Gloucester County Public Schools 2020-2021 New Hire Benefits Guide

 
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
Gloucester County Public Schools
2020-2021 New Hire Benefits Guide
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
CONTENTS
Medical & Pharmacy Coverage                        4
Medical Plan Comparison                            5
Virtual Care                                       6
Mobile App                                         6
Health Savings Account                             7
Voluntary Benefits Program                         8
Voluntary Dental                                   9
Vision                                            10
Employee Contributions in 2020                    11
Employee Contributions in 2020 (cont.)            12
Flexible Spending Arrangements                    13
Flexible Spending Arrangements, continued         14
Disability Income Benefits                        15
Employee Assistance Program                       16
Contact Information                               17
Required Notices                                  18

2020 New Hire Benefits Guide                -2-
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
WELCOME TO YOUR BENEFITS!
Our 2020-2021 Benefits Guide will provide you with an overview of the comprehensive and rewarding benefits
package offered by Gloucester County Public Schools. We value your contributions, as an employee and our
competitive benefits are one way that we thank you for all that you bring to Gloucester County Public Schools. We
are proud to offer you a benefits program designed to protect the health and financial security of you and your
family.

Benefits Eligibility
If you are a full-time employee, working 30 or more hours per week, and
have completed 30 days of service, you are eligible to enroll in the benefits      WE ARE HERE TO HELP
described in this guide. Eligible dependents may enroll in medical, dental,
                                                                                   If you have any questions about
and vision coverage. Eligible dependents include:
                                                                                   the employee benefits described
      Your legal spouse                                                           herein or would like more
                                                                                   information, please refer to your
      Children up to age 26
                                                                                   plan documents and insurance
      Unmarried children over age 26 who are incapable of self-support
                                                                                   booklets or contact:
How to Enroll
                                                                                   Budget & Finance Department
    1. Evaluate plan options and make your benefit
        elections on Employee Navigator.                                           Lydia Gilbert (804) 693-7835
    2. Submit elections through website.                                           lydia.gilbert@gc.k12.va.us
        https://www.employeenavigator.com/Benefits/
        Login/Registration.aspx                                                    Laurie Greisz (804) 693-7817
    Click on the green “Log In” button on the top right                            Laurie.greisz@gc.k12.va.us
corner, then select “Register as a New User”.
Complete the fields noted on the next page, using the                              Heather Lucas (804) 693-7811
Company Identifier – GCP-S01. Then click “Next”.                                   Heather.lucas@gc.k12.va.us

Making Changes
Since your benefits paid via payroll deduction with pre-tax premiums, you can make a change during the year only if
you have a qualifying life event. The only exception to this rule is Open Enrollment. You must notify HR within 30
days of date of your qualifying event to make the change. If you do not make the change in the 30-day timeframe
consistent with the event, you will have to wait until the next annual open enrollment.

Examples of changes in status:
                                                                                If you (and/or your dependents)
      You get married or divorced
      You experience a loss of other group coverage                             have Medicare or will become
      You have a baby or adopt a child                                         eligible for Medicare in the next
      You or your spouse has a change in employment status                     12 months, a Federal law gives
      Your spouse dies                                                           you more choices about your
      You become eligible for or lose Medicaid coverage
                                                                                   prescription drug coverage.
                                                                                  Please see page 29 for more
                                                                                              details.

2020 New Hire Benefits Guide                                                                            -3-
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
MEDICAL & PHARMACY COVERAGE
                             Gloucester County School’s offers Cigna medical benefits. Benefits include
                             preventive care and prescription drug coverage. Under both plans, you have access
                             to Cigna’s national network. This is an overview of the benefits; refer to the medical
                             summary of benefits for complete details.

                             Plan Option 1

Key Terms                    Plan 25/30/1000 OAP Plus– This is an open access point of service plan that has a
                             $1,000 individual and $2,000 family plan year deductible. You are not required to
 A premium is the           pick a primary care physician and do not need referrals for specialist visits. In-
  amount you pay out of      network providers will charge flat copays for each of your visits, so costs are more
  your paycheck for          predictable for PCP and specialist visits.
  insurance coverage
 A deductible is the        Plan Option 2
  amount you pay before
  the plan contributes to    Choice Fund OAP HDHP w/ HSA – This is a high deductible health plan paired with
  the cost for services      a tax-advantaged health savings account (HSA). This option has the highest
 A copay is a fixed         deductible - $2,800 for individual and $5,600 for family; however, you can contribute
  amount you pay for         pre-tax funds to your HSA to help offset out-of-pocket costs. Gloucester County
  medical services or        Public Schools also contributes to your HSA. Employees will pay the lowest premium
  prescription drugs         for this option.
 Coinsurance is the
  percent of charges you
  pay after you reach the       Use the Employee Navigator comparison tool to
  deductible until you
  reach the plan’s out-of-
                                compare plan options based on your expected
  pocket maximum                             medical expenses
 The out-of-pocket
  maximum is the most
  you will pay during the
  plan year for health
  care expenses,
  including your                                                     Find a Network Doctor
  deductible, copays,
                                                                     Visit www.mycigna.com for a list of
  and coinsurance
                                                                     In-Network doctors near you

2020 New Hire Benefits Guide                                                                        -4-
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
MEDICAL PLAN COMPARISON

                                                                                   Choice Fund OAP HDHP with HSA
                                            Plan 25/30/1000 OAP Plus
                                                                                             (Embedded)
In Network Benefits                                  In Network                               In Network
 Accumulators (Calendar Year
                                                          PY                                           PY
 or Plan Year)
 Deductible (Ind/Fam)                             $1,000/$2,000                                $2,800/$5,600
                                                 $5,500/$11,000                                $4,000/$8,000
Out of Pocket Max (Ind/Fam)
                                        All covered services except vision           All covered services except vision
Embedded or Non Embedded                            Embedded                                     Embedded
Coinsurance                                            30%                                          0%
Office Visit - (PCP/Specialist)                     $25 / $50                                 0% after the ded
Virtual Visit                                       $25 copay                           $55 cost share, 0% after ded
Preventive Care                                 Covered at 100%                              Covered at 100%
Urgent Care                                         $50 copay                                 0% after the ded
Emergency Room                                  30% after the ded                             0% after the ded
Inpatient Hospital                              30% after the ded                             0% after the ded
Outpatient Surgery                              30% after the ded                             0% after the ded
                                       Included in OV copay; Independent
Labs/X-rays                                                                                    0% after the ded
                                                lab 30% after ded
Advanced Diagnostic Imaging                     30% after the ded                              0% after the ded
Chiropractic Care                         30% after ded. Up to 30 visits                       0% after the ded
Vision Exam – copay does not
apply towards the medical/RX out                      $15 copay                                    $15 copay
of pocket
Out of Network Benefits
Deductible (Ind/Fam)                       $2,000/4,000                                          $2,800/$5,600
Out of Pocket Max (Ind/Fam)                    50%                                                   20%
Coinsurance                               $7,750/$15,500                                        $5,000/$10,000
Prescription Drug Benefits
Deductible (Ind/Fam)                    $250/$500 tiers 2-4                             Subject to medical deductible
Retail 30-day (Tier 1/2/3/4)      $15/$50/$90/20% to $200 max/rx                      $10/$30/$50/20% to $200 max/rx
Mail Order 90-day (Tier 1/2/3/4) $38/$125/$225/20% to $200 max/rx                    $25/$75/$125/20% to $200 max/rx

Disclosure: The above is a summary of benefits only. If there are any discrepancies, the certificate of coverage will prevail.

2020 New Hire Benefits Guide                                                                                   -5-
VIRTUAL CARE
Cigna’s telemedicine benefit allows you to visit with local board-certified doctors online via video using your phone
or computer any time, from practically anywhere. Their national network is available 24/7, including holidays to
provide affordable quality care. Online physicians can diagnose, treat, and write prescriptions for routine medical
conditions. All you have to do is sign up online or download the free mobile app to get started.

            www.MDLIVEforCigna.com                                           www.AmwellforCigna.com

           Toll free number: 888-726-3171                                  Toll free number: 855-667-9722

MOBILE APP
Whether you are traveling across the country, across the state, or just away from home, Cigna’s Mobile app keeps
your health information within reach, wherever you go.

With the mobile app, you can:

      Find a Doctor
      Get your ID card
      Estimate your costs
      Manage Prescription benefits
      Access your health records

And more! Download the Mobile app today at www.cigna.com/individuals-families/member-resources/mobile-apps/!
It is available for iOS and Android devices!

Cigna Healthy Pregnancies, Healthy Babies

                    With the Cigna Healthy Pregnancies,
                    Healthy Babies Program you can work
                       with a maternity nurse in your 1st
                    trimester and post-partum and earn a
                   $150 gift card. Join in the 2nd trimester
                            and earn a $75 gift card.

2020 New Hire Benefits Guide                                                                           -6-
HEALTH SAVINGS ACCOUNT
If you enroll in the High Deductible Health Plan (Choice Fund OAP), you can also open a Health Savings Account
(HSA) to help pay for eligible medical expenses.

     What is an HSA?
       An HSA is a deposit account that you can use to pay for current and future qualified medical expenses – tax-
       free. Money in your HSA earns interest and you have the option to invest funds.
     Who is eligible to open an HSA?
       To open an HSA, you must enroll in the HDHP plan. You cannot be a dependent on another person’s tax
       return, be enrolled in Medicare if you’re over 65, or have received Veteran's Affairs benefits during the
       previous 3 months, except for preventative care. If you are a veteran with a disability rating from the VA, this
       exclusion does not apply.
     What is the tax benefit associated with an HSA?
       The money you contribute to your HSA is tax-deductible and is used for expenses for yourself and your
       dependents. You can maximize your tax savings by contributing up to the maximum annual amount allowed
       by the Internal Revenue Service (IRS). Your HSA balance plus investment earnings carry over from year to
       year – tax-free.
       Plus – your HSA funds are yours to keep – even if you switch health plans, change jobs, or retire.

       Gloucester County Public Schools will contribute $100 per month ($1,200 a year) to your
       HSA.

                   IRS HSA Contribution Maximum*
                                                                         2020             2021
                   Individual                                           $3,550           $3,600
                   Family                                              $7,100           $7,200
                                                                      Additional       Additional
                   Catch-up – 55 or older
                                                                       $1,000           $1,000
                   * Maximums include any employer contribution

     What are qualified medical expenses?
       The IRS maintains a list of all eligible medical expenses, common qualified expenses include:
              Acupuncture                                                      Doctor’s fees
              Ambulance services                                               Hearing aids
              Dental treatment                                                 Chiropractic Care
              Contact lenses                                                   COBRA premiums

        Effective 1/1/2020, the IRS now allows Over-the-Counter (OTC) medicines to be purchased with HSA
       funds without a prescription.

View the complete list of qualified expenses at https://www.irs.gov/publications/p502/index.html

HSA Bank is the administrator of our HSA Benefits. See their website at www.hsabank.com.

2020 New Hire Benefits Guide                                                                           -7-
VOLUNTARY BENEFITS PROGRAM
Gloucester County Public Schools knows that employees value the opportunity to customize their insurance
coverage that meets individual needs. Aflac is the carrier for these plans. Please refer to the plan summaries in
Employee Navigator for additional information.

Voluntary Program 1 – Group Accident Insurance
Accident Insurance can help protect you, your spouse or your children from the unexpected expense of an accident.
Some of the common reasons for claims (cash benefits paid directly to you!) under an Accident benefit include broken
bones, burns, and sports related injuries. Coverage is guarantee issue and includes portability with certain stipulations.

This plan will include a $50 Wellness Rider! If you receive a wellness exam or health screening, you can receive a $50
wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples include (but are
not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests.

Voluntary Program 2 – Group Hospital Indemnity Insurance
Hospital Indemnity Insurance provides cash benefits directly to you, unless otherwise assigned, that helps pay for medical
and non-medical costs associated with a covered hospital stay due to a covered sickness or accidental injury. Coverage
is available for employees, their spouses and dependent children. This is guarantee issue coverage and you can take this
plan with you if you were to leave Gloucester County Public Schools (with certain stipulations). There is no pregnancy
limitation and no pre-existing condition exclusions apply!

This benefit will include a $50 Health Screening Benefit! If you receive a wellness exam or health screening, you can
receive a $50 wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples
include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood
tests.

Voluntary Program 3 – Group Critical Illness Insurance
Critical Illness Insurance pays a lump sum benefit to you, unless otherwise assigned, upon diagnosis of one of the
covered critical illnesses in the plan. Examples of these are cancer, heart attack, stroke, paralysis, and major
organ failure. Coverage is also available for your spouse. Each dependent child is covered at 50 percent of the primary
insured’s benefit amount at no additional charge. Children-only coverage is not available. This coverage comes with
guaranteed issue amounts up to $30,000 for employees and $15,000 for spouses only at this initial enrollment. If you
waive this year and choose to enroll in the future, you will be subject to medical questions.

This benefit will include a $50 Health Screening Benefit! If you receive a wellness exam or health screening, you can
receive a $50 wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples
include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood
tests. This benefit is not paid for dependent children.

Accident, Critical Illness, and Hospital Indemnity Insurance are underwritten by Continental American Insurance Company
(CAIC), a proud member of the Aflac family. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or
the Virgin Islands. This is a brief description of coverage and is not a contract. Read your certificate carefully for exact
terms and conditions. These overviews are subject to the terms, conditions, and limitations of the Policy Forms
C70100VA, C21100VA, and C80100VA. AGC1802565 IV (7/18)

2020 New Hire Benefits Guide                                                                                -8-
VOLUNTARY DENTAL
Dental coverage is available through United Concordia. The plan allows you and your dependents to visit the in
network dentist of your choice. Preventive services are covered at 100% and other services are covered with
coinsurance. See an overview of the coverage below and view full details in your dental summary of benefits.

Dental Plan                              High Plan                                      Low Plan

Deductible                                $50/$150                                       $50/150
Preventive Services
Exams, cleanings, x-                  Covered at 100%                               Covered at 100%
rays
Basic Services
Fillings, simple                             20%                                           20%
extractions
Major Services
Oral surgery, root canal,                    50%                                            0%
crowns
                                           $2,000
Annual Maximum                                                                            $2,000
                                   (excludes orthodontics)

Waiting Periods                             None                                           None

Orthodontic Services
                                             50%                                       No Coverage
(Adults & Children)
Orthodontic Lifetime
                                     $2,000 (per Person)                                   N/A
Max
                            Covered at 100% (Class I/Preventative         Covered at 100% (Class I/Preventative
                                         Services)                                     Services)
Out of Network*
                                   20% (Basic Services)                           20% (Basic Services)
                                   50% (Major Services)                          100% (Major Services)
Coverage                                     Adults and Children to age 26 (end of birthday year)

*Out-of-Network providers can balance bill you the difference between what they charge and the carrier’s reasonable
and customary amount.
Included Plan Features:
                                                               • Covers 1 additional cleaning during pregnancy
                                                               • Covers 1 additional periodontal maintenance
Pregnancy Benefit                                              • Scaling and root planing
                                                               • 4 periodontal surgery procedures

                                                              • Covers 1 additional periodontal maintenance per
Smile for Health®--Wellness Provides periodontal care         year and all are covered at 100%
for people with certain chronic medical conditions:           • are covered at 100%
diabetes, heart disease, lupus, oral cancer, organ            • 4 periodontal surgery procedures are covered at
transplant, rheumatoid arthritis and stroke                   100% (scaling and root planning)

2020 New Hire Benefits Guide                                                                        -9-
VISION
Vision benefits are available through EyeMed. Our
vision plan covers eye exams and helps offset the                        Find an Eye Doctor
cost of corrective eyewear. An overview of the plan is
below; please see your summary of benefits for                           Visit www.eyemedvision.com for a list of
complete details.                                                        eye doctors near you

                                                                                 Out-of-Network Maximum
                                                    In-Network
                                                                                     Reimbursement
 Eye Exam Copay                                        $10                                     $40
 Contact Lenses Standard Fitting                     Up to $55                                 N/A
                                         $0 copay, $130 Allowance & 20%
 Frames                                                                                        $91
                                            off balance over allowance

 Lenses

   Single                                            $25 Copay                                 $30

   Bifocal                                           $25 Copay                                 $50

   Trifocal                                          $25 Copay                                 $70

   Progressive (Standard)                            $90 Copay                                 $50

 Contact Lenses

                                         $0 copay, $130 Allowance & 15%
   Conventional                                                                               $130
                                            off balance over allowance

   Medically Necessary                          $0 copay; Paid-in-full                     Up to $210

 Frequency                                                               12/12/12

2020 New Hire Benefits Guide                                                                         - 10 -
EMPLOYEE CONTRIBUTIONS IN 2020
Your premium for elected plans will be deducted pre-tax from each paycheck.

Medical Coverage

                                                     Plan 1
                                                                                   Plan 2*
                                              Cigna OAP 25/30/1000
                                                                              Choice Fund HDHP
                                                  15/50/90/20%
            Employee Only                            $73.21                          $55.00
            Employee & Child(ren)                    $125.16                         $105.00
            Employee & Spouse                        $379.33                         $335.11
            Employee & Family                        $426.11                         $362.15
            Employee & Family (both)**               $176.11                         $112.15

 *Employees enrolling in Choice Fund OAP HDHP will receive $100 monthly ($1,200 annually) into their individual
 HSA account.
**Rates based on Employee and Spouse both qualifying as benefit eligible employees of Gloucester County Public
Schools.

Dental Coverage

            Employee Monthly Premium
                                               High Plan                  Low Plan
            Employee Only                        $37.25                    $20.97
            Employee & 1 Dependent               $65.33                    $35.47
            Employee & Family                    $103.79                   $56.81

Vision Coverage
            Employee Monthly Premium
            Employee Only                   $6.02
            Employee & Children            $12.03
            Employee & Spouse              $11.43
            Employee & Family              $17.69
                                                                   Tips for Keeping Costs Down:
                                                                       Choose in-network providers
                                                                       Take advantage of preventive care services
                                                                       Request generic prescriptions
                                                                       Use Urgent Care providers instead of the
                                                                        Emergency Room
                                                                       Try telemedicine for non-emergent health
                                                                        consultations

2020 New Hire Benefits Guide                                                                      - 11 -
EMPLOYEE CONTRIBUTIONS IN 2020 (CONT.)

Aflac Group Accident Coverage                       Aflac Group Hospital Indemnity Coverage
 Employee Monthly Post Tax Premium                       Employee Monthly Post Tax Premium
                    Accident                                            Hospital Indemnity
 Employee Only                     $16.10                Employee Only                       $22.44
 Employee & Child(ren)             $33.58                Employee & Child(ren)               $34.54
 Employee & Spouse                 $26.11                Employee & Spouse                   $42.82
 Employee & Family                 $43.59                Employee & Family                   $54.92

Aflac Group Critical Illness Coverage (Uni-Tobacco Rates)
Employee Rates - Note if you have dependent children, they will automatically be covered for 50% of your benefit.

    Employee Monthly POST TAX Premium
                                 $10,000                            $20,000                    $30,000
           18 - 25                $5.60                              $9.68                     $13.76
           26 - 30                $7.27                             $13.02                     $18.78
           31 - 35                $8.51                             $15.50                     $22.49
           36 - 40                $11.03                            $20.53                     $30.04
           41 - 45                $13.18                            $24.83                     $36.49
           46 - 50                $15.63                            $29.75                     $43.86
           51 - 55                $24.12                            $46.72                     $69.32
           56 - 60                $23.78                            $46.03                     $68.29
           61 - 65                $48.18                            $94.84                     $141.49
            66+                   $84.28                            $167.05                    $249.81

    Spouse can elect up to 50% of the employee benefit.
                                     $5,000                       $10,000                     $15,000
            18-25                     $3.56                        $5.60                       $7.64
            26-30                     $4.40                        $7.27                      $10.15
            31-35                     $5.02                        $8.51                      $12.01
            36-40                     $6.27                       $11.03                      $15.78
            41-45                     $7.35                       $13.18                      $19.01
            46-50                     $8.58                       $15.63                      $22.69
            51-55                    $12.82                       $24.12                      $35.42
            56-60                    $12.65                       $23.78                      $34.91
            61-65                    $24.85                       $48.18                      $71.51
             66+                     $42.90                       $84.28                      $125.66

2020 New Hire Benefits Guide                                                                          - 12 -
FLEXIBLE SPENDING ARRANGEMENTS
FSAs provide you with an important tax advantage that can help you pay for out-of-pocket medical, dental, vision,
and dependent care expenses on a pre-tax basis.

Contributions to your FSA deduct from your paycheck before any taxes. You should contribute the amount of money
you expect to spend on eligible expenses for the year. Per IRS ruling you may rollover up to $500 in your Health and
Limited FSA. Effective 1/1/2020, the IRS now allows Over-the-Counter (OTC) medicines to be purchased with
health care and limited FSA funds without a prescription.

Health Care FSA
The HealthCare FSA is for eligible medical, dental and vision
                                                                   Health Care Tax Savings Example*
expenses. The maximum you can contribute to a health care          Prescription drugs                             $225
FSA for 2020 is $2,750. The full amount you elect is available
at the beginning of the plan year. Examples of qualified           Doctor co-pays                                 $80
expenses include:                                                  Orthodontia (braces)                          $1,500

  Prescriptions                 Dental care                      Suggested Plan Year Election                  $1,805
  Doctor visit co-pays          Copays & Coinsurance             Taxes (30%)                                   x 0.30
  Contact lenses                                                  Estimated Annual Savings                     $541.50

Limited FSA
The Limited FSA is for those employees enrolled in the High Deductible Health Plan (Choice Fund OAP
HDHP/HSA). This FSA can only be used for eligible dental and vision expenses. The maximum you can
contribute to a Limited FSA for the 2020 plan year is $2,750. The full amount you elect is available at the beginning
of the plan year.

Dependent Care FSA
                                                                     Dependent Care Tax Savings Example*
A Dependent Care FSA can be used to reimburse expenses
related to care of eligible dependents while you and your          Day care for child                           $3,500
spouse work (dependent children under the age of 13 by a           Summer child care                            $1,500
babysitter, day care or before/after-school care, disabled
spouse, parent or child (if individual lives with the covered      Suggested Plan Year Election                 $5,000
employee). The maximum you can contribute to the                   Taxes (30%)                                   x 0.30
dependent care FSA is $5,000 (or $2,500 if you are married
and filing separately). Funds are available only after they        Estimated Annual Savings                     $1,500
deduct from your paycheck. This benefit is not eligible for        *Tax savings examples are for illustrative purposes only
rollover.                                                          and not intended to reflect actual costs of care. 30% tax
                                                                   rate is for illustration only and may be differ from your
                                                                   rate.
 Effective 1/1/2020, the IRS now allows Over-the-Counter
(OTC) medicines to be purchased with FSA funds without a prescription.

                 Full List of Qualified Expenses
                 The IRS maintains a complete list of qualified medical and dependent care expenses eligible for
                 FSA reimbursement. See the list at: https://www.irs.gov/publications/p502/index.html

2020 New Hire Benefits Guide                                                                               - 13 -
FLEXIBLE SPENDING ARRANGEMENTS, CONTINUED

2020 New Hire Benefits Guide         - 14 -
DISABILITY INCOME BENEFITS
Gloucester County Public Schools is committed to providing a comprehensive benefits program. As part of your
benefits package, short-term disability coverage is provided to you at no cost. Long-term disability coverage is
available on a voluntary basis. Should you become unable to work due to a non-work related illness or injury,
disability coverage acts as income replacement to protect you and your family from serious financial hardship.

Short-Term Disability Coverage
Gloucester County Public Schools provides benefit eligible employees with short-term disability income benefits with
CIGNA. This is 100% employer paid. This program provides income protection for up to 24 weeks. Employees are
required to use all of their accumulated sick leave before becoming eligible for STD benefits. The elimination period
is the greater of the number of accumulated sick leave days or 15 days. Benefits are paid at 66-2/3% of regular
weekly compensation, up to $1,500 per week. Overtime, bonuses and any other form of extra pay are excluded
from the benefit calculation. The following exclusions apply: 1. Injury arising from employment; 2. Illness/Injury for
which employee is entitled to benefits under worker’s compensation; 3. Self-inflicted injury; 4. War or act of war; 5.
Injury from commission of a crime; 6. Disability while on active military duty; and 7. Disability which existed prior to
employment date. This plan will be available to members of the VRS Hybrid Plan only during the one year
waiting period for non-work related disability with the VRS

  Short Term Disability                                                 CIGNA
 Weekly Benefit Percentage                                             66.67%
 Weekly Maximum                                                        $1,500
 Benefits Begin for Accident                                          15th Day
 Benefits Begin for Sickness                                          15th Day
 Duration Maximum                                                     26 Weeks

Voluntary Long-Term Disability Coverage
Gloucester County Public Schools provides all full-time, benefit-eligible employees the option to enroll in long term
disability income benefits with CIGNA. The employee pays 100% of the cost for this coverage through payroll
deductions. Hybrid VRS employees are only eligible for Option 1 coverage during the first year of Hybrid VRS
membership with GCPS. This eligibility ends when the employee is eligible for non-work related disability
through VRS. Employees will not be able to enroll on the Employee Navigator site. A paper application will
be required for NEW enrollments.

     Long Term Disability                             Option 1                                 Option 2
 Monthl y Benefit
                                                         50%                                     60%
 Percentage
 Monthl y Benefit Maximum                              $6,000                                  $6,000
 Elimination Period                                   180 days                                180 days
 Benefit Duration                                      2 years                                 SSNRA
 Ow n Occupation Period                              24 months                               24 months
 Under 35                                               $0.02                                   $0.08
 35 - 39                                                $0.06                                   $0.12
 40 - 44                                                $0.07                                   $0.19
 45 - 49                                                $0.10                                   $0.30
 50 - 54                                                $0.13                                   $0.45
 55 +                                                   $0.18                                   $0.56

2020 New Hire Benefits Guide                                                                            - 15 -
EMPLOYEE ASSISTANCE PROGRAM
The Employee Assistance Program (EAP) offers confidential resources and referral services through Cigna. This
program no cost to you and provided by Gloucester County Public Schools.

The EAP assists you and your dependents on a variety of issues including:

        Relationship counseling
        Financial and legal counseling
        Mental health counseling including depression and anxiety
        Work/life balance resources
        Family assistance including help finding childcare or elder care

Employees can take advantage of this resource with the full confidence that all information discussed with Cigna is
kept confidential.

You can access services by calling the toll free number or log onto their website.

Toll free number:      1(877) 622-4327
Website:               www.cignabehavioral.com
Employer ID:           Gloucester

LEGAL RESOURCES
Legal Resources® provides 100% coverage for you,
your spouse, and qualified dependents for the most
often needed legal services, protecting you and your
family from the high cost of attorney fees. Whether your
legal matter is for an everyday legal need or a result of
an unexpected life event, you will have immediate and
ongoing access to a network of top-rated law firms in
your area.

You pay no attorney fees for all Fully Covered Services,
which include will preparation, traffic court, advice and
consultation, real estate matters, divorce, billing
disputes, and more. The Legal Resources Plan covers
the employee, spouse, and dependent children to age
19 or full-time students to age 23 with unlimited use of
all services for $18.00 per month.

2020 New Hire Benefits Guide                                                                         - 16 -
CONTACT INFORMATION
Most questions or issues you may encounter can be resolved through the insurance carrier customer service
(phone numbers are on the back of your ID cards) and websites. The websites are designed for you to have
access to your entire plan and claims information, including information for any of your enrolled dependents.
It is simple for you to register and login to each of the sites. These sites have terrific interactive and
informational tools for you to get most of your questions answered. The websites include the following
information:
         Claims Information – View expanded claims information and receive a report detailing your health
          care expenditures.
         Eligibility – See covered dependents under your plan and what benefits they are eligible for.

         ID Cards – Request ID cards for you and your covered family members.

         Provider Directory – Look up doctors and facilities to find participating providers.

         Forms – Download and print necessary forms.

           Benefit                     Provider                           Website                         Phone

 Medical and Pharmacy                     Cigna                      www.mycigna.com                  1-800-244-6224

 Dental                             United Concordia             www.unitedconcordia.com            1-800-972-4191 x 1

 Vision                                  EyeMed                      www.eyemed.com                   1-866-939-3633

 Flexible Spending
                             Flexible Benefit Administrators        www.flex-admin.com                1-800-437-3539
 Account
 Short-Term Disability
                                          Cigna                        www.cigna.com                  1-800-244-6224
 Long-Term Disability
 Employee Assistance
                                 Cigna Behavioral Health         www.cignabehavioral.com              1-877–622-4327
 Program
 Health Savings
                                       HSA Bank                      www.mycigna.com                  1-800-244-6224
 Accounts
 Group Accident, Critical
 Illness and Hospital                     Aflac                     www.aflacgroup.com                1-800-433-3036
 Indemnity
 Current Individual Aflac
                                          Aflac                        www.aflac.com                  1-800-992-3522
 Products

   The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by
   the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit
   information. While every effort was taken to accurately report your benefits, discrepancies or errors are always
   possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will
   prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If
   you have any questions about your Guide, contact Human Resources.

2020 New Hire Benefits Guide                                                                               - 17 -
REQUIRED NOTICES
WOMEN’S HEALTH AND CANCER RIGHTS ACT
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights
Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in
consultation with the attending physician and the patient, for:
        all stages of reconstruction of the breast on which the mastectomy was performed;
        surgery and reconstruction of the other breast to produce a symmetrical appearance;
        prostheses; and
        treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits
provided under this plan. Therefore, the Deductible and the Coinsurance applies.
If you would like more information on WHCRA benefits, call your Plan Administrator.

NEWBORNS’ AND MOTHERS HEALTH PROTECTION ACT ENROLLMENT NOTICE
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours
following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after
consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case,
plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a
length of stay not in excess of 48 hours (or 96 hours).

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE
PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have
a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your
children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy
individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or
CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov
to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-
sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan,
your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment”
opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have
questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA
(3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The
following list of states is current as of January 31, 2020. Contact your State for more information on eligibility –

2020 New Hire Benefits Guide                                                                                            - 18 -
ALABAMA – Medicaid                                          LOUISIANA – Medicaid
 Website: http://myalhipp.com/                               Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
 Phone: 1-855-692-5447                                       Phone: 1-888-695-2447
                        ALASKA – Medicaid                                             MAINE – Medicaid
 The AK Health Insurance Premium Payment Program             Website: http://www.maine.gov/dhhs/ofi/public-
 Website: http://myakhipp.com/                               assistance/index.html
 Phone: 1-866-251-4861                                       Phone: 1-800-442-6003
 Email: CustomerService@MyAKHIPP.com                         TTY: Maine relay 711
 Medicaid Eligibility:
 http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
                   ARKANSAS – Medicaid                                  MASSACHUSETTS – Medicaid and CHIP
 Website: http://myarhipp.com/                               Website: http://www.mass.gov/eohhs/gov/departments/masshealth/
 Phone: 1-855-MyARHIPP (855-692-7447)                        Phone: 1-800-862-4840
                   CALIFORNIA – Medicaid                                         MINNESOTA – Medicaid
 Website:                                                    Website:
 https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.as    https://mn.gov/dhs/people-we-serve/seniors/health-care/health-
 px                                                          care-programs/programs-and-services/other-insurance.jsp
 Phone: 1-800-541-5555                                       Phone: 1-800-657-3739
 COLORADO – Health First Colorado (Colorado’s Medicaid
                                                                                  MISSOURI – Medicaid
          Program) & Child Health Plan Plus (CHP+)
 Health First Colorado Website:                              Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
 https://www.healthfirstcolorado.com/                        Phone: 573-751-2005
 Health First Colorado Member Contact Center:
 1-800-221-3943/ State Relay 711
 CHP+: https://www.colorado.gov/pacific/hcpf/child-health-
 plan-plus
 CHP+ Customer Service: 1-800-359-1991/ State Relay 711
                      FLORIDA – Medicaid                                           MONTANA – Medicaid
 Website: http://flmedicaidtplrecovery.com/hipp/             Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
 Phone: 1-877-357-3268                                       Phone: 1-800-694-3084
                    GEORGIA – Medicaid                                           NEBRASKA – Medicaid
 Website: https://medicaid.georgia.gov/health- insurance-    Website: http://www.ACCESSNebraska.ne.gov
 premium-payment-program-hipp Phone: 678-564-1162 ext        Phone: (855) 632-7633
 2131                                                        Lincoln: (402) 473-7000
                                                             Omaha: (402) 595-1178
                       INDIANA – Medicaid                                          NEVADA – Medicaid
 Healthy Indiana Plan for low-income adults 19-64            Medicaid Website: http://dhcfp.nv.gov
 Website: http://www.in.gov/fssa/hip/                        Medicaid Phone: 1-800-992-0900
 Phone: 1-877-438-4479
 All other Medicaid
 Website: http://www.indianamedicaid.com
 Phone 1-800-403-0864
                         IOWA – Medicaid                                       NEW HAMPSHIRE – Medicaid
 Website: http://dhs.iowa.gov/hawk-i                         Website: https://www.dhhs.nh.gov/oii/hipp.htm
 Phone: 1-800-257-8563                                       Phone: 603-271-5218
                                                             Toll free number for the HIPP program: 1-800-852-
                                                             3345, ext 5218
                     KANSAS – Medicaid                                      NEW JERSEY – Medicaid and CHIP
 Website: http://www.kdheks.gov/hcf/                         Medicaid Website:
 Phone: 1-785-296-3512                                       http://www.state.nj.us/humanservices/
                                                             dmahs/clients/medicaid/
                                                             Medicaid Phone: 609-631-2392
                                                             CHIP Website: http://www.njfamilycare.org/index.html
                                                             CHIP Phone: 1-800-701-0710
                     KENTUCKY – Medicaid                                           NEW YORK – Medicaid
 Website: https://chfs.ky.gov                                Website: https://www.health.ny.gov/health_care/medicaid/
 Phone: 1-800-635-2570                                       Phone: 1-800-541-2831

2020 New Hire Benefits Guide                                                                                 - 19 -
NORTH CAROLINA – Medicaid                                                     TEXAS – Medicaid
  Website: https://dma.ncdhhs.gov/                                    Website: http://gethipptexas.com/
  Phone: 919-855-4100                                                 Phone: 1-800-440-0493

                   NORTH DAKOTA – Medicaid                                               UTAH – Medicaid and CHIP
  Website:                                                            Medicaid Website: https://medicaid.utah.gov/
  http://www.nd.gov/dhs/services/medicalserv/medicaid/                CHIP Website: http://health.utah.gov/chip
  Phone: 1-844-854-4825                                               Phone: 1-877-543-7669
                OKLAHOMA – Medicaid and CHIP                                                VERMONT– Medicaid
  Website: http://www.insureoklahoma.org                              Website: http://www.greenmountaincare.org/
  Phone: 1-888-365-3742                                               Phone: 1-800-250-8427
                  OREGON – Medicaid and CHIP                                             WASHINGTON – Medicaid
  Website: http://healthcare.oregon.gov/Pages/index.aspx               Website: https://www.hca.wa.gov/
  http://www.oregonhealthcare.gov/index-es.html                        Phone: 1-800-562-3022 ext.5473
  Phone: 1-800-699-9075
                   PENNSYLVANIA – Medicaid                                               WEST VIRGINIA – Medicaid
  Website:                                                            Website: http://mywvhipp.com/
  http://www.dhs.pa.gov/provider/medicalassistance/healthinsura       Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
  ncepremiumpaymenthippprogram/index.htm
  Phone: 1-800-692-7462
              RHODE ISLAND – Medicaid and CHIP                                        WISCONSIN – Medicaid and CHIP
  Website: http://www.eohhs.ri.gov/                                   Website:
  Phone: 855-697-4347, or 401-462-0311 (Direct Rite Share             https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
  Line)                                                               Phone: 1-800-362-3002
                  SOUTH CAROLINA – Medicaid                                                  WYOMING – Medicaid
  Website: https://www.scdhhs.gov                                     Website: https://health.wyo.gov/healthcarefin/medicaid/
  Phone: 1-888-549-0820                                               Phone: 307-777-7531

                   SOUTH DAKOTA - Medicaid
  Website: http://dss.sd.gov
  Phone: 1-888-828-0059
                                                      VIRGINIA – Medicaid and CHIP
  Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm
  Medicaid Phone: 1-800-432-5924
  CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
  CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since January 31, 2020, or for more information on special
enrollment rights, contact either:

         U.S. Department of Labor                       U.S. Department of Health and Human Services
         Employee Benefits Security Administration      Centers for Medicare & Medicaid Services
         www.dol.gov/agencies/ebsa                               www.cms.hhs.gov
         1-866-444-EBSA (3272)                                   1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes
that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays
a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a
currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be
subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid
OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent.
Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of
Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or
email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 12/31/2019)

2020 New Hire Benefits Guide                                                                                               - 20 -
IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS
Introduction
You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important
information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice
explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your
right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than
COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage
would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review
the Plan’s Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an
individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower
costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also
called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation
coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could
become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries
who elect COBRA continuation coverage are required to pay COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying
events:
         Your hours of employment are reduced, or
         Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the
following qualifying events:
          Your spouse dies;
          Your spouse’s hours of employment are reduced;
          Your spouse’s employment ends for any reason other than his or her gross misconduct;
          Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
          You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying
events:
       The parent-employee dies;
       The parent-employee’s hours of employment are reduced;
       The parent-employee’s employment ends for any reason other than his or her gross misconduct;
       The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
       The parents become divorced or legally separated; or
       The child stops being eligible for coverage under the Plan as a “dependent child.”

Sometimes, filing a proceeding in bankruptcy under Title 11 of the United States Code can be a qualifying event. If a proceeding in
bankruptcy is filed with respect to the Employer, and that bankruptcy results in the loss of coverage of any retired employee covered
under the plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and
dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the plan.

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a
qualifying event has occurred. The employer will notify the Plan Administrator of the following qualifying events:

        The end of employment or reduction of hours of employment;
        Death of the employee;
        Commencement of a proceeding in bankruptcy with respect to the employer for retirees, or
        The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

2020 New Hire Benefits Guide                                                                                            - 21 -
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for
coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must
provide this notice to: the plan administrator.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each
of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.
Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation
coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment
termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage,
may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan
Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA
continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of
COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent
children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is
properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting
COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or
both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension
is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had
the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the
Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage
options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than
COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial
enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of

        The month after your employment ends; or
        The month after group health plan coverage based on current employment ends.

If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty
and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in
Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if
Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account
of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA
continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.

For more information visit https://www.medicare.gov/medicare-and-you.

If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified
below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the
Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office
of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa.

2020 New Hire Benefits Guide                                                                                               - 22 -
(Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information
about the Marketplace, visit www.HealthCare.gov.

Keep your Plan Administrator informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should
also keep a copy, for your records, of any notices you send to the Plan Administrator.
Please contact the Plan Administrator for additional information.

HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Gloucester County Public Schools sponsors certain group health plan(s) (collectively, the “Plan” or “We”) to provide benefits to our
employees, their dependents and other participants. We provide this coverage through various relationships with third parties that
establish networks of providers, coordinate your care, and process claims for reimbursement for the services that you receive. This
Notice of Privacy Practices (the “Notice”) describes the legal obligations of Gloucester County Public Schools, the Plan and your legal
rights regarding your protected health information held by the Plan under HIPAA. Among other things, this Notice describes how your
protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other
purposes that are permitted or required by law.

We are required to provide this Notice to you pursuant to HIPAA. The HIPAA Privacy Rule protects only certain medical information
known as “protected health information.” Generally, protected health information is individually identifiable health information, including
demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health
plan, or your employer on behalf of a group health plan, which relates to:

    (1) your past, present or future physical or mental health or condition;
    (2) the provision of health care to you; or
    (3) the past, present or future payment for the provision of health care to you.

Note: If you are covered by one or more fully-insured group health plans offered by Gloucester County Public Schools, you will receive
a separate notice regarding the availability of a notice of privacy practices applicable to that coverage and how to obtain a copy of the
notice directly from the insurance carrier.

Contact Information

If you have any questions about this Notice or about our privacy practices, please contact the Gloucester County Public Schools HIPAA
Privacy Officer or:

                                                Gloucester County Public Schools
                                                Attention: HIPAA Privacy Officer
                           Contact:             Payroll
                           Address:             6099 T.C. Walker Road Gloucester, VA 23061
                           Phone Number:        804-693-7811
Effective Date
This Notice as revised is effective August 1, 2020.
Our Responsibilities
We are required by law to:

        maintain the privacy of your protected health information;
        provide you with certain rights with respect to your protected health information;
        provide you with a copy of this Notice of our legal duties and privacy practices with respect to your protected health
         information; and
        follow the terms of the Notice that is currently in effect.

We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we
maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised
Notice of Privacy Practices. You may also obtain a copy of the latest revised Notice by contacting our Privacy Officer at the contact

2020 New Hire Benefits Guide                                                                                             - 23 -
information provided above. Except as provided within this Notice, we may not disclose your protected health information without your
prior authorization.
How We May Use and Disclose Your Protected Health Information
Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The
following categories describe the different ways that we may use and disclose your protected health information. For each category of
uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose protected health information will fall within one of the categories.

For Treatment
We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose
medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who
are involved in taking care of you. For example, we might disclose information about your prior prescriptions to a pharmacist to
determine if a pending prescription is inappropriate or dangerous for you to use.

For Payment
We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the
treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan
coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is
experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share
your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected
health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to
coordinate benefit payments.

For Health Care Operations
We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to
run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement
activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss)
coverage; conducting or arranging for medical review, legal services, audit services, and fraud & abuse detection programs; business
planning and development such as cost management; and business management and general Plan administrative activities. The Plan
is prohibited from using or disclosing protected health information that is genetic information about an individual for underwriting
purposes.

To Business Associates
We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide
certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create,
maintain, use and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate
safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business
Associate to administer claims or to provide support services, such as utilization management, pharmacy benefit management or
subrogation, but only after the Business Associate enters into a Business Associate Agreement with us.

As Required by Law
We will disclose your protected health information when required to do so by federal, state or local law. For example, we may disclose
your protected health information when required by national security laws or public health disclosure laws.

To Avert a Serious Threat to Health or Safety
We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or
the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the
threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.

To Plan Sponsors
For the purpose of administering the Plan, we may disclose to certain employees of the Employer protected health information.
However, those employees will only use or disclose that information as necessary to perform Plan administration functions or as
otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for
employment purposes without your specific authorization.

2020 New Hire Benefits Guide                                                                                             - 24 -
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