ATU and DCU Actives - Portland Public Schools
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D C U A c tives
ATU an d
B E N E F I T S
YOU R 20
N YEAR 20
PLA
700 NE Multnomah St., Suite 350 • Portland, OR 97232
1-844-203-0239 • sdtrust.com
R E TO HE LP
W E’R E H E
Trust Administrative Office Trust Prescription Kaiser Permanente
NORTHWEST ADMINISTRATORS Drug Plan Dental Plan
nwadmin.com ADMINISTERED BY CVS/CAREMARK kp.org/dental/nw
Access to personalized eligibility (through Dec. 31, 2019) Learn about your coverage, get
and enrollment information, Caremark.com treatment plan estimates and
secure messaging and more. Find a participating pharmacy, view claims.
Customer Service: use the mail order service and
844-203-0239 view claims. Customer Service:
503-238-6961 CVS/caremark® 800-813-2000
503-238-0205 (Fax) 800-552-8159
Mailing Address: ADMINISTERED BY Trust Life, AD&D and
700 NE Multnomah St., Suite 350
Portland, OR 97232 EXPRESS-SCRIPTS LTD Coverage
(beginning Jan. 1, 2020) ADMINISTERED BY THE STANDARD
Claims Appeals:
206-726-3347 Express-scripts.com Life and AD&D Customer
P.O. Box 12267 Find a participating pharmacy, Service:
Seattle, WA 98102 800-628-8600
use the mail order service and
PPS HR/BENEFITS view claims. LTD Customer Service:
800-368-1135
PPS-provided benefit information: Customer Service:
503-916-3544
800-282-2881 PPS Employee Assistance
PPS IT SERVICE DESK Program (EAP)
Forgot your PPS password?
503-916-3375
Trust Vision Plan ADMINISTERED BY RELIANT
ADMINISTERED BY VSP BEHAVIORAL HEALTH
itservicedesk@pps.net
vsp.com MyRBH.com and enter access
code OEBB
Kaiser Permanente Find a provider, view claims and
print an ID card. 866-750-1327 (toll-free),
kp.org
Choose a provider, email your Customer Service: 24 hours a day
doctor, make appointments and 800-877-7195
learn about your coverage. Health Reimbursement
Customer Service: Trust Dental Plan Arrangement (HRA)
503-813-2000 (Portland) ADMINISTERED BY REGENCE ADMINISTERED BY PACIFICSOURCE
800-813-2000 BLUECROSS BLUESHIELD OF OREGON Customer Service:
(through Dec. 31, 2019) 800-422-7038
Providence Personal Option regence.com psa.pacificsource.com/Flex
and Option Advantage Learn about your coverage, get
psacustomerservice@
treatment plan estimates and
Medical Plans view claims. pacificsource.com
providencehealthplan.com
Find an in-network provider, view Customer Service:
claims and learn about your 866-240-9580
coverage. ADMINISTERED BY DELTA DENTAL
Customer Service: OF OREGON
503-574-7500 (Portland) (beginning Jan. 1, 2020)
800-878-4445
deltadentalor.com
Learn about your coverage, get
treatment plan estimates, view
claims and print an ID card.
Customer Service:
888-217-2365
2 | ATU and DCU ACTIVES
ST
FIND IT FA
Your ID card has the
numbers, too.
Your key provider
phone numbers are
as close as the back of your
Plan ID card. You’ll get an ID
card when you enroll, and
your eligibility has been
verified by the Trust; after
that, you’ll get a new card
when you change Plans, and
add or remove dependents.
Keep your Medical and
Dental ID cards each year
(you can print a Vision Plan
card at vsp.com).
Get the apps.
Find everything you need to know to use your Most of the Trust’s
benefits wisely on the sdtrust.com website. Plan partners have an
app, giving you anytime/
anywhere access to your
On sdtrust.com, you can: personal health plan
• Choose your bargaining group and work status to get details information. You can view
for the benefit plans that are available to you. claims, see your ID card,
send and receive secure
• Get important contact information. messages, refill
prescriptions, see test
• Learn how to enroll or make a midyear change.
results, access wellness
• Find a form. tools … and more!
• Log in to your carrier’s website to find a doctor, check a
claim status or send a secure message.
• Get healthy ideas and benefit tips.
• And, much more!
PLAN YEAR 2020 | 3
T YO U R P L AN ABOU Your Trust. Benefits Since 1972. The School District No. 1 Health and Welfare Trust provides you and your family with the security of knowing that you have health insurance coverage you can count on—for help with everyday bumps along the road, from managing challenging health issues, to financial protection in the event of a catastrophic illness or accident. The security of having health coverage is a valuable benefit you receive as a Trust member. The Trust works with Portland Public Schools and your bargaining group to offer high-quality benefits that are low in cost to members and provide the option to cover their eligible dependents. For more than four decades, the Trust has provided group health and welfare benefits to active employees and retirees of the Portland Public Schools (PPS) who are members of the Portland Association of Teachers (PAT), Portland Federation of School Professionals (PFSP), District Council of Unions (DCU), and Amalgamated Transit Union (ATU) bargaining groups. 4 | ATU and DCU ACTIVES
R M S TO K NOW
TE
COPAY: The fixed dollar amount EXPLANATION OF BENEFITS
you pay each time you receive (EOB): For each medical claim, Explanation of
covered services. you’ll receive an EOB statement Benefits (EOB)
that shows how your claim was
COINSURANCE: The percentage THE EOB SHOWS YOU:
paid. Compare this to your
you pay for covered services after • The services provided
provider’s bill to see if you are
any applicable deductible. responsible for any amount. • The amount paid by
your insurance
COVERED AMOUNT: The maximum NETWORK: Participating providers, • The balance you owe
amount your Plan allows for a facilities, and suppliers your Plan
covered service. The percentage has contracted with to provide
the Plan pays is based on the health care services.
covered amount, not the billed GO TO THE
amount. The covered amount is OUT-OF-POCKET MAXIMUM: DOCTOR
equal to the discounted network When the amount you’ve paid in
rate charged by participating deductibles, copays and
providers, or the Usual, Customary coinsurance in a Plan Year reaches
and Reasonable (UCR) rate a certain limit, called the Out-of-
explained at right. Pocket Maximum, the Plan pays
100% of covered expenses for the
COVERED SERVICES: Medically rest of the year.
necessary health care services or DOCTOR
SENDS
course of treatment. See your Plan UCR (USUAL, CUSTOMARY, AND CHARGES
Booklet for details on services that REASONABLE) RATE: The TO BILLING
your Plan excludes or limits. maximum amount your Plan
allows for a covered service, based
DEDUCTIBLE: The annual amount on the prevailing rate in a
you pay for covered services geographic area. When applicable,
before the Plan pays benefits. Plan payment is based on this EOB IS
amount, instead of the covered SENT TO
YOU
amount.
PLAN YEAR 2020 | 5
L I G I B I L I T Y
E
Who’s Eligible for the
Jan. 1–Dec. 31, 2020 Plan Year Verifying your
dependent’s
You are, if: you are legally responsible to eligibility.
• You’re a member of the provide health coverage under a The Trust works with
Amalgamated Transit Union Qualified Medical Child Support an independent
Order (QMCSO) agency, Secova, to
(ATU) or District Council of
confidentially verify eligibility
Unions (DCU) bargaining units • Disabled children over age 26 if for each enrolled dependent.
• And, a regular, full-time employee unmarried, incapable of self- You’ll be asked to securely
of the District, as defined in the support, dependent on you for submit documentation (such
primary support, and the as a birth certificate,
current ATU/PPS or DCU/PPS
disability occurred before the age marriage certificate,
negotiated agreements, that
domestic partner affidavit,
requires contributions to the Trust of 26
etc.) to Secova, which will
You are full-time if you are Eligible dependents protect the privacy of your
regularly scheduled to work do not include: personal information.
30 hours or more per week. Please respond within the
• A spouse from whom you are
timeframe you’re allowed, to
You may also enroll legally separated or divorced
ensure your eligible
these eligible dependents dependents are enrolled in
• Anyone on active military duty
in the same Plan: coverage.
• Your legally married spouse or • Children over the age of 26 who
eligible domestic partner are not disabled
• Your children and your legal • Your grandchildren, nieces/ When a dependent’s
spouse’s or domestic partner’s nephews or other relatives who eligibility ends.
children, up to age 26: live with you (unless you have
You must notify the
court-appointed custody) Trust’s Administrative
• This includes natural children,
Office when a dependent is no
stepchildren, legally adopted
longer eligible. You may be
children, children for whom you
required to repay any benefits
are the legal guardian, foster paid after the dependent’s
children, and children for whom eligibility ends.
See a complete list of
qualifying events at
sdtrust.com.
6 | ATU and DCU ACTIVESG S TA RT E D
GETTIN
When you first Here’s how to enroll
become eligible
Enroll within 31 days after you’re 1 You must enroll online via PPS Peoplesoft Employee
Self-Service. (You can find a link to the 2-step
authentication process and set-up guide on sdtrust.com.)
notified that you’re eligible.
2
If you miss this deadline, your Go to selfservice.pps.net and log in using your PPS
next opportunity to enroll will be username and password.
during Open Enrollment, unless
you have a major life change
3 Click Benefits Enrollment.
When Open Enrollment
takes place
This is your annual opportunity to
4 Make or edit your selections and add or drop
dependents.
enroll for benefits, or change your
benefit options and add or drop
5 To decline Medical, Prescription, Dental, Vision, or
Optional Life and Voluntary AD&D coverage, click
Waive Medical Plan Coverage. (You must have proof
dependents if you’re already
of other Medical coverage.)
enrolled.
Open Enrollment typically takes
place in October for the next Plan 6 Verify your selections and click Submit to
complete your enrollment.
Year. If you do not make changes
during Open Enrollment, your cur-
rent benefit coverage automatically Here’s when benefits begin
Open Enrollment changes take
Don’t remember
continues in the next Plan Year.
your login
effect beginning January 1 of the
When you have a information?
new Plan Year.
major life change Initial enrollment and midyear
Contact the PPS IT
Qualifying events in your family Service Desk.
changes take effect depending on
(marriage, divorce, birth, adoption,
when you submit your enrollment:
disability, etc.) or changes in
• Enroll before the mid-month
employment status or other health
payroll cutoff date, and benefits
care coverage may allow you to
begin on the first day of the next
enroll dependents and/or make
month.
Plan changes midyear.
• Enroll after the mid-month payroll
You must enroll
cutoff date, and benefits begin the
dependents or make
changes online within 31 first day of the following month.
calendar days of the qualifying
event.
PLAN YEAR 2020 | 7R O P T I O N S
YOU
COMPARE
Full-Time Employees—Full Coverage including: Medical, Prescription,
Dental, Vision, Long-Term Disability, Basic Term-Life and Accidental Death
and Dismemberment (AD&D), Optional Term Life and Voluntary AD&D
MEDICAL/Rx/VISION Choose One of These Plans*
Providence Personal Providence Option
Plan Name Kaiser Permanente Plan
Option Plan Advantage Plan
Medical
The Plan pays 100% of most The Plan pays 100% for most The Plan pays 100% for most in-
covered services after you pay the covered services after you pay network covered charges after you
How the Plan Pays Benefits
copay copays and deductible pay copays and deductible, and
Copays and deductible waived for 60% of UCR for out-of-network
No out-of-network coverage No out-of-network coverage
commonly used in-network services covered charges
except emergency care and except emergency care.
urgent care when traveling.
Choose a Provider in these Choose a Provider in the You may choose any Provider, but
networks: Providence Network: your out-of-pocket costs will be
Provider Choices • Kaiser Permanente: kp.org ProvidenceHealthPlan.com lower when you choose a Provider
• The Portland Clinic: in the Providence Network:
theportlandclinic.com ProvidenceHealthPlan.com
Prescription Kaiser Permanente Trust Prescription Drug Plan
Use Kaiser Permanente Use CVS/caremark through Dec. 31, 2019;
Retail and Mail Order Available
pharmacies and mail order Express-Scripts beginning Jan. 1, 2020
Vision Kaiser Vision Plan Trust Vision Plan (Administered by VSP)
Provider Choice Use Kaiser Permanente Providers Use VSP Providers
Your Out-of-Pocket Costs
$100/individual $100/individual $100/individual
Annual Medical Deductible
$300/family $200/family $200/family
Annual Medical Out-of-Pocket $600/individual $1,200/individual $1,200/individual
Maximum $1,200/family $2,400/family $2,400/family
Annual Prescription Prescription expenses apply to the $2,200/individual $2,200/individual
Out-of-Pocket Maximum medical out-of-pocket maximum $4,400/family $4,400/family
INCOME SECURITY BENEFITS (Administered by The Standard)
Long-Term Disability (LTD) Insurance
Basic Coverage Self-pay coverage required for all employees
Term Life and Accidental Death and Dismemberment (AD&D) Insurance
Basic Coverage Included for all Plans
Optional Life and AD&D Coverage Available to purchase for all Plans
*You must enroll in a Dental Plan if you enroll in a Medical/Prescription Plan.
This is an overview of commonly used services. For additional Plan comparisons, go to sdtrust.com. Rates are
evaluated annually and are subject to change. If there is a conflict between this chart and the official Plan documents,
provisions of the official Plan documents will govern how the Plans work and how the Plans pay benefits.
8 | ATU and DCU ACTIVESDENTAL Choose One of These Dental Plans1
Plan Name Kaiser Permanente Dental* Trust Dental Plan**
Use any provider; save money with
Provider Choice Use Kaiser Permanente providers
an in-network provider
Dependent Dental Coverage Yes Yes
Your Costs
Annual Dental Plan Deductible None None
Maximum Annual Dental Benefit $2,500 $2,500
1
You must be enrolled in a Medical/Prescription Plan.
* Effective Jan. 1, 2020.
** Administered by Regence through Dec. 31, 2019; Delta Dental of Oregon effective Jan. 1, 2020.
MONTHLY CONTRIBUTION RATES
Providence Personal Providence Option
Plan Name Kaiser Permanente Plan
Option Plan Advantage Plan
Includes Dental (Kaiser or Trust Plan) and mandatory self-pay LTD of $19.30*
Full-Time Member Only $19.30 $19.30 $19.30
Full-Time Member + one
$32.30 $34.30 $36.30
dependent
Full-Time Member + Family $47.30 $57.30 $58.30
* Your mandatory, self-pay Long-Term Disability contribution of $19.30 will be taken out of your paycheck on a post-tax basis.
PLAN YEAR 2020 | 9R B E N E FI TS
O U
O ST F R O M Y
GET THE M
Understand coordination Get preventive care— Choose generics
of benefit rules at no cost to you Did you know that, by law,
If you have other coverage Preventive services are so generic drugs are just as
(i.e., through your spouse’s important to maintaining safe and effective as their brand-
employer) check with the other good health and detecting issues name counterparts? And, that the
plan before you enroll to early that your Plan pays 100% of average cost of a generic drug is
understand how the two plans will the covered amount. So, get that 80% less than the brand-name
coordinate your benefit coverage. annual checkup and those version? Whenever possible,
recommended screenings, tests choose generics!
Find an in-network and immunizations!
Urgent Care clinic Use the mail-order
For non-life-threatening but Some services require program for ongoing meds
urgent care or for care when prior authorization Skip the monthly trip to the
your doctor’s office is closed, find Your Plan requires a medical drugstore by using your
the nearest in-network Urgent Care review of certain procedures Plan’s mail-order option to buy
clinic to save time and money. (inpatient and outpatient surgery, prescriptions that you take every
for example) to help you make day. You save with a lower copay
In an emergency! informed decisions about your for a 90-day supply (compared to a
In a medical emergency,
medical care and use your benefits monthly drugstore refill) and enjoy
where a person’s life or
cost effectively. Your in-network the convenience of having your
body is in serious jeopardy, call
provider will obtain prior authori- medication delivered right to your
9-1-1 or go to the nearest
zation when required. If you use mailbox.
Emergency Department. Care will
an out-of-network provider, it is
be covered at your Plan’s in-
highly recommended that you get Request a treatment
network benefit level.
prior authorization from your Plan
estimate
If you have dental coverage
Try virtual care—from before you receive services,
and need care beyond basic
wherever you are whenever possible.
services, ask your dentist to submit
With virtual care, you can
Make sure your eligible a treatment plan so you can get a
connect with a doctor by
out-of-area dependents summary of what the Plan covers
phone or video visit from are covered and your estimated costs.
anywhere to get care for you and If you have eligible
your family. It could even save you dependents who are
time and money! temporarily out of the area, be sure
you take the necessary steps each
year to ensure that they are
enrolled in dependent out-of-area
coverage.
To learn more contact your Plan (see page 2).
10 | ATU and DCU ACTIVEST S O V E RV IEW
L BEN E F I
M E D I CA This is an overview of commonly used services. For medical benefit
details, go to sdtrust.com. If there is a conflict between this chart and
the official Plan documents, provisions of the official Plan documents
will govern how the Plans work and how the Plans pay benefits.
Kaiser Permanente Providence Personal Option Providence Option Advantage
You pay $10 copay ($0 for In-Network: You pay $10 copay, then Plan
Office Visits for primary or You pay $10 copay; then Plan pays
pediatric visits), then Plan pays pays 100%
specialty care 100%
100% Out-of-Network: You pay 40%, Plan pays 60%
Preventive Health Exams
In-Network: You pay $0, Plan pays 100%
and Well-Baby Care You pay $0; Plan pays 100% You pay $0; Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
(Frequency schedule applies)
In-Network: You pay $0, Plan pays 100%
Labs and X-rays You pay $0; Plan pays 100% You pay $0; Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
Pre- and post-natal: You pay Pre- and post-natal: You pay $0; Pre- and post-natal—In-Network: You pay $0,
$0; Plan pays 100% Plan pays 100% Plan pays 100% Out-of-Network: You pay 40%,
Plan pays 60%
Maternity Care Delivery and hospital services: Delivery and hospital services: You
The Plan pays 100% pay $100; then Plan pays 100% Delivery and hospital services—In-Network:
You pay $100, then Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
Acupuncture, chiropractic Acupuncture & Chiropractic: You Acupuncture & Chiropractic—In-Network: You
and naturopathy: You pay pay $15 copay, then Plan pays pay $25 copay, then Plan pays 100% up to $500/
$10 copay/visit; then the Plan 100% up to $1,500/year year Out-of-Network: Not covered
pays100%
Alternative Care Naturopathy: You pay $10 copay, Naturopathy—In-Network: You pay $10 copay,
Acupuncture, chiropractic, Massage therapy: You pay then Plan pays 100% then Plan pays 100% Out-of-Network: You pay
naturopathy and massage $25/visit; then the Plan pays 40%, Plan pays 60%
Massage therapy not covered.
therapy 100% up to 12 visits/calendar
Massage therapy not covered.
year
$1,500/year max benefit
combined for all alternative care
Telehealth / Virtual Visits In-Network: You pay $0, Plan pays 100%
You pay $0; Plan pays 100% You pay $0; Plan pays 100%
Phone and video consultations Out-of-Network: Not covered
In-Network: You pay $10 copay, then Plan
You pay $10 copay/visit; then You pay $10 copay/visit; then the
Urgent Care pays 100%
the Plan pays 100% Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
Emergency Care You pay $100 copay, then the Plan
You pay 10%; Plan pays 90% You pay $100 copay, then the Plan pays 100%
(Copay waived if admitted) pays 100%
In-Network: You pay $0, Plan pays 100%
Hospital (Inpatient) You pay 0%; Plan pays 100% You pay 0%; Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
In-Network: You pay $0, Plan pays 100%
Ambulatory Surgery Center You pay 0%; Plan pays 100% You pay $0; Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
In-Network: You pay $0, Plan pays 100%
Outpatient Surgery You pay 0%; Plan pays 100% You pay 0%; Plan pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
Inpatient: You pay 0%; Plan Inpatient: You pay $0 Plan pays Inpatient—In-Network: You pay $0, Plan pays
pays 100% 100% 100% Out-of-Network: You pay 40%, Plan
Mental Health / pays 60%
Outpatient: You pay $10 copay Outpatient: You pay $10 copay;
Substance Abuse ($0 for pediatric); then Plan then Plan pays 100% Outpatient—In-Network: You pay $10 copay,
pays 100% then Plan pays 100% Out-of-Network: You pay
40%, Plan pays 60%
In-Network: You pay $10 copay, then the Plan
Routine Hearing You pay $10 copay; then the You pay $10 copay; then the Plan
pays 100%
Exams/Tests Plan pays 100% pays 100%
Out-of-Network: You pay 40%, Plan pays 60%
Plan pays $500/ear every 3 In-Network: You pay $0, Plan pays 100%
Hearing Aids (Adult) You pay 0%; Plan pays 100%
years Out-of-Network: You pay 40%, Plan pays 60%
Out of Area Dependent
Limited services Full services; requires annual enrollment
Coverage
World-wide urgent/ emergency
care coverage
Coverage While Traveling World-wide urgent/emergency care coverage
Routine care available in other
KP service areas
PLAN YEAR 2020 | 11S O V E R V I EW
L BENEFI T
ADDITIONA
Prescription Drug Benefits Overview
Providence Personal Providence Option
Kaiser Permanente
Option Plan Trust Prescription Advantage Plan Trust
Prescription Drug Plan
Drug Plan Prescription Drug Plan
CVS/caremark through Dec. 31, CVS/caremark through Dec. 31,
In-network/Participating
Kaiser Permanente 2019; Express-Scripts beginning 2019; Express-Scripts beginning
Pharmacies
Jan. 1, 2020 Jan. 1, 2020
Plan pays 100% after your copay: Plan pays 100% after your copay: Plan pays 100% after your copay:
Participating Pharmacy Generic: $5/30 day supply Generic: $10/$20/$30 per Generic: $10/$20/$30 per
Benefits Brand name: $10/30 day supply 34/68/90-day supply 34/68/90-day supply
Brand name: $20/$40/$60 per Brand name: $20/$40/$60 per
34/68/90-day supply 34/68/90-day supply
Non-Participating Generally not covered You pay the full amount, then submit You pay the full amount, then submit
Pharmacy Benefits a claim for reimbursement a claim for reimbursement
Plan pays 100% after your copay: Plan pays 100% after your copay: Plan pays 100% after your copay:
Mail-order Service Benefits Generic: $10/90-day supply Generic: $20/90-day supply Generic: $20/90-day supply
Brand name: $20/90-day supply Brand name: $40/90-day supply Brand name: $40/90-day supply
Vision Benefits Overview
Providence Personal Providence Option
Kaiser Permanente Option Plan Advantage Plan
Trust Vision Plan administered by VSP
Every 12 months
You pay $10 copay per exam;
Well Vision Exam VSP Provider: 100%
then Plan pays 100%
Other Provider: Up to $70
Every 12 months
Contact Lens Exam
(Fitting and Evaluation) You pay $30 contact fitting fee VSP Provider: Not to exceed $60 per exam
Other Provider: Combined with contacts
Every 24 months
$250 credit every 24 months towards VSP Provider: Up to $150 allowance and 20% off amount
Frames
frames, lenses and contacts over allowance
Other Provider: Up to $70
Every 12 months
Lenses Included in $250 credit VSP Provider: 100% for most lens types
Other Provider: Up to $50-$125 for most lens types
Every 12 months
Contacts Instead of Glasses Included in $250 credit VSP Provider: Up to $150 for contacts
Other Provider: Up to $137 for fitting, evaluation and contacts
12 | ATU and DCU ACTIVESDental Benefits Overview
Kaiser Permanente Dental Trust Dental Plan*
Diagnostic and Preventive Care
Plan pays 100% of UCR Plan pays 100% of UCR
(exams, cleaning, X-rays)
Basic and Restorative Services
You pay 20%; Plan pays 80% of UCR You pay 20%; Plan pays 80% of UCR
(fillings, extractions, crowns, minor oral surgery)
Major Services (bridges, dentures) You pay 50%; Plan pays 50% of UCR You pay 50%; Plan pays 50% of UCR
Plan pays 50% up to $4,000 maximum lifetime Plan pays 50% up to $4,000 maximum lifetime
Orthodontia
benefit per person benefit per person
Maximum Annual Benefit $2,500 $2,500
* Administered by Regence through Dec. 31 2019; Delta Dental of Oregon beginning Jan. 1, 2020.
Term Life and Accidental Death & Dismemberment Benefits Overview
Life Insurance AD&D Insurance
Provided by The Trust Basic Term Life Basic AD&D
$30,000 per member Up to $30,000 per member
You may purchase coverage for yourself and Optional Life; Voluntary AD&D
eligible covered dependents. Employee and Spouse: $10,000 to $500,000 in Employee: $25,000 to $300,000 in $25,000
$10,000 increments not to exceed 5 times annual increments
You must purchase Optional Life and
salary Spouse: 50% of your selected coverage
Voluntary AD&D for yourself in order to buy
coverage for your dependents. Child(ren): $2,000 to $10,000 in $2,000 Child(ren) Only: 15% of your AD&D coverage
increments amount for each child up to $25,000
Coverage may be subject to medical
Spouse and Child(ren): 40% of your selected
underwriting approval. You can find the
coverage for your spouse and 10% of your
Enrollment Guide and a needs calculator
selected coverage (up to $25,000) per child
on sdtrust.com.
Administered by The Standard
Long Term Disability Overview
Coverage
All eligible, full-time employees are Plan pays 60% of your pre-disability earnings,
automatically enrolled for self-pay Long-Term up to $3,500/month, if you become disabled as
Disability benefits, without the option to a result of a covered injury, sickness or
decline, regardless of enrollment for healthcare pregnancy.
benefits.
Administered by The Standard
For details and rates, go to sdtrust.com. If there is a conflict between this chart and the official Plan documents, provisions of the
official Plan documents will govern how the Plans work and how the Plans pay benefits.
PLAN YEAR 2020 | 13INTENTIONALLY BLANK 14 | ATU and DCU ACTIVES
INTENTIONALLY BLANK
PLAN YEAR 2020 | 15’ S M O R E …
R E
AND THE
Valuable Discounts on health services and more
The Trust’s partners offer exclusive Providence Members:
member discounts on things like Get details at providencehealthplan.com
chiropractic care, acupuncture, Kaiser Permanente Members
massage therapy, hearing aids, (medical/prescription, vision and/or dental):
Get details at kp.org
vision services, fitness centers,
gym memberships, recreational VSP Members:
Get details at vsp.com/specialoffers
activities, wellness products and a
lot more. WEIGHT WATCHERS SUBSCRIPTION SUBSIDY: The Trust will subsidize a
subscription for you and your enrolled dependents to join Weight Watchers for up
to 12 months if you are enrolled in a Trust medical plan. Get details at sdtrust.com.
Benefits and resources through Portland Public Schools
You may be eligible for additional THE EMPLOYEE ASSISTANCE PROGRAM (EAP) is provided through Reliant
benefits like these through Behavioral Health to you and anyone living in your household at no cost to you.
For a complete list of services, go to MyRBH.com and enter access code OEBB, or
Portland Public Schools:
call 1-866-750-1327.
Get details at pps.net/Page/927 LEAVE OF ABSENCE: You can take time off work to care for your own or your
family’s medical needs, including time off to care for a new child, in keeping with
the Family Medical Leave Act (FMLA) and Oregon Family Leave Act (OFLA).
NOTE: You are not required to disclose your personal medical information except
as required by the FMLA or OFLA for leave approval purposes. Contact PPS HR/
Benefits for more information.
RETIREMENT RESOURCES: You may be eligible to participate in Oregon
Public Services Retirement Plan (PERS/OPSRP) or a 403(b) tax-deferred annuity
to help you save for retirement. For more information, call 1-888-320-7377.
CREDIT UNION MEMBERSHIP: You and your immediate family members may
join OnPoint Credit Union or Consolidated Federal Credit Union. Be sure to
mention that you are a PPS employee.
EMPLOYEE MILEAGE REIMBURSEMENT: If you regularly use your car for
on-the-job travel, you may be eligible for mileage reimbursement.
TRIMET TRANSIT PASS: You may be able to buy a monthly Hop Fastpass on a
pre-tax basis through your PPS paycheck.
ATU/DCU
Actives
16 | ATU and DCU ACTIVESYou can also read
