Complete YourAnnual Open Enrollment November 4 - 15, 2019 · Your legal spouse. Your children under...

Employee Benefits Guidefor USD 259 Employees

2020

All CURRENT BENEFITTED EMPLOYEES (including New Hires)

Complete Your Annual Open EnrollmentNovember 4 - 15, 2019

www.usd259.bswift.com

http://www.usd259.bswift.com/

What’s InsideIt’s important for you to understand how your benefits work. The information and tools in this brochure are intended to help you make the best benefit choices for you and your family.

Important Information

November 4 - 15, 2019

Annual Open Enrollment for your 2020 benefits will be

This guide is a summary of the employee benefits provided by Wichita Public Schools. If there is a discrepancy between the benefits illustrated in this guide and the official plan document, the plan document will always govern. Wichita Public Schools reserves the right to change or terminate these plans at any time. This guide is in no way an attempt to constitute a contract of employment. Responsibility for making your benefit elections is yours alone. No one at Wichita Public Schools is authorized to give you advice.

2020 Employee Benefits Guide 2


The 2020 benefit year is 01/01/2020 - 12/31/2020.

Current EmployeesOpen Enrollment is your once-a-year opportunity to enroll in or change your benefits coverage. Your benefit elections are some of the most important decisions you will make all year. Please take the time to understand your benefit options.

New HiresBenefit elections made during your New Hire Enrollment were for the current 2019 plan year. You will still need to complete the 2020 Open Enrollment between November 4th – November 15th to enroll in your benefits for the 2020 plan year.

If you have questions about your benefits after reading this guide and visiting the online benefits portal at www.usd259.bswift.complease contact Employee Benefits at 316-973-4581 or by email at [email protected].

Important Information ………………………..…2Dependent Coverage ………………………………4Dependent Verifications ………………………...4Medical Plan Benefits ………………………………5Teladoc …………………………………………………… 7Prescription Drug Benefits ……………………..8Medical Plans At A Glance …………………….. 9Medical Plan Premiums …………………………. 10Wellness Discount …………………………………. 12Additional Employee Paid Premiums ……..13Cash Option …………………………………………….13Vision Benefits ………………………………………..14Dental Plans At A Glance ……………………... 16Flexible Spending Accounts ……………………17Life Insurance ………………………………………… 18KPERS Retirement Benefits ………………….. 19Voluntary Retirement Plans ………………….. 20Additional WPS Benefits ………………………… 22Employee Assistance Program ……………...23bSwift Online Enrollment Portal ………..…. 24How to Login ……………………………………….... 24Forgot Password ……………………………………. 24How to Enroll ………………………………………... 25Benefit Confirmation Statements …………. 29After You Enroll – ID Cards …………….……. 29Wellness Verifications …………………….…….. 30Uploading Documents ……………………….……30Benefit Changes During the Year …………. 31Life Events ……………………………………….……. 31Useful Contacts ……………………………………… 32Glossary of Medical Terms ……………………. 33

Enrollment ElectionsEmployees are able to enroll in medical, dental and visioncoverage separately. An employee can be enrolled in medical only, dental only, vision only, or enroll in all three.

Tiered Monthly PremiumsThere are four coverage levels available with each plan:• Employee only• Employee + spouse• Employee + child(ren) same cost for one child or multiple children• Family coverage this would include spouse and child(ren)


You will now have the option to enroll in the free Base Vision Plan or the voluntary Buy Up Vision Plan when completing your annual enrollment.

The free annual eye exam is no longer part of your medical plan enrollment. You must enroll in one of the two vision plans to have your annual eye exam covered.

Your vision provider must participate in the EyeMed “Insight” Network to be considered an in-network provider.

You can learn more about the two vision plans offered on pages 14-15 of this brochure.

Dependent Coverage Who Can I Cover?You may elect employee only coverage or you may elect to cover your eligible dependents under the district’s medical, dental or vision plans.

Eligible dependents include the following: Your legal spouse.

Your children under age 26 by birth, adoption, or legal guardianship, including eligible children of your spouse.

Your disabled child(ren) age 26 and over, including eligible disabled child(ren) of your spouse upon approval by Meritain.

Children up to age 26 can stay on the USD 259 health plan, regardless of student or marital status.

You can add or drop dependents during your enrollment period or within 31 days of a qualifying life event. (See page 28 – Benefit Changes During the Year)

Dependent Verification RequirementsDependent eligibility documentation is required for any new dependents added to the medical, dental or visionplans. This information must be submitted within 31 days of your hire date or qualifying life event date.

Copies of social security cards are required for all dependents. Individual Taxpayer Identification Numbers (ITIN) will be accepted.

You will be able to upload your documents during online enrollment by clicking on “profile” then “employee file.”(See page 27 – Uploading Documents)

Dependent Being Added Document(s) Needed

Spouse Copy of Legal Marriage Certificate or notarizedcommon law affidavit and copy of Social Security Card

Dependent (0–26 yrs.) Copy of Birth Certificate (with parental information), orhospital birth confirmation letter and copy of SocialSecurity Card

Adopted Children Legal adoption or placement for adoption paperworkand a copy of Social Security Card

Legal Guardianship(Court Appointed)

Legal guardianship paperwork and copy of SocialSecurity CardNewborn Coverage

You must go online to www.usd259.bswift.com to enroll your newborn as a dependent onto your medical plan within 31 days of birth and provide dependent verification documents. (See page 28 – Benefit Changes During the Year)

Failure to enroll your newborn within 31 days will result in no coverage from the date of birth.

IMPORTANT: Dependents must be added to or dropped from the Health Planwithin 31 days of a life event (birth, marriage or divorce) otherwise you would not be able to make benefit changes until the next open enrollment period.

!

IMPORTANT: Your dependents will not be added to the plan without uploading the required dependent documentation before the end of your enrollment period.

2

3

!Need a New Social Security Card?

https://www.ssa.gov/ssnumber1-800-772-1213

Need a New BirthCertificate?Access www.vitalchek.com anytime

orcall 1-877-305-8315


http://www.usd259.bswift.com/https://www.ssa.gov/ssnumberhttp://www.vitalchek.com/

Free Preventive ServicesAll three (3) of the medical plan options include the following free annual preventive care services per calendar year at in-network providers:

• Annual physical, including lab work

• Preventive colonoscopy or fecal testing

• Free Adult Vaccines (CDC Recommended)

• One preventive annual Mammogram

• One annual PAP test & corresponding office visit

• One annual PSA test & corresponding office visit

• Well-Baby/child immunizations (up to age 19)

Medical Plan BenefitsWhen you enroll with Meritain Health, it’s important for you to understand how your health plan works so you can make the changes you want in your health and in your life.

Chances are, you try every day to keep a healthy balance in your life. Time can get away from you, or you might put other details first. You can think of your healthcare benefits as your resource to protect your body, mind, and spirit.

All medical plan options are administered by Meritain Health and are on the Aetna Wesley Preferred ProviderNetwork.

The preventive screenings can be done anytime during the calendar year and do not have to be 12 months apart.!4

CopaysAll three (3) of the medical plan options have the same copayamounts outlined below.Office Visit Copay (in-network):

Primary Care (including mental health) Specialist

$ 30$ 50

Chiropractor $ 30__________Other Copays(in-network):

TeladocTake Care / Little Clinic (Convenience Clinic)UrgentCare

$ 15$ 30$ 50

ER $ 100 Copay + Deductible & Co-insurance__

__ _______

__ __ _____

To ensure the highest benefit reimbursement, we recommend you verify your provider is in network prior to the services being rendered.

To verify whether or not a doctor or healthcare facility is in-network, call 1 (800) 343-3140 or visit http://www.meritain.com. Select Tools & Resources/Aetna/ Kansas & W Missouri Special Network- Wesley Preferred Network.

Preferred Providers


http://www.meritain.com/

24x7 Nurse LineCall anytime, day or night

What do you do when you’re not sure what to do?

When you don’t know where to go for care or if it’s really an emergency.

When it’s 4:00 a.m. and your child can’t stop coughing.

When you’ve taken a tumble andyour ankle is swelling.

You can call the 24x7 Nurse Line to talk to a registered nurse who will listen and give you professional, seasoned advice,making sure you get care in the rightplace at the right time.

24 Hour Nurse Line1-866-726-6529

Maternity Management ProgramAvailable at no cost to you as part of your medical plan enrollment!

Are you, your spouse, or dependent childpregnant? If so, you can take advantage ofone-to-one support from a registered nurse who will help you achieve a healthypregnancy.

Through the Maternity Management program, you, your spouse, or dependent child will be able to speak to a nurse over the phone on a regular basis. The nurse will provide educational information anddiscuss ways to minimize the risks to you and your baby.

The nurse, who is experienced in all aspects of prenatal care, will also help you manage your diet and exercise and discuss other ways to stay healthy throughout your pregnancy. Even if you aren’t a first-time mom, the nurse can help you through the changes that come witheach unique pregnancy.

To learn more, contact Meritain Health at 1-800-641-3224 and dial option 3.

Mental Health CoverageIf you are enrolled in any of the medical plans, Meritain Health provides coverage for mental health and substance abuse. They are here with the help you need to work toward recovery, so you can get back to being your best.

Visit www.meritain.com and search “emotional health” to learn about various behavioral health conditions like depression and anxiety.

Not sure where to look for a mental health professional in your area?

Contact Meritain Health at 1-866-760-9568 or visit their website at www.meritain.com to find:

• Psychiatrists• Psychologists• Clinical social workers• Clinical counselors• Certified addiction counselors


http://www.meritain.com/http://www.meritain.com/

Common conditions treated: • Allergies/Bronchitis

• Cold/Flu

• Rash/Skin Infections

• Sinus Infections

• Stomach Ache/Diarrhea

• Many other conditions

Saves time and money

Quicker Recovery from illness

Convenient prescriptions

Choice of consultation method

Great health means peace of mind

• Headaches/Migraines

• Eye/Ear Infections

• Urinary Tract Infections

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Teladoc is the on-demand healthcare solution that gives you the medical care you need, when you need it. You can talk to a doctor anytime, anywhere about non-emergent medical conditions. With Teladoc, you can talk to a doctor 24/7/365 by phone, online video, or mobile app. When you use Teladoc, your medical questions will be answered by a highly qualified doctor.

6

Teladoc is a great option for medical advice and care during weekends, holidays or after business hours, when general practitioners don’t typically schedule appointments. Teladoc is also perfect for those times when you are at home, traveling or do not want to take time off work to see a doctor.

Contact a Teladoc physician at 1-800-362-2667

or by visiting www.MyDrConsult.com.


Your prescription drug benefit is included with your medical plan enrollment and is administered by MaxorPlus, a pharmacy benefits manager. The Prescription Drug Plan is designed to help keep medications affordable for you andyour family. When you enroll in medical coverage, you will receive a separate MaxorPlus ID card and information on locating a pharmacy near you.

Most major pharmacy chains accept MaxorPlus. Present your MaxorPlus ID card when filling prescriptions. You can save money on medications you take on a long-term basis by using mail order with Maxor. With Maxor mail order, you can buy up to a 93-day supply at a reduced copayment when compared to retail pharmacies.

Free MedicationsFormulary generic blood pressure, cholesterol, and select diabetic medications and supplies are free at any in-network pharmacy. Please talk to your doctor about prescribing a generic so you can save money.

For additional benefits on oral diabetic medication and formulary insulin, contact Employee Benefits at 316-973-4564, to inquire about the Dillon’s Diabetic Coaching Program.

We’re Here to HelpIf you have questions, please call MaxorPlus customer service at 1-800- 687-0707.

Representatives are available to assist Monday through Friday 7AM-9PM, Saturday 8AM-6PM, and Sunday 9AM-5PM CST (Central Standard Time).

In the event of an emergency, MaxorPlus has staff readily available 24/7 to assist you with your prescription benefit questions.

If you or your physician request a brand name drug when a generic equivalent exists and you choose to fill the brand drug, you will be responsible to pay the brand copay plus the difference in cost between the brand and generic.*This is not intended to be a full explanation of benefits, limitations, or exclusions.

Prescription Drug Benefit

Pharmacy Network• COSTCO PHARMACY• CVS PHARMACY• DILLONS PHARMACY• HY-VEE PHARMACY• MEDICINE SHOPPE

Plus many more participating pharmacies.

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Drug Retail Copay (31 Day Supply)

Generic

Preferred Brand

Non-Preferred Brand

Specialty

$10$30$55

10% up to $100

Drug Mail Order Copay (93 Day Supply)

Generic

Preferred Brand

Non-Preferred Brand

Specialty

$20$60$110N/A

“Pay the Difference” Provision

• PRICE CHOPPER PHARMACY• SAM'S CLUB PHARMACY• SHOPKO PHARMACY• WALGREENS• WAL-MART PHARMACY


Medical Deductible(Ded)

Out-of-Pocket Maximum (Including Deductible, Copayments &Co-insurance)

Co-insurance

Base PlanIn-Network Out-Of-Network

Premium Option 1 PlanIn-Network Out-Of-Network

$1,500/Individual $3,000/Individual$3,000/Family $6,000/Family

$4,500/Individual $9,000/Individual$9,000/Family $18,000/Family

70% Plan Pays 50% Plan Pays

Premium Option 2 PlanIn-Network Out-Of-Network

$4,500/Individual$9,000/Family


70% Plan Pays



50% Plan Pays



70% Plan Pays



50% Plan Pays

Preventive Care 100%, Deductible Waived Not Covered 100%, Deductible Waived Not Covered 100%, Deductible Waived Not Covered

Teladoc $15Copay Not Covered $15Copay Not Covered $15Copay Not Covered

Physician Office Visits $30Copay Deduct then50% $30Copay Deduct then50% $30Copay Deduct then50%

Specialist Office Visits $50Copay Deduct then50% $50Copay Deduct then50% $50Copay Deduct then50%

Convenience Clinic $30Copay Not Covered $30Copay Not Covered $30Copay Not Covered

Urgent Care $50Copay $50Copay $50Copay

Emergency Room $100 Copay Plus In-Network Deduct then 30% $100 Copay Plus In-Network Deduct then 30% $100 Copay Plus In-Network Deduct then 30%

Ambulance In-Network Deduct then 30% In-Network Deduct then 30% In-Network Deduct then 30%

TestingDiagnostic Test (x-ray, blood work)

Imaging(CT/PET scans, MRI)

$30Copay

$100 Copay plus Deduct then30%

Deduct then50%

Deduct then50%

$30Copay


Deduct then50%

Deduct then50%

$30Copay


Deduct then50%

Deduct then50%

Outpatient Surgery Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Hospital Inpatient Care Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Mental and Behavioral Health,SubstanceAbuseOutpatient Services $30Copay Deduct then50% $30Copay Deduct then50% $30Copay Deduct then50%

Inpatient Services Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Maternity CarePrenatal visits No Charge Deduct then50% No Charge Deduct then50% No Charge Deduct then50%Childbirth/delivery- global professional fees

$50Copay Deduct then50% $50Copay Deduct then50% $50Copay Deduct then50%

Childbirth/delivery facility fees Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Home HealthCare Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Skilled NursingCare Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Hospice Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Rehabilitation Services Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Outpatient Physical Therapy Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

Durable Medical Equipment Deduct then30% Deduct then50% Deduct then30% Deduct then50% Deduct then30% Deduct then50%

4

Medical Plans At-A-Glance

This guide is a summary of the employee benefits provided by Wichita Public Schools. If there is a discrepancy between the benefits illustrated in this guide and the official plan document, the plan document will always govern. 8


Base Plan

Premium Option 1 Plan


Annual premium is divided by your total number of paychecks received each year. Your actual total premium can vary based on your specific pay calendar and anyapplicable additional premiums as outlined on the following pages.

Employee Only $0 $0 $0 $0

Employee + Spouse $0 $0 $0 $0

Employee + Child(ren) $0 $0 $0 $0

Employee + Family $0 $0 $0 $0

62020 Employee Benefits Guide

Medical Plan Premiums - WITH Wellness Discount

9

Annually Monthly Bi-weekly 20 paysPart-time premium may apply

Bi-weekly 26 pays

Employee Only $666.24 $55.52 $33.32 $25.62

Employee + Spouse $1,398.96 $116.58 $69.95 $53.80

Employee + Child(ren) $1,265.64 $105.47 $63.29 $48.68

Employee + Family $2,065.20 $172.10 $103.26 $79.42

Employee Only $464.52 $38.71 $23.23 $17.86

Employee + Spouse $975.24 $81.27 $48.76 $37.50

Employee + Child(ren) $882.48 $73.54 $44.12 $33.94

Employee + Family $1,440.00 $120.00 $72.00 $55.38



Bi-weekly 26 pays


Bi-weekly 26 pays

Base Plan



Employee Only $1,200.00 $100.00 $60.00 $46.15

Employee + Spouse One with & One without wellness

$2,400.00$1,200.00

$200.00$100.00

$120.00$60.00

$92.31$46.15


Employee + FamilyOne with & One without wellness

$2,400.00$1,200.00

$200.00$100.00

$120.00$60.00

$92.31$46.15

Employee Only $1,866.24 $155.52 $93.31 $71.78


$3,798.96$2,598.96

$316.58$216.58

$189.95$129.95

$146.11$99.96



$4,465.20$3,265.20

$372.10$272.10

$223.26$163.26

$171.74$125.58

Employee Only $1,664.52 $138.71 $83.23 $64.02


$3,375.24$2,175.24

$281.27$181.27

$168.76$108.76

$129.82$83.66



$3,840.00$2,640.00

$320.00$220.00

$192.00$132.00

$147.70$101.54


Medical Plan Premiums - WITHOUT Wellness Discount

10


Annual premium is divided by your total number of paychecks received each year. Your actual total premium can vary based on your specific pay calendar and anyapplicable additional premiums as outlined on the following pages.


Bi-weekly 26 pays


Bi-weekly 26 pays


Bi-weekly 26 pays

ALL employees and spouses who wish to enroll in the medical plan will be required to have their wellness items verified in order to receive the Wellness Premium Discount. Employees and spouses each earn a $1,200 annual wellness discount by completing 100 wellness points.

Credits must be earned between September 1, 2018 –August 31, 2019 to apply towards the 2020 premium discount. All 100 wellness points are subject to verification and approval before the premium discount is reflected on the enrollment screen.

Wellness Credit VerificationsPreventive service claims that are filed through the district health plan are loaded throughout the year into bswift. If a screening is missing, it is your responsibility to upload the verification document into bswift.

For services that still require verification, please ensure that each document clearly states the patients:• Name• Date of Service• Screening performed• Employee ID numberExamples of accepted documentation include:• Itemized receipts• Benefit Statements• Billing Statements• Printout from Patient Portal• Written verification from provider• Optional Wellness Form completed & signed by

healthcare provider (available on district website or bswift portal)


Wellness Discount

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(See page 27: Checking Wellness Points & Uploading documents)


Additional Employee Paid Premiums

Working Spouse PremiumThe working spouse premium is in addition to thepremium for your selected medical plan. If your spouse has an employer who offers group health insurance,then you would select “YES” to pay the working spousepremium.

If your spouse is not offered insurance, is self employed, unemployed, or also a USD259 employee, you would select “NO” to the working spouse premium.

The working spouse premium will only apply if your spouse is enrolled in your medical plan.

Part Time PremiumPermanent employees who are employed in a primary benefited position (0.75 FTE to 0.99 FTE) will be charged the part time premium in addition to the premium for the selected medical plan.

Paraeducators are considered part-time employees.

Bi-weekly26pays

Bi-weekly 20pays Monthly Annually

Working Spouse $92.31 $120.00 $200.00 $2,400.00

Bi-weekly 26pays


Part Time Premium $18.47 $24.00 $40.00 $480.00

Tobacco PremiumThe additional tobacco premium applies to both the employee and spouse if enrolled under one of the medical plans. The tobacco premium applies to thosewho have used tobacco or nicotine products four ormore times within the last six months.

Tobacco and/or nicotine products include: Cigarettes, electronic cigarettes, pipes, or any form of chewingtobacco. By selecting “No” to tobacco use whenenrolling you and/or your spouse will be given 25wellness points for being a non-tobacco user and maybe subject to audit & confirmation testing.

Once you have been tobacco free for 6 months, you can enroll as a non-tobacco user the following Open Enrollment period.

Bi-weekly 26pays


Employee $46.15 $60.00 $100.00 $1,200.00

Spouse $46.15 $60.00 $100.00 $1,200.00

Employee + Spouse $92.30 $120.00 $200.00 $2,400.00

Cash Option – Declining Medical CoverageEligible employees who are covered under another medical insurance plan may elect the cash option benefit in lieu of the Board provided group medical plan. You will receive a $1,200 annual cash benefit, prorated according to your pay schedule and paid out on each pay check (see chart below).

Employees covered by another USD 259 employee are still required to complete the enrollment process, elect the cash option benefit and provide a copy of your current health insurance card.

To receive the cash option payment, even if you are covered under another USD 259 employee, you must provide a copy of your current health insurance card.

Employees who elect the cash option, must still go online and complete the benefit enrollment process and upload a copy of your current medical insurance card or military ID to receive the cash option benefit.

Bi-weekly 26pays


Cash Option ($46.15) ($60.00) ($100.00) ($1,200.00)


The premiums listed below are in addition to the premium for your selected medical plan.

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!Parenthesis around dollar amounts indicate a credit or payment to the employee.

You will not receive the cash option payment until proof has been provided even if you are covered by another USD 259 employee.


EyeMed Base Vision Plan


Employee Only$0 $0 $0 $0




Vision Benefits

Annually MonthlyBi-weekly

20 paysBi-weekly

26 pays

14

Annual premium is divided by your total number of paychecks receivedeach year. Your actual total premium can vary based on your specific pay calendar

You must enroll in the base or buy up vision plan for annual Eye Exams to be covered

Select an EyeMed “Insight” Provider

Present your EyeMed card for annual eye exams


New For 2020 Vision Care Services In-Network/Member Cost Out of Network/Member ReimbursementExam (with dilation as necessary) $0 Up to $40

Retinal Imaging Up to $39 N/A

**Complete Pair Eyeglasses Purchase Discounts*: Frame, lenses and lens options must be purchased in the same transaction to receive full discount

Frames* 35% off retail price N/A

Standard Plastic LensesSingle Vision $50 N/ABifocal $70 N/ATrifocal $105 N/ALenticular $105 N/aStandard Progressive Lens $135 N/A

Lens OptionsUV Treatment $15 N/ATint (Solid and Gradient) $15 N/AStandard Plastic Scratch Coating $15 N/AStandard Polycarbonate—Adults $40 N/AStandard Polycarbonate—Kids under 19 $40 N/AStandard Anti-Reflective Coating $45 N/APolarized 20% off retail N/AOther Add-Ons and Services 20% off retail N/A

Contact Lenses (materials only)Conventional 15% off retail N/ADisposable 0% off retail N/A

Laser Vision CorrectionLASIK or PRK form U.S. Laser Network 15% off the retail price or 5% of promotional

price

Hearing CareHearing Health Care from Amplifon Hearing Network 40% off hearing exams and discounted

hearing aids N/A

Frequency Exam Once every calendar yearLenses or Contact Lenses UnlimitedFrame Unlimited

Additional Discounts (Additional discounts are not insured benefi ts )Complete pair of prescription eyeglasses 40% OffNon-prescription sunglasses 20% offRemaining balance beyond plan coverage 20% off

Frame, Lens, & Lens Option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price.

EyeMed Buy Up Vision Plan


Vision Benefits


Product or Service In-Network/Member Cost Out of Network/Member ReimbursementExam (with dilation as necessary) $0 $40Eyeglass Frames $0 copay, $150 Allowance, 20% off balance over $150 $105Lenses Per Pair Single Vision $25 copay $30 Bifocal $25 copay $50 Trifocal $25 copay $70 Standard Progressive $80 copay $50Covered Lens Options Standard Anti-Reflective $45 copay $5 Premium Anti-Reflective Tier 1 $57 copay $5 Premium Anti-Reflective Tier 2 $68 copay $5 Premium Anti-Reflective Tier 3 $85 copay $5Contact Lenses (includes materials only) Conventional $0 copay, $150 Allowance, 15% off balance over $150 $120 Disposable $0 copay, $150 allowance, plus balance over $150 $120 Medically Necessary $0 copay, Paid in Full $210 Standard Fit & Follup Up $40 Premium Fit & Follow Up 10% off retail priceFrequency Exam, Lenses, Contact Lenses Once every calendar year Once every calendar year Frames Once every two calendar years Once every two calendar years

Employee Only $49.68 $4.14 $2.49 $1.91Employee + Spouse $94.44 $7.87 $4.73 $3.64Employee + Child(ren) $99.48 $8.29 $4.98 $3.83Employee + Family $146.16 $12.18 $7.31 $5.63

Annually Monthly Bi-weekly 20 pays Bi-weekly 26 pays

Annual premium is divided by your total number of paychecks received each year. Your actual total premium can varybased on your specific pay calendar

Sheet1

EYEMED BUY UP HARDWARE PLAN (EXAM + HARDWARE)

Product or ServiceIn-Network/Member CostOut of Network/Member Reimbursement

Exam (with dilation as necessary)$0$40

Eyeglass Frames$0 copay, $150 Allowance, 20% off balance over $150$105

Lenses Per Pair

Single Vision$25 copay$30

Bifocal$25 copay$50

Trifocal$25 copay$70

Standard Progressive$80 copay$50

Covered Lens Options

Standard Anti-Reflective$45 copay$5

Premium Anti-Reflective Tier 1$57 copay$5



Contact Lenses (includes materials only)

Conventional$0 copay, $150 Allowance, 15% off balance over $150$120

Disposable$0 copay, $150 allowance, plus balance over $150$120

Medically Necessary$0 copay, Paid in Full$210

Standard Fit & Follup Up$40

Premium Fit & Follow Up10% off retail price

Frequency

Exam, Lenses, Contact LensesOnce every calendar yearOnce every calendar year

FramesOnce every two calendar yearsOnce every two calendar years

AnnuallyMonthlyBi-weekly 20 paysBi-weekly 26 pays

Employee Only$49.68$4.14$2.49$1.91

Employee + Spouse$94.44$7.87$4.73$3.64

Employee + Child(ren)$99.48$8.29$4.98$3.83

Employee + Family$146.16$12.18$7.31$5.63

Annual premium is divided by your total number of paychecks received each year. Your actual total premium can vary based on your specific pay calendar.

DiagnosticOral evaluations, Bitewing x-rays Fullmouth or panoramic x-rays

PPO ProviderBase Plan

Premier Provider Non-Participating PPO Provider

100%

Buy-Up PlanPremier Provider

70%Non-Participating

60%100% 70% 60%

PreventiveCleanings, Fluoride, Space Maintainers,Sealants

100% 70% 60% 100% 70% 60%

BasicOne emergency exam, Oral surgery, Fillings, Endodontics, Periodontics

0% 0% 0% 80% 70% 50%

MajorBridges, Dentures, Repairs,Implants

0% 0% 0% 50% 50% 40%

Base Plan PremiumsAnnually Monthly Bi-weekly 20 pays Bi-weekly 26 pays

Buy-Up Plan PremiumsAnnually Monthly Bi-weekly 20 pays Bi-weekly 26 pays

EmployeeOnly $0 $0 $0 $0




EmployeeOnly $189.84 $15.82 $9.49 $7.30

Employee + Spouse $398.64 $33.22 $19.93 $15.33

Employee + Child(ren) $360.60 $30.05 $18.03 $13.87

Employee + Family $588.48 $49.04 $29.42 $22.63

Great oral health is an essential part of a healthy lifestyle. Oral health is often overlooked, but regular oral care can helpprevent common diseases and greatly impact your overall quality of life. We offer two dental insurance plans through DeltaDental to help you maximize your oral health.

Base Plan - Covers Preventive Services Only. Basic, Major Services, Orthodontia and Implant Coverage are NOT included.

Buy-Up Plan – Basic & Major Services are included. Orthodontia Coverage is NOT included.There is Limited Lifetime Implant Coverage of $2,500 per person. Prior authorization is required for implants.

Dental Plans At-A-Glance


Wichita Public Schools partners with ASI Flex to provide you the opportunity to pay for out-of-pocket medical, prescription, dental, vision, and dependent day care expenses with pre-tax dollarsthrough Flexible Spending Accounts (FSA). You must enroll/re-enroll annually during open enrollment to participate for the following calendar year.

Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay federal income tax, social security taxes, or state and local income taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to payout of pocket for eligible expenses for the plan period.

Bob and Jane’s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,300 for day care next plan year, they decide to direct a total of $5,000 into their FSA account.

*Assumes standard deductions and four exemptions.** Varies, assume 3 percent.

The example above is for illustrative purposes only. Every situation varies and we recommend that you consult a tax advisor for all taxadvice.

Health Care FSAThe Health Care FSA provides you an opportunity to use pre-tax dollars to pay for out-of-pocket healthcare expenses for you, your spouse and any IRS covered dependents (even if they are not enrolled in the district health plan). For a complete list of eligible expenses go to www.asiflex.com or contact ASI at 1-800-659-3035.

Maximum Annual Amount The maximum annual amount you can contribute to the Health Care FSA is $2,700 per calendar year. You can use these funds for eligible expenses you incur throughout the calendar year. Your full annual election is available to you on the effective date of your plan. Up to $500 of unused contributions can be rolled over into the next calendar year. Any balance over $500 with claims not submitted by the filing deadline will be forfeited to the plan. Claims filed for services prior to your benefit effective date are not eligible for reimbursement.

Dependent Day Care FSAThe Dependent Day Care FSA is used to reimburse daycare expenses related to care of eligible dependents while you and your spouse work. Eligible expenses include day care, summer day camps (overnight camps are NOT eligible), babysitting, before and after school care (under age 13), nursery school, and pre-kindergarten expenses, which are primarily for the protection and well-being of the dependent.

Maximum Annual Amount You can set aside up to $5,000 per household, per calendar year ($2,500 if married and filing separate income tax returns). Any balance not submitted by the filing deadline will be forfeited to the plan.

Participants can order a debit card for the HealthCare Flexible Spending Account by completingthe “FSA Debit Card Application” located under Employee Benefits on the USD259 website or in

the library on the bswift benefit portal.

Without FSAs With FSAs

Grossincome $30,000 $30,000FSAcontributions 0 -5,000Grossincome 30,000 25,000Estimated taxes

Federal -2,550* -1,776*State -900** -750**FICA -2,295 -1,913After-tax earnings 24,255 20,314

Eligible out-of-pocket

Medical & dependent care expenses -5,000 0Remaining spendable income $19,255 $20,561Spendable income increase $1,306

2019 Employee BenefitsGuide 102020 Employee Benefits Guide

Flexible Spending Accounts

Sample Savings

Check out ASI’s free tax savings calculator here: http://www.asiflex.com/Calculator.aspx

2020 Employee Benefits Guide17

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http://www.asiflex.com/Calculator.aspx

Group Term Life InsuranceThe Board provides group term life insurance coverage free of charge for all permanent employees who work twenty (20) hours or more per week. This coverage will not be effective until the employee reports for work.

The face value of your personal term life policy is basedupon your position.• Certified employees – $30,000

• Classified/Hourly employees – $30,000

• Supervisory and technical employees – $40,000

• Administrators – $50,000

College Tuition Benefit® Rewards Program

Life Insurance


Voluntary Term Life InsuranceWichita Public Schools understands that having a comprehensive benefits plan is important to our employees and their families.

Life insurance can provide an additional layer offinancial protection for you and your loved ones.This benefit would be in addition to the district provided life insurance benefit.

It also offers flexibility to update your coverage as your life changes or take it with you if you change jobs or retire.

Additionally, when you enroll for coverage you also receive an equal amount of Accidental Death & Dismemberment insurance, which provides a layer of financial protection in the event of a serious injury or death as a result of an accident.

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KPERS Life InsuranceAs an active member of KPERS, you are provided a life insurance policy with a face value of 1.5 times your annual base pay. The effective date of coverage is your date of hire. New employees and employees who become KPERS benefit eligible will complete the KPERSdesignation of beneficiaries form to assign beneficiaries.

A Benefit that Helps you Save for College:When you enroll in Guardian Life insurance you also receive access to the College Tuition Benefit Rewards Program. Annual enrollment in this plan earns you 2,000 Tuition Rewards®

1 Reward = $1 in tuition reduction at a network of Private Colleges and Universities in the U.S.

These rewards are yours for your lifetime andcan be given to Children, Grandchildren, Nieces, Nephews and Godchildren.

To learn more visit https://guardian.collegetuitionbenefit.com

! It is important to review and designate a beneficiary for this benefit.


https://guardian.collegetuitionbenefit.com/

KPERS 1 Benefits Members hired before July 1, 2009Contribution Amount: As a KPERS 1 member you contribute 6%of your income (5% for 2014 and 4% for 2013 and before).

Earning Interest: If you became a member before July 1, 1993, your contributions earn 8% interest. On or after July 1, 1993, your contributions earn 4% interest.

KPERS 2 Benefits Members hired July 1, 2009 through December 31, 2014

Contribution Amount: As a KPERS 2 member you contribute 6%of your income.

Earning Interest: Your contributions earn 4% interest.

KPERS 3 Benefits Members hired January 1, 2015 and after

Contribution Amount: As a KPERS 3 member you contribute 6%of your income.

Earning Interest: Your contributions earn 4% interest annually (paid quarterly). There is also a possibility of additional interest, depending on KPER’s investment returns.

All district employees who work in KPERS covered positions are members of the Kansas Public Employees Retirement System(KPERS). Kansas law requires that all eligible employees must become members. As an active member you contribute a percentage of your gross earnings. The KPERS website has valuable information regarding your KPERS membership. Links to all KPERS publications and forms are online for members and retirees. You can review your benefits as a member of KPERS and the retirement benefits you are accruing. KPERS also has an online “Retirement Estimate Calculator” you can use to calculate yourretirement benefits. To get the best possible estimate results have your latest KPERS Annual Statement available to enter years of service and salary information.

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Retirement BenefitsKansas Public Employees Retirement System (KPERS) Pension Plan

Your Retirement CreditsYou earn retirement credits while working. They are based on a percentage of your pay and the number of years you’ve worked. You receive these credits quarterly and your annual credit rate increases the longer you work. They can only be used at retirement.

NOTE: Kansas law does not allow you to borrow from your contributions.


Voluntary Retirement PlansUSD 259 employees have the opportunity to set up contributions to their personal investment programs through payroll deductions. There are two options available: the USD 259 endorsed 457 Deferred Compensation program with Massachusetts Mutual, and 403(b) tax-sheltered annuity plans. Employees interested in setting up personal accounts must work with an investment counselor to determine an investment program and begin a payroll deduction.

2019 Employee BenefitsGuide

403(B) Tax-Sheltered Annuity PlansThe Omni Group is our 403(b) plan administrator. Employees wanting to set up a payroll deductionwill work with an investment advisor from one ofour approved participating service providers.

The list of providers can be found on the Omni website www.omni403b.com. You can also contact Omni at 1-877-544-6664.

457(B) Deferred Compensation Plan457(b) deferred compensation plans are employer-sponsored retirement savings plans, offered by municipalities and governmental entities, which allow employees to defer a portion of their current compensation on a tax-advantaged basis forretirement.

With a 457(b) plan, employees put a portion of their earnings into an employer-sponsored plan on a tax-advantaged basis. Employees may choose between a traditional pre-tax contribution and a Roth contribution.

Traditional pre-tax contributions – Contributions are made on a pre-tax basis, reducing the employee’staxable income. Earnings accumulate on a tax-deferred basis. All distributions are taxed as ordinary income.

Roth contributions – Contributions are made on an after-tax basis. Earnings accumulate on a tax-deferred basis, and distributions are tax-free if made five years after the initial contribution to the plan and the employee is over 59½.

For more information contact Deb Anton,your RPA Advisor:

Deb Anton, MBAFinancial Advisor (316) 210-5049

[email protected]

USD 259 Retirement Specialist & KPERS Designated Agent

Alexis Summers Business: (316) 973-4590 Email: [email protected]

Retirement planning assistance is available through the Retirement Office in the Employee Benefits department. Information regarding KPERS retirement options may be obtained through personal meetings, or you may request a retirement estimate.

Employees planning to retire from USD 259 must contact the Retirement office at least six months in advance to complete paperwork and ensure all steps for a successful retirement have been taken.


mailto:[email protected]:[email protected]

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Physical well-being Ability to maintain a healthy quality of life that allows us to get through daily tasks without undue fatigue or physical stress.

Wichita Public Schools believes in employees being future ready, too. We take great pride in promoting to staff intellectual, social, emotional, physical, and financial well-being.

LOWEST HEALTH PLAN PREMIUMS in the state for benefitted employees

FREE Annual Preventative Services FREE Medications Wellness Program Discount

Social well-beingAbility to establish and maintain positive relationships with family, friends and co-workers.

Distinguished Classroom Teacher Awards

Excellence in Public Education Awards

Good Apple Awards Partners in Education Awards

Financial well-beingAbility to balance and manage financial needs and wants with income, debts, savings, and investments.

Emotional well-beingAbility to be aware of and accept our feelings, rather than deny them, have an optimistic approach to life, and enjoy life despite its occasional disappointments and frustrations.

FREE EMPLOYEE ASSISTANCE PROGRAM Dedicated Helpline Assessments and Referrals Short-term Counseling Relationship Issue Guidance Legal and Financial Resources Health Resource Library

FREE in-house professional development and training

Employees are encouraged to engage in creative and stimulating mental activities to expand their knowledge, skill sets, and to discover the potential for sharing their gifts with others

Intellectual well-beingAbility to open our minds to new ideas and experiences that can be applied to personal decisions, group interaction and community betterment.

KPERS Retirement Plan Federal Loan Forgiveness FREE Short-Term Disability Catastrophic Emergency Benefit Pool Flexible Spending Accounts FREE District-provided Life Insurance FREE KPERS-provided Life Insurance

Wichita Public Schools wants to be your employer of choice where you, too, can dream, believe and achieve.2020 Employee Benefits Guide


Catastrophic Benefit Donation PoolDisability and Leave Programs

Workers CompensationThe Board provides worker’s compensation coverage under the Kansas Workers Compensation Law for all employees. Workers compensation covers injury and disease arising out of and in the course of one’s employment. Benefits include medical expenses and disability payments when applicable.

Job related accidents must be reported immediately to your supervisor and the Workers Compensation office at 316-973-4579. The Employee Report of Incident (EROI) and the Supervisor’s Report need to be completed and forwarded to the Employee Benefits and Insurance Management office as soon as possible, but no more than 24 hours after the occurrence.

Short-Term Disability (STD)The Board provides Short-Term Disability benefits for disabilities resulting from non-occupational illness or injury, as outlined in the STD plan summary. STD replaces a portion of your pay once your temporary leave balance has been exhausted. Disability benefits must be approved by the district’s leave administrator.

Under no circumstances will short term disability benefits be paid in excess of 180 calendar days from the date of disability.

Contact Employee Benefits at 316-973-4632 for more information about FMLA, maternity leave, or medical leave.

KPERS Long-Term Disability (LTD)Membership in KPERS also includes Long-Term Disability benefits. The KPERS long-term disability plan provides financial protection by replacing a portion of the member’s income if he or she is disabled for a prolonged period as the result of an injury or sickness. KPERS also provides aninsured death benefit to the member’s beneficiary should the member die while receiving long-term disability benefits. The death benefit amount is based on the member’s salary at the time of disability.


Additional WPS Benefits

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This pool was established for USD 259 employees in 1995 to help participants recover at least a portion of used temporary leave days when an FMLA eligible, catastrophic emergency occurs.

To become a member of this pool, employees voluntarily make a one time donation of one day of their temporary leave to the pool during our annual donation period each fall.

All temporary leave must be exhausted before individuals are eligible to apply for reinstatement of temporary leave days already deducted because of the catastrophe. The Catastrophic Benefit Pool is not an option on days an employee is receiving compensation under Disability or Workers’ Compensation.

As a benefited district employee, you may donate one day of temporary leave during the annual donation period to the Catastrophic Benefit Pool. Donating one day of your leave means you are a participant in the pool, and are eligible to apply for assistance unless you move to a non-benefited position or terminate employment. If you wish to participate in the Catastrophic Benefit Pool you may go online during the annual donation period and elect to donate one day of your temporary leave.


EAP Can Give You the Support You Need Relationship challenges Life-changing events Legal or financial issues Excessive worry or stress Substance dependence Workplace challenges

Resources to Find Your Best SelfThe expansive list of resources, free to you and yourloved ones, can be accessed at your pace.

Log on: www.ndbh.com with passcode USD259Request a session online at www.ndbh.com or by phone 1-800-624-5544.

USD 259 has partnered with New Directions to offer an Employee Assistance Program (EAP) designed to assist employees and their dependents in coping with personal situations that may impact their lives, behavior, or performance.

All USD 259 employees are automatically enrolled in this benefit and are eligible to utilize the EAP. The EAP is provided through New Directions Behavioral Health.

The benefit provides short term counseling (6 visits per issue) and referral services for employees and their dependents. EAP services are provided in strict confidentiality. This benefit is provided by USD 259 at no cost to the employee.

Text Message TherapyEven better, you can now reach therapists via text and video messaging through a new partnership with Talkspace. Around-the-clock support through text, phone conversation or in-person makes anytime the perfect time to reach out.

How it works:1. Visit ndbh.com2. Select For Individuals and Families3. Select EAP in the drop down menu4. Enter company code: USD2595. On the employee portal, scroll down and look on right for

Text a therapist6. Answer profile questions7. Match with a therapist8. Begin texting almost immediately

Get startedFollow the instructions above or at any time call the EAP Help Line at 1-800-624-5544 to request any form of counseling. Five days per week of texting equals approximately one EAPsession.

*Message and data rates apply.

Employee Assistance Program (EAP)

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New Directions Behavioral Health

To access:


http://www.ndbh.com/http://www.ndbh.com/

Your benefit decisions are important, and a lot goes into making the right choice. We have partnered with bswift, an easy-to-use, online benefits tool which provides a smart, simple and personalized enrollment experience to help you choose the plan that’s right for you.

Forgot Password?If you have forgotten your password or are having trouble loggingin, please click on the Forgot Password link to reset, using the security question you have already provided.

If you are still unable to log in, contact bswift at 1-866-524-5063.

Representatives are available Monday through Friday from 8:00 a.m. to 6:00 p.m.

You can access the benefit portal 24/7 from any computer.

Open your internet browser and enter www.usd259.bswift.com

How to Access the Benefit Portal

You’ll find everything you need on bswift’s online portal. You can go there during enrollment and throughout the year to:

Look up general benefits information

Find important plan details

Enroll in your benefits

Make changes when you have qualifying life events

Update life insurance beneficiaries

View annual notices

BSWIFT Online Enrollment Portal

Username: Employee ID number

Password: Your initial password will be the last 4 of your social security number


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www.usd259.bswift.com

*Do not contact the 259 Help Desk as they will not be able to assist you.*


2019 Employee BenefitsGuide

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How to EnrollOnce you have logged in to the benefit enrollment website, click on the Start Your Enrollment button to begin enrolling in your benefits.

Enter and/or review your spouse’s information, along with your eligible dependent children, whom you would like to enroll in your benefits.

This is only necessary if you want to add them to your health plan.

Enter and/or review your family information

Enter your personal informationMake sure all your personal information, including your address and telephone number are correct.

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Start selecting your benefits

Select dependents to be coveredAfter you click on the green view options button, you will be asked to select who youwould like to cover with the plan at the top ofthe page, then view all of your plan optionsbelow.

2019 Employee BenefitsGuide 102020 Employee Benefits Guide

From this screen you can select which benefits to enroll in or to enroll in the cash option. As you progress through each benefit you will see your selections.

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You will need to check the boxnext to each dependent youwish to cover under the plan.

View your plan optionsFrom this screen, click on the green view plan options to make your selections under each benefit type. As you progress through each benefit type, you’ll see your selections completed on this screen.



You cannot complete your enrollment without reviewing all nine of the benefits.

There are nine benefits options for you to review.

Medical Plans

Dental Plans

Vision Plans

Health Care Spending Account

Dependent Care Spending Account

Supplemental Employee Life

Basic Employee Life You will only be able to edit and view information (e.g. beneficiaries) here. You cannot select different options or opt out. This benefit is provided by the district to you at no cost.

KPERS Life You will not be able to edit KPERS Life insurance through bswift, you will only be able to view your current

beneficiaries. Go to www.KPERS.org to change your beneficiaries.

Employee Assistance You will only be able to view information here. You cannot select different options or opt out. This benefit

is provided by the district to you at no cost.

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http://www.kpers.org/


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Review & Confirm Your Selections

Take another moment to look over your selections and make any necessary changes. Remember, if all your wellness points have not yet been verified, that discount will not show in the total cost.

Pay special attention to the dependents you enrolled and verify they show as covered under your plans.“X” waived means they are not enrolled in that plan.

Select Complete Your Enrollment

You’re finished - view your confirmation statement

If changes need to be made, you can go back into your enrollment anytime during the enrollment period to make and save those changes.


Benefits Confirmation StatementYou have the option to email or print your confirmation statement from the online benefits portal once you have completed your enrollment. Review your elections carefully as changes will not be allowed once your enrollment window closes unless you have a qualifying life event. (See page 31 for more information about qualifying life events)

If you choose to email a copy of your statement to yourself it will be sent to the preferred email you have listed in bswift. If you have your personal email listed be sure to check your email account frequently through Open Enrollment.

We recommend you save a copy of your final benefit confirmation statement.

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ID Cards and Flex Debit CardsHere is what you need to know about ID cards and flex debit cards.

Medical: You will receive your medical ID cards from Meritain Health three to four weeks after enrollment. Your ID card will list all covered dependents. You can also go online to www.meritain.comand register on the member portal to print out temporary cards.

Prescription: If you enrolled in a medical plan, you will receive a separate ID card from MaxorPlus for your prescription benefits. The Maxor cards will have all covered dependents listed.

Dental: You will receive your Delta Dental ID cards three to four weeks after enrollment. Your dental card will only have the employee’s name listed.

Vision: You will receive your EyeMed vision cards three to four weeks after enrollment. Your EyeMed card will only have the employee’s name listed.

Flexible Spending Debit Card: (For health FSA only) The debit card is not sent automatically. You must complete the debit card application located in the bswift library or at www.asiflex.com and submit to ASI for processing.

After You Enroll


http://www.meritain.com/http://www.asiflex.com/

Wellness Verifications



In order to view the current status of your wellness points, please log in to www.usd259.bswift.com

Your username = Your Employee ID #

From the Home page, select “My Profile”from the tool bar. Then, on the “Personal Information” page select the “Wellness tab”.

• From the home page, click on the “My Profile” tab.

• Then select “Employee file”.• To upload new documentation, click on

the appropriate option (e.g. Add Birth Certificate).

• Change the document title to reflect the documentation.

• Leave the Description field blank.• Check the document type to verify that

it states the appropriate option (e.g. Add Social Security Card).

• Browse your computer for the correct document.

• Click upload.• Repeat this process for each document

you need to upload.

Uploading Documents


IMPORTANT: Dependents must be added to or dropped from the Health Plan within 31 days of a life event (birth, marriage, divorce).

Benefits Changes During the YearIRS regulations limit when you can make changes to your benefits during the year. After you have made your elections during your first 31 days of eligibility, you cannot change your medical, dental, vision, or FSA elections outside the annual Open Enrollment period (held each fall), unless you have a qualifying life event that permits you to make benefits changes under IRS rules.

Examples of qualifying life events that may allow you to make benefit changes:• Marriage• Divorce or legal separation• Birth or adoption• Loss of eligibility for other health coverage• Dependent Losing Eligibility – dependent child reaches the maximum age of 26• Death of a dependent• Change in employment status• Medicare eligibility

!

If you experience one of these qualifying life events during the year you can make plan changes through the benefit portal at www.usd259.bswift.com within 31 days of the life event.

Once you are logged into bswift, you would select “All Other Life Events” under the Life Event Section.

The system will then walk you through step by step.

Once your changes are completed, click on “My Profile” then “Employee File” to upload the appropriate documentation.

The benefit change will not be approved until the appropriate documentation is submitted.


http://www.usd259.bwift.com/

Useful Contacts


Glossary of Medical TermsHealth coverage pays for provided services, medications, hospital care, and special equipment when you’re sick. It is also important when you’re notsick. Here are explanations of some key health insurance words that you may hear.

Copayment An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $30 for a doctor’s visit or $10 for aprescription.

Co-insurance An amount you may be required to pay as your share of the cost for services after your deductible is satisfied. Co-insurance is usually a percentage (for example, 30%).

Deductible The amount you owe for health care services before your health insurance plan begins to pay.

Explanation of Benefits (EOB) A summary of health care charges that your insurance company sends you after you see a provider or receive a service. It is not a bill. It is a record of the health care you or individuals covered on your policy received and how much your provider is charging your insurance company. If you have to pay morefor your care, your provider will send you a separate bill.

Formulary A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Hardware This includes glasses, frames, and contacts under the EyeMed vision plan.

In-network The facilities, providers, and suppliers your health plan has contracted with to provide health care services.

Non-formulary Drugs that are not included in the list of preferred medications that a committee of pharmacists and doctors deems to be the safest, most effective andmost economical. They are drugs not included in the drug list approved by Maxor Plus.

Out-of-network A provider or facility who does not have a contract with your health plan to provide services to you. You will pay more to use them.

Out-of-pocket Maximum The most you pay during a calendar year before your health insurance or plan starts to pay 100% for covered essential health benefits. The out-of-pocket maximum includes the yearly deductible, co-insurance and copayments.

Out-of-network Co-insurance The percent (for example, 50%) you pay of the allowed amount for covered health care services to providers who don’t contract with your health insurance or plan. Out-of-network co-insurance costs you more than in-network co-insurance.

Preauthorization Sometimes called prior authorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization is not a guarantee of benefits.

Specialist A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms andconditions. A non-physician specialist is a provider who has more training in a specific area of healthcare.

Urgent Care Urgent care is non-preventive or non-routine health care service needed to prevent serious deterioration of a person’s health following an unforeseen illness, injury or condition. Urgent care includes conditions that could not be adequately managed without immediate care or treatment, but do not require the level ofcare provided in an Emergency Room. Often referred to as Immediate Care.

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Wichita Public Schools 903 S. EdgemoorWichita, KS 67218

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Complete YourAnnual Open Enrollment November 4 - 15, 2019 · Your legal spouse. Your children under...

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