2020 2021 Employee Benefits Guide - Newark City Schools
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2020 - 2021 Employee Benefits Guide
Welcome to your 2020-2021
Benefits Enrollment
What’s in the Guide?
Enrollment Process……………………….………..…….3
We are honored to present your 2020 Benefit
Login Instructions………………………………………….4
Options! The elections you make during en-
rollment will be effective through June 30, 2021 Medical……………………………………………………...5-6
unless you have a qualifying event (see below).
Health Savings Account…...…………………...….….7
Dental………………………………………………….……….8
Newark City Schools offers you and your eligible
family members a comprehensive and valuable Vision………………………………………………….…..……9
benefits package. We encourage you to take the
time to educate yourself about your options and Life Insurance………………………………...………..…10
choose the best coverage for you and your Voluntary Benefits………………………….……..11-12
family.
Flexible Spending Accounts…………...………13-14
Identity Theft Protection……..…………………..…15
Important Contacts…………...……………………....16
Annual Enrollment
Annual Enrollment is the time of year in which you may enroll, drop, or make changes to your benefits. The
benefit choices you make should be tailored to your personal needs. After the annual enrollment period ends,
you may not add, delete, or change the coverage you have selected for yourself and your dependents until the
next annual enrollment period, which is held every year in May for an effective date of July 1st. The only
exception is if you have a qualifying event. Qualifying events include but are not limited to:
• Marriage or Divorce • Your spouse has a change of employment or status
• Birth or adoption of a dependent child affecting benefits coverage
• Change in custody of a dependent child • Your change of employment status
• Death of a spouse or dependent child • You experience an involuntary loss of other group
Many of these Qualifying Events are also opportunities to reassess your Life Insurance needs and make
changes to the amount of coverage you have.
2
Enrollment Process
The benefits you elect during Annual Enrollment will be effective July 1, 2020.
Annual Enrollment is the one time per year that you can make changes to your benefits without a
qualifying life event.
Annual Enrollment will be held from Friday, May 8th - Sunday, May 17th
Full-time, benefit eligible employees must enroll or waive coverages during Annual Enrollment. Benefits will
not roll over this year. You must enroll via one of the available enrollment options in order to receive ben-
efits for the upcoming plan year.
Annual Enrollment is required to renew/enroll in the FSA and/or Health Savings Account. If you are currently
enrolled in either of these accounts now, your current election will not rollover.
Options to Enroll
Decide which of these two convenient enrollment options best fits your needs:
Self-Service - available May 8th - May 17th
Visit www.explainmybenefits.com/newark using any computer with internet access, click on
the red “Log into Your Benefit System” button and move through the enrollment system at
your own pace.
Login instructions are on page 4.
If choosing this option, be sure to click “Checkout” at the end of the process and make note
of your confirmation. If you do not receive a confirmation, you have not completed your
enrollment and you will not be enrolled for the new plan year.
Return to the system anytime to view your confirmation statement.
Call Center - available May 8th - May 17th
Call the Explain My Benefits Call Center at 800-505-8416
9:00am - 5:00pm EST; Monday - Friday during the enrollment period to speak with a benefit
counselor one-on-one regarding your benefits.
Reminders
We suggest you review the 2020-2021 Benefit Guide and plan summaries prior to going through any
enrollment process.
Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates
of Birth).
3
Login Instructions 4
Medical - PPO
Anthem Blue Cross Blue Shield is the medical provider this year for Newark City Schools. To find an in-network
provider go to www.anthem.com and search under the Blue Access PPO Network.
Comprehensive healthcare provides peace of mind. In case of an illness or injury, you and your family are
covered with an excellent medical plan through Newark City Schools.
The PPO plan allows you to select where you receive your medical services; however, if you use in-network
providers, your out-of-pocket costs will be less. Your Cost Share is:
Anthem Blue Cross Blue Shield (PPO) In Network Out of Network
Deductible
Individual $500 $1,000
Family $1,000 $2,000
Coinsurance 20% 40%
Out of Pocket Maximum
Individual $1,000 $2,000
Family $2,000 $4,000
Doctor’s Office
Office Visit (PCP/Specialist) $25 copay 40% after deductible
Preventive Care Services
(routine exams, x-rays/tests, immunizations, No Charge 40% after deductible
well baby care and mammograms)
Hospital Services
Emergency Room $250 copay $250 copay
Urgent Care Center Services $75 copay 40% after deductible
Inpatient 20% after deductible 40% after deductible
Outpatient Surgery 20% after deductible 40% after deductible
Ambulance Service 20% after deductible 20% after deductible
Other Services
Maternity Services 20% after deductible 40% after deductible
Diagnostic Lab/X-ray (outpatient) No Cost Share 40% after deductible
Diagnostic (MRI, CT Scans, Nuclear Medicine) 20% after deductible 40% after deductible
Prescriptions
Retail - 30 day or 90 day supply* $20 / $40 / $80 / $150** 50% - minimum $50
Direct Mail - 90 day supply $50 / $100 / $200 / $150** Not Covered
*Retail 90 day supply will charge three 30-day co-pays based on drug tier.
**Tier 4 Specialty Medications are limited to a 30 day supply.
Dependent coverage terminates at the end of the month in which the dependent turns 26.
5
Medical - High Deductible
Health Plan
Anthem Blue Cross Blue Shield High Deductible Health Plan uses the same Network and Prescription Drug
Formulary as the PPO Plan. This plan is designed to work with a tax-favored Health Savings Account that you
own and control how funds are contributed and withdrawn for medical expenses.
If you answer YES to any of the following questions, you are NOT eligible to open or fund a Health Savings
Account:
1. In 2020, will you be covered by another non-qualified medical plan such as a PPO, Medicare or Tricare?
2. In 2020, will you or a spouse participate in a General Purpose Flexible Spending Account?
3. In 2020, will you be enrolled in either Medicare Part A, Part B, Part C or Part D?
4. In 2020, if you are under age 26, will you be claimed as a dependent on your parents tax return, or
covered under your parents health insurance plan?
Anthem Blue Cross Blue Shield (HDHP) In Network Out of Network
Deductible
Individual $1,500 $3,000
Family $3,000 $6,000
Coinsurance 20% 40%
Out of Pocket Maximum
Individual $3,000 $6,000
Family $6,000 $12,000
Doctor’s Office
Office Visit (PCP/Specialist) 20% after deductible 40% after deductible
Preventive Care Services
(routine exams, x-rays/tests, immunizations, well No Charge 40% after deductible
baby care and mammograms)
Hospital Services
Emergency Room 20% after deductible 20% after deductible
Urgent Care Center Services 20% after deductible 40% after deductible
Inpatient 20% after deductible 40% after deductible
Outpatient Surgery 20% after deductible 40% after deductible
Ambulance Service 20% after deductible 20% after deductible
Other Services
Maternity Services 20% after deductible 40% after deductible
Diagnostic Lab/X-ray (outpatient) 20% after deductible 40% after deductible
Diagnostic (MRI, CT Scans, Nuclear Medicine) 20% after deductible 40% after deductible
Prescriptions
Retail - 30 day or 90 day supply (Specialty 30 day) 20% after deductible 40% after deductible
Direct Mail - 90 day supply 20% after deductible Not Covered
Dependent coverage terminates at the end of the month in which the dependent turns 26.
6
Health Savings Account (HSA)
with HDHP
What is an Health Savings Account?
A health savings account (HSA) is a tax-favored savings account that you own. Money in the savings account
helps pay your deductibles, coinsurance and out of pocket expenses. Once the deductible is met, the plan
starts to pay. Money left in the savings account carries over year over year, may earn interest, and is yours to
keep. You must be enrolled in a High Deductible Health Plan in order to open a Health Savings Account.
Health
Savings
Account
Plans
High-
Savings
Deductible
+ Account
Insurance
HSAs have many benefits:
• The money you put in your HSA account is pre-tax and tax deductible.
• You don’t pay taxes on withdrawals when paying for qualified medical expenses.
• YOUR HSA balance can be carried over year after year.
• You own the savings account and you decide when to use the funds in it to pay for qualified medical
expenses!
• Maximum plan year contributions: $3,550 Single and $7,100 Family*.
• A “Catch Up” contribution of an additional $1,000 can be made once per calendar year, when and after,
you turn age 55*.
• Myra will contact you, after open enrollment, to open your HSA account.
• Upon your Initial Enrollment ONLY into the High Deductible Health Plan (HDHP), Newark City Schools will
contribute to your Health Savings Account (HSA) $1,000 for Single enrollment or $2,000 for Family
enrollment. This will reduce the amount you are able to contribute to $2,550 for Single enrollment or
$5,100 for Family enrollment. If you are 55 or older, you will still be able to make the catch up
contribution of $1,000*.
* Per IRS Guidelines, all contributions (including Catch-up) must be pro-rated to the number of full months you are enrolled in
the High Deductible Health Plan. If you have questions about this please contact Myra Brandenburg.
7
Dental
Good oral care enhances overall physical health, appearance and
emotional well-being. Regular check-ups help eliminate common oral
health problems. Keep your teeth healthy and your smile bright with
the Newark City Schools dental benefit plan through Delta Dental.
Delta Dental PPO
Calendar Year Deductible
Individual / Family $25 / $50
Annual Maximum
Per Individual $2,500
Preventive Services
Exams, Cleanings, X-Rays Plan pays 100% Deductible is waived.
Non-Participating
Deductible Applies PPO Dentist Premier Dentist
Dentist
Basic Services
Fillings, Oral Surgery, Root Canals 80% Covered 80% Covered 80% Covered
Major Services
Crowns, Bridges, Dentures 50% Covered 50% Covered 50% Covered
Orthodontics
Orthodontia Lifetime Maximum
Per Individual $1,000
Adults & Eligible Dependents
Deductible does not apply to Orthodontic 50% Covered
services.
Go to www.deltadentaloh.com to locate a network PPO provider. Please note that your out-of-pocket costs
may be more if you choose to go to a non-participating provider.
Dependent coverage terminates at the end of the year in which the dependent turns 23 and your dependent, unmarried children to
the end of the year in which they turn 25 if a full-time student and eligible to be claimed by you as an IRS dependent.
8
Vision
Regular eye examinations cannot only determine your need for corrective vision but also may detect general
health problems in their earliest stages. An annual vision exam should be part of your overall health and well-
being routine Take advantage of an annual preventive eye exam with VSP by visiting a VSP Choice Network
provider.
Description In-Network Out-of-Network
Comprehensive Eye Exam
Once every 12 months $10 copay Up to $45 reimbursement
Eyeglass Lenses Once every 12 months
Single Vision, Lined Bifocal and Trifocal $25 copay Up to $30 - $65 reimbursement
Standard Progressive $55 copay Up to $50 reimbursement
Premium Progressive $95 - $105 copay Up to $50 reimbursement
Custom Progressive $150 - $175 copay Up to $50 reimbursement
Eyeglass Frames Once every 24 months
$150 allowance
$170 allowance feature frame brands Up to $70 reimbursement
20% off amount over allowance
Contact Lenses (in lieu of glasses) Once every 12 months
Conventional (Elective) $150 allowance
Up to $105 reimbursement
Contact lens exam Up to $60
Laser Vision Correction (LASIK) Discounts available from contracted facilities
To take advantage of your VSP vision benefit, simply contact a VSP provider and let them know you have VSP
coverage—they handle the paperwork for you. No need for an ID card.
Monthly Payroll Deductions
Employee Only Family
$8.96 $20.27
Unmarried dependent children are eligible for coverage. Dependent coverage terminates at the end of the month in which the
dependent turns 23 or to the end of the month in which they turn 25 if a full-time student.
9
Term Life Insurance
Basic Term Life and Accidental Death &
Dismemberment
Newark City Schools provides a basic life and accidental
death and dismemberment (AD&D) insurance coverage to
all benefit eligible employees - at no cost to you.
Voluntary Supplemental Life
You also have the opportunity to purchase supplemental
coverage for yourself and your dependents through The
Hartford. Please note that dependent children include
unmarried adopted, natural or stepchildren from live birth
to age 19 (26 if full-time student). You may elect life or ac-
cidental death independently of each other.
Employee: You may purchase in $10,000 increments up to
a maximum of $500,000
Spouse: You may purchase for your spouse up to 50% of
your elected amount in $5,000 increments up to a
maximum of $250,000
Child(ren): You may purchase for your child(ren) in $5,000
increments up to a maximum of $10,000
Guaranteed Issue
Employee - $200,000
Spouse - $50,000
Child(ren) - $10,000
Two married employees of NCS cannot cover each other as
dependents and only one of them may insure dependent
children.
Monthly Rate per $1,000 of Life and AD&D
Employee & Spouse Employee & Spouse Dependent Child
Age Band Life AD & D Age Band Life AD & D Life AD&DVoluntary Benefits
What are Voluntary Benefits?
Voluntary Benefits are offered to strengthen your overall
benefits package. You customize the benefit based on need
and affordability.
• Ownership – Policies are fully portable and belong to you
if you leave your employer, same price and same plan
• Benefits are payroll deducted
• Cash benefits are paid directly to you, not to a hospital or
to a doctor
• Benefits are paid regardless of any other coverage you
may have
• Level premiums—Rates do not increase with age
• Guaranteed Renewable
• Designed to provide additional cash flow to assist with out of pocket medical costs and other bills
The Voluntary Benefits offered through Trustmark are Accident, Critical Life Events and Universal Life.
Accident Plan
A plan that is designed to cover unexpected expenses that result from all kinds
of accidents, even sports-related and household ones!
• On and off the job coverage - 24 hours per day, 7 days a week
• Family coverage available
Just a few examples of benefit included in the plan:
• Emergency Room Visits - $200
• Hospitalization - $2,000 admission benefit, $400 per day benefit
• Fractures - up to $10,000
• Dislocations - up to $8,000
• Wellness Benefit - $100 per insured per year
• See brochure for a complete list of benefits
Monthly Payroll Deductions
Employee Employee
Employee Family*
& Spouse & Children*
$19.07 $29.08 $35.36 $45.37
*Dependents through age 26 can be covered regardless of student status.
11Voluntary Benefits
Critical Health Events
Critical Illness coverage focuses on cancer, stroke and heart attack, to help cover medical and non-medical
expenses. Pays partial benefits for early identification, full benefits for later-stage diagnosis. Early-diagnosis
benefit can provide funds to help prevent conditions from worsening. Replenishing benefit amount fully
restores each year with no lifetime maximum.
Guaranteed Issue for New Hires Only
$25,000 employee / $12,500 spouse / $2,500 children
Examples of covered conditions: Cerebral Vascular Disease (Stroke, TIA/RIND), Coronary Artery Disease (Heart
Attack, Obstruction, Initial Diagnosis), Cancer (Stage I, II, III, IV), Skin Cancers, Leukemia, Myelodysplastic
Syndrome, In-situ, Multiple Myeloma, Benign Tumors
A Healthy Living Benefit is included and pays $50 for each insured. Each covered person will get one routine
test and one follow-up diagnostic test, providing support for early detection and prevention.
Examples of Routine Screenings:
• Mammography • EKG/ECG • HPV Vaccination • CA 125 Blood Test
• Pap Smear • Colonoscopy • Prostate Specific Antigen • Skin Cancer Screening
Rates: This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week.
See brochure for more details. Your specific rate will be calculated for you in the electronic enrollment system.
Universal Life with Long Term Care
Universal Life with Long Term Care includes both a death benefit and a living benefit.
• Universal Life with Long Term Care is a permanent life insurance that is designed to match your needs
throughout your lifetime. It pays a higher death benefit during your working years when expenses are high
and you need maximum protection.
• The Universal Life with Long Term Care is priced to remain the same cost to you until age 100.
• The death benefit reduces at age 70 when the need for life insurance typically decreases.
• The Living Benefit, Long Term Care, never reduces and is 4% of the original death benefit per month for up
to 25 months.
• If you use the Long Term Care beneift, your death benefit amount does not reduce due to the Benefit
Restoration feature included.
• Coverage is availabe for spouse ($25,000) and children (child term rider).
• Employee must enroll in coverage in order to cover spouse and/or children.
• Available through age 64.
Guaranteed Issue: $100,000 (Employee Only)
Rates
This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your
specific rate will be calculated for you in the electronic enrollment system.
12Flexible Spending Accounts
Flexible Spending Accounts allow you to pay for certain medical, dental vision and dependent care expenses
with pre-tax dollars. You won’t pay taxes on the funds you put into your FSA because they are deducted on a
pre-tax basis.
There are 2 Medical FSAs and a Dependent Care FSA available and are administered by FlexBank.
General Purpose FSA Limited Purpose FSA Dependent Care FSA
Who is Eligible? Newark employees who Newark employees who are Newark employees with a
enroll in the PPO Plan, enrolled in the Newark qualifying dependent.
cannot have a Health medical HDHP Plan and
Savings Account or who who have an HSA.
waive coverage under both
medical plans.
Maximum Annual
$2,750 per employee $2,750 per employee $5,000 per family
Contribution
Sample of • Co-pays/Deductibles • Dental & Vision • Babysitters
Qualified Expenses • Prescriptions Expenses Only • Daycare Centers
• Dental Work • Dental Work • Elder Care
• Vision Exams • Vision Exams • Day Camps
• Eyeglasses • Eyeglasses • Preschool
• Lasik • Lasik • After-School Care
• Chiropractic Care • Contact Lenses &
• Contact Lenses & Supplies Eligible dependents are
Supplies children up to age 13
and/or elder dependents
(i.e. aging parents) that
live in your home. Also
covers a spouse or
dependent who is
physically or mentally
challenged and for whom
you claim an exemption.
13Flexible Spending Accounts
A Flexible Spending
Account saves you
money and it’s so
Easy.
The Benefits
As you now know, the money you set aside in your FSA is pre-
tax. When you don’t have to pay taxes, it’s like getting an
instant pay raise. The money is deposited into your FSA each
pay period through pre-tax payroll deduction. You then get to
Flex Bank Administrators make withdrawals for eligible expenses...tax-free!
1250 W. Dorothy Lane, Suite 107
Dayton, OH 45409 The Rules
Phone: 937.299.5515 No one likes rules. But, the rules are easy once you know
Fax: 937.299.7992 what they are.
Free Phone: 888.677.8373 1. Plan ahead because you can only elect once a year during
Free Fax: 888.677.9373 your FSA open enrollment period.
www.flexbank.net 2. Your elected amount, with few exceptions, can’t be
changed during the Plan year.
Mobile Site: flexbank.net/m 3. Any money left in your account at the end of the Plan year
cannot be returned to you...you have to use it or lose it.
The “Secret” of living with the rules.
You should only set aside money for eligible expenses that are
repetitive or predictable. These are expenses you know you
will be buying anyway. Your dates of service must be during
your employer’s Plan year, so make sure to budget carefully.
14Identity Theft Protection
Identity theft in the United States is a major problem
that continues to be on the rise. Professional
protection and assistance have become important
tools in fighting the identity theft epidemic.
Thieves today can get a hold of your personal
information from trash cans, dumpsters, stolen mail,
and even shoulder surfing. Once thieves have your
information, it’s a simple matter to open new
fraudulent accounts and make purchases in your
name.
When you enroll in LifeLock, you can be confident
knowing that they are available 24 hours a day, 7 days a week, and committed 100% to helping protect your
information as if it were their own.
LifeLock offers Proactive Protection:
• LifeLock Identity Theft Alert System • Lost Wallet Protection
• Address Change Verification • Black Market Website Surveillance
• Live Member Service Support • Live Member Service Support
• LifeLock Privacy Monitor • Reduced Pre-Approved Credit Card Offers
• Identity Restoration Support • Stolen Funds Replacement—up to $100,000
• Fictitious Identity Monitoring • Court Records Scanning
• Data Breach Notifications • Investment Account Activity Alerts
• Offered through payroll deduction at a 15%
discount off retail rates
$1 Million Total Service Guarantee
LifeLock’s proactive approach works to help stop identity theft before it happens. As a LifeLock member, if
you become a victim of identity theft because of a failure in their service, they will help fix it at their expense,
up to $1,000,000.
Monthly Payroll Deductions
Employee Employee & Spouse Employee & Children* Family*
$8.50 $16.98 $14.86 $23.36
*Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18
and 26.
15Important Contacts
Vendor Phone Website
Medical
833-505-0456 www.anthem.com
Anthem Blue Cross Blue Shield
Dental
800-524-0149 www.deltadentaloh.com
Delta Dental
Vision
800-877-7195 www.vsp.com
Vision Service Plan (VSP)
Voluntary Benefits
800-918-8877 www.trustmarksolutions.com
Trustmark
Life Insurance
800-523-2233 www.thehartford.com
The Hartford
Flexible Spending Accounts
888-677-8373 www.flexbank.net
FlexBank
Identity Theft Protection
800-543-3562 www.lifelock.com
LifeLock
District Insurance Brokers 614-761-2901
www.ajg.com
Gallagher Benefit Services 800-435-1552
Trustmark Claims Help
888-743-6937, Option 2 service@explainmybenefits.com
Explain My Benefits
16Benefit Guide Description This summary of benefits is not intended to be a complete description of Newark City Schools’ insurance benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the official document will prevail. For questions regarding the information provided in this overview, please contact your Newark City Schools human resources representative.
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