the marriage, birth, • coverage of the employee’s or spouse’s plan;
adoption, or placement for adoption. and
You and your dependents may also enroll in this plan • changes consistent with special enrollment rights
if you (or your dependents): and FMLA leaves.
• change in number or status of dependents (e.g., You must notify the plan in writing within 31 days of
birth, adoption, death); the mid-year change in status event by contacting
• change in employee’s/spouse’s/dependent’s Scottsdale Unified School District. The plan will
employment status, work schedule, or residence determine if your change request is permitted, and
that affects eligibility for benefits; if so, changes will become effective prospectively on
the first day of the month following the approved
• have a Qualified Medical Child Support Order change-in-status event (except for the case of
(QMCSO); newborn and adopted children, who are covered
• have a change in entitlement to or loss of retroactively to the date of birth, adoption, or
eligibility for Medicare or Medicaid; placement for adoption).
• experience certain changes in the cost Losing medical coverage through the Marketplace is
of coverage, composition of coverage, or not considered a qualified life event with Scottsdale
curtailment of coverage of the employee’s or Unified School District, and you will not be allowed
spouse’s plan; and to join the plan mid-year. However, you can drop
• have coverage through Medicaid or a State your Scottsdale Unified School District medical
Children’s Health Insurance Program (S-CHIP) coverage to join a Marketplace plan mid-year. You
and you (or your dependents) lose eligibility will be required to provide proof of coverage within
for that coverage. However, you must request 31 days of your enrollment.You can also read
