School Employees Benefit Board (SEBB)

Fall 2019

Upcoming Health Benefit Changes

• Medical• Dental• Vision• Long-term disability (LTD)

• The School Employees Benefits Board (SEBB) of the Washington State Health Care Authority (HCA) will manage the program

• Districts are required to be part of SEBB and are no longer able to offer their own benefit plans

• Districts may offer limited optional supplemental benefits• SEBB coverage begins January 1, 2020

The State will now manage health benefits for all school districts, ESDs and Charter Schools

• Flexible spending accounts (FSA)• Dependent care assistance program (DCAP)• Life and Accidental Death &

Dismemberment (AD&D)

Why SEBB?

• Standardize benefits, rules, and costs• Transparency and accountability in state

expenditures for school employee benefits• Provide health benefits to more people• Reduce the cost of health benefits for school

employees• Consolidate collective bargaining for school

employee benefits

Am I Eligible?

• Employees will be eligible on 1/1/20 if:• They have a 630-hour or more contract with the Pasco School

District.

• If not initially eligible as listed above, employees will beeligible when:

• They reach 630 work hours (hours worked accumulatebeginning 9/1/19)

• Letters will be sent to each employee stating their anticipated eligibility status

Medical Plans

Amounts will be withheld from your paycheck starting January 31, 2020District pooling and benefit allotments end as of 12/31/19

Employee Cost Employee Employee & Spouse

Employee & Child(ren) Full Family

Kaiser PermanenteWA Core 1 $13.00 $26.00 $23.00 $39.00Kaiser PermanenteWA Core 2 $19.00 $38.00 $33.00 $57.00Kaiser PermanenteWA Core 3 $89.00 $178.00 $156.00 $267.00Premera High PPO $70.00 $140.00 $123.00 $210.00Premera Standard PPO $22.00 $44.00 $39.00 $66.00

UMP Achieve 1 $33.00 $66.00 $58.00 $99.00

UMP Achieve 2 $98.00 $196.00 $172.00 $294.00UMP High Deductible $25.00 $50.00 $44.00 $75.00

Surcharges*

Tobacco Surcharge $25.00 $25.00 $25.00 $25.00

Spousal Surcharge $50.00 $50.00 $50.00 $50.00

*Employees may be subject to the above surcharges

Plans shown are those available in Benton and Franklin Counties

Core 1 Core 2 Core 3Provider Network Core HMO Core HMO Core HMODeductible

Individual $1,250 $750 $250 Family $3,750 $2,250 $750

Coinsurance 20% 20% 20%Medical Out-of-pocket Maximum

Individual $4,000 $3,000 $2,000 Family $8,000 $6,000 $4,000

Primary Care/Specialty Care $30 / $40 Copay $25 / $35 Copay $20 / $30 CopayDiagnostic Lab & Imaging 20% over $500 20% over $500 20% After DeductibleInpatient Services 20% After Deductible 20% After Deductible 20% After DeductibleAmbulance 20% After Deductible 20% After Deductible 20% After DeductibleEmergency Room $150 + 20% After Ded. $150 + 20% After Ded. $150 + 20% After Ded.Urgent Care $30 Copay $25 Copay $20 CopaySpinal Manipulations $30 Copay $25 Copay $20 CopayMental Health Office Visit $30 Copay $25 Copay $20 CopayOutpatient Rehab (PT,OT,ST) $40 Copay $35 Copay $30 CopayPrescription DrugsRX Deductible (Individual/Family) $0 /$0 $0 /$0 $0 / $0RX Out of Pocket Maximum Combined w/ Medical Combined w/ Medical Combined w/ Medical

Value NA NA NAGeneric $5 Copay $10 Copay $10 CopayPreferred Brand $25 Copay $25 Copay $25 CopayNon-preferred Brand $50 Copay $50 Copay $50 CopaySpecialty 50% up to $150 50% up to $150 50% upto $150

Kaiser Permanente Medical Plans(True HMO Plan, Requires Referrals from PCP, No Out of Network Benefits)

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board.

TRIOS is out of Network for this provider.

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board.

Kadlec, Lourdes, & TRIOS are in network for these plans.

Uniform Medical Plans – Regence Blue Shield(Largest PPO Network)

Achieve 1 Achieve 2 High Deductible UMP Plus**Provider Network Regence Blue Shield Regence Blue Shield Regence Blue Shield Regence Blue ShieldDeductible-Medical Yakima Co. ONLY

Individual $750 $250 $1,400 $125 Family $2,250 $750 $2,800 $375

Coinsurance 20% 15% 15% 15%Medical Out-of-pocket Maximum

Individual $3,500 $2,000 $4,200 $2,000 Family $7,000 $4,000 $8,400 $4,000

Primary Care/Specialty Care 20% After Deductible 15% After Deductible 15% After Deductible $0 Copay/15% After Ded.Diagnostic Lab & Imaging 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible

Inpatient Services $200 / Day to $600+20% $200 / Day to $600+ 15% 15% After Deductible $200 / Day to $600 + 15%

Ambulance 20% After Deductible 20% After Deductible 20% After Deductible 20% After DeductibleEmergency Room $75 + 20% After Ded. $75 + 15% After Ded. 15% After Deductible $150 + 15% After Ded.Urgent Care 20% After Ded. 15% After Ded. 15% After Deductible 15% After DeductibleSpinal Manipulations 20% After Ded. 15% After Ded. 15% After Deductible 15% After DeductibleMental Health Office Visit 20% After Deductible 15% After Deductible 15% After Deductible 15% After DeductibleOutpatient Rehab (PT,OT,ST) 20% After Deductible 15% After Deductible 15% After Deductible 15% After DeductiblePrescription DrugsRX Deductible(Individual/Family) $250 / $750* $100 / $300* Combined w/ Medical $0 / $0RX Out-of-Pocket Maximum $2,000 / $4,000 $2,000 / $4,000 Combined w/ Medical $2,000 / $4,000

Value 5% up to $10 5% up to $10 15% After Deductible 5% up to $10Generic 10% up to $25 10% up to $25 15% After Deductible 10% up to $25Preferred Brand 30% up to $75 30% up to $75 15% After Deductible 30% up to $75Non-preferred Brand NA NA NA NA

Specialty 30% up to $75 30% up to $75 15% After Deductible 30% up to $75

* Prescription Deductible waived for Generics** UMP Plus Requires referrals from a PCP and has no out of network benefits for non-emergency care.

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board.

High PPO Standard PPOProvider Network PRIME PRIMEDeductible

Individual $750 $1,250 Family $1,875 $3,125

Coinsurance 25% 20%Medical Out-of-pocket Maximum

Individual $3,500 $5,000 Family $7,000 $10,000

Primary Care/Specialty Care $20 / $40 Copay $20 / $40 CopayDiagnostic Lab & Imaging 25% After Ded. 20% After Ded.Inpatient Services 25% After Deductible 20% After DeductibleAmbulance 25% After Deductible 20% After DeductibleEmergency Room $150 + 25% After Ded. $150 + 20% After Ded.Urgent Care 25% After Ded. 20% After Ded.Spinal Manipulations 25% After Ded. 20% After Ded.Mental Health Office Visit $20 Copay $20 CopayOutpatient Rehab (PT,OT,ST) $40 Copay $40 CopayPrescription DrugsRX Deductible (Individual/Family) $125 / $312 $250 / $750*RX Out of Pocket Maximum Combined w/ Medical Combined w/ Medical

Value NA NAGeneric $7 Copay $7 CopayPreferred Brand $30 Copay 30%Non-preferred Brand 30% 50%Specialty $50 Copay 40%

* RX Deductible is waived for Generic Drugs

Premera Blue Cross Medical Plans(Kadlec Hospital is out of network)

Dental Plans

This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board.

Benefit Uniform Dental Delta Care Willamette

Annual Maximum $1,750 No Maximum No Maximum

Annual Deductible $50 Ind / $150 Family $0 $0

Preventive Visits 0% 0% 0%

Basic Services

Fillings 20% $10 - $50 Copay $10 - $50 Copay

Root Canals 20% $100 - $150 Copay $100 - $150 Copay

Oral Surgery 20% $10 - $50 Copay $10 - $50 Copay

Major Services

Crowns 50% $100 - $175 Copay $100 - $175 Copay

Orthodontia50% of $1,750;

Then remainder of cost over $1,750

$1,500 per case $1,500 per case

Vision Plans

This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board.

Benefit Davis Vision EyeMed MetLifeRoutine Eye Exam(1 Per Calendar Year) $0 $0 $0

Lenses(Every 24 Months) $0 $0 $0

Progressive Lenses(Every 24 Months) $50 - $140 $55 - $175 $0 - $175

ConventionalContacts $0 of First $150; Then 85%. $0 of First $150; Then 85%. $0 of First $150; Then 100%.

Disposable Contacts Up to 4 Boxes $0 of First $150; Then 100%. $0 of First $150; Then 100%.

Frames(Every 24 Months) $0 of First $150; Then 80%. $0 of First $150; Then 80%. $0 of First $150; Then 80%.

Employer Paid Life MetLife

Basic Benefit $35,000

Accidental Death & Dismemberment $5,000

Benefit Employee Spouse Child

Employee Paid Supplemental Life

Benefit Increments $10,000 $5,000 $5,000

Benefit Maximum $1,000,000 Up to 50% of Employee Election $20,000

Guarantee Issue – No Health Questions(Children from 2 weeks old to age 26)

$500,000 $100,000 $20,000

Employee Paid Supplemental AD&D

Benefit Increments $10,000 $10,000 $5,000

Benefit Maximum $250,000 $250,000 $25,000

Guarantee Issue $250,000 $250,000 $25,000

* Supplemental Life and AD&D Rates are based on age and tobacco use.

SEBB Life and Supplemental Life InsuranceMetLife

SEBB Long-term DisabilityStandard Insurance

Employer Paid Basic Long Term Disability Standard

Benefit Elimination Period 90 Days or when Family/Medical Leave Ends(Whichever is longer)

Maximum Monthly Benefit $400

Benefit Duration Based on Age when Disability Begins

Employee Paid Supplemental Long Term Disability Standard

Monthly Benefit 60% of Pre-disability Earnings

Maximum Monthly Benefit $10,000 (60% of $16,667 of Earnings)

* Supplemental Long Term Disability Rates are based on your age as of January 1, 2020.

Which plan is right for me?

ALEX will:• Ask questions about how you use benefits

• Based on your responses*, ALEX will make suggestions about which plans might be best for you to consider

• Help you understand your benefits• Be available October 3rd

*Your responses to ALEX are private and confidential

SEBB has purchased an online benefits advisor tool called ALEX.

Default Enrollment

• If you don’t enroll during open enrollment SEBB will default you to the following selections:

• Employee enrolled as a single subscriber with:• Uniformed Medical Plan Achieve 1• Uniform Dental Plan• MetLife vision• Basic Life and AD&D• Basic LTD• Tobacco use premium surcharge incurred ($25)

• Total cost to employee $33 + $25 = $58

Default Enrollment• An employee who defaults will not be allowed to:

• Enroll dependents• Select Medical Flexible Spending Arrangement (FSA)• Select Dependent Care Assistance Program (DCAP)• Make plan selection changes until:

• Next annual open enrollment • Or experiences a Special Open Enrollment (SOE)

event

Waiving Enrollment• A school employee may waive SEBB medical if enrolled in:

• Other employer – based group medical insurance• TRICARE• Medicare

• A school employee who waives enrollment in SEBB medical must enroll in:

• Dental• Vision• Basic life & AD&D• Basic LTD

• You can not waive medical if enrolled in Medicaid • To waive medical you must do so in the SEBB My Account

online system

Eligible Dependents

• Legal spouse• State-registered domestic partner (SRDP)

Defined in RCW 26.60.020 (1)

• Child(ren) up to age 26Child, step child, legally adopted child, etc.

• Extended dependentsGrandchild, niece, nephew, etc. with legal custody or guardianship

• Disabled dependentsChildren age 26 or older – Disability occurred before age of 26 (if you have already filled out this paper within the last few years, you can work with the payroll office so you don’t have to redo the paperwork)

Required Forms & Dependent Verification

SpouseMost recent year’s Federal Tax Return, orMarriage Certificate, and

Proof of common residence, orProof of financial interdependency

Children up to age 26Most recent year’s Federal Tax Return, orBirth Certificate

State-registered Domestic PartnerCertificate of state-registered domestic partnership, and

Proof of common residence, orProof of financial interdependency

Extended DependentExtended Dependent Certificate form, andCourt order

Serves as DVDependent must reside with subscriber

Disabled DependentCertificate of a Child With a Disability form

ALL dependent documentation must be verified by PSD no later than November 15th

Additional Resources

WE ARE PASCO!

• School Employee Initial Enrollment Guide• SEBB My Account Introduction Video• Pasco School District SEBB Webpage• Pasco School District Benefits App• Washington Health Care Authority Website

PSD’s Benefits AppText “Pasco” to 36260 to get the App!

Questions?

WE ARE PASCO!