13-14 Benefit Plan Summary Booklet - Lake Stevens School District #4

No. 4

PSE of Lake Stevens, PSE Office Professionals, Teamsters Bus Drivers & Mechanics, Teamsters Custodians, Adminstrators and Non-Represented A SUMMARY OF HEALTH & WELFARE BENEFIT PLANS FOR THE 2013 – 2014 SCHOOL YEAR

Benefit Fair

Open Enrollment

Tuesday, September 10th 12:00 - 6:00 p.m. Lake Stevens Administrative Building

September 3rd to September 24th

Insurance applications should be returned to Michelle Williams at the Payroll Office. To be effective by November 1st, your application must be received by Michelle no later than September 24th, 2013.

Open Enrollment September 3-September 24, 2013 for an effective date of November 1, 2013 for all lines of coverage except Group Health. Group Health’s effective date: October 1, 2013. Group Health members will NOT need to make any changes if they wish to stay with Group Health. All Classified employees and Administrators currently on Regence Blue Shield or Premera Blue Cross will be moving to a new medical insurance carrier effective November 1st. The new carrier is MODA Health. In order to have coverage, a new enrollment/election form must be completed and turned into the Payroll Department by Tuesday, September 24, 2013. Enrollment forms will be available at the benefits fair and at the Educational Service Center. IMPORTANT Dental Coverage Information: Please log on to http://resources.hewitt.com/wea to review your dependent coverage with WDS/Washington Dental Service and Willamette Dental. They will no longer accept dependent enrollments outside of open enrollment unless they have a qualifying event. Make sure young children who have not yet been to the dentist have been added to your coverage during open enrollment otherwise they will not have coverage this year. You will not be able to enroll them when you make their first appointment mid-year Please Note: All plan and rate changes have been outlined in bold. Available to Classified Employees for 2013 – 2014

1

Table of Contents How to Select a Medical Plan........................................................................................................................................ 3 Benefit changes for 2013 – 2014.................................................................................................................................... 4 Benefit Notes................................................................................................................................................................ 5 Medical Premiums for 2013-2014.................................................................................................................................. 5 Brief Comparison of Medical In-Network Benefits...................................................................................................... 6-7 HDHP-HSA Plan Questions and Answers .................................................................................................................... 8-9 APS HealthCare (Employee Assistance Program)...........................................................................................................10 CIGNA Behavioral Health (Additional Employee Assistance Program)...........................................................................11 Voluntary Benefits

WEA Select – Salary Insurance..........................................................................................................................12

AFLAC Supplemental Insurance........................................................................................................................12

Helpful Information

Flexible Benefit Spending Account (Section 125)..............................................................................................13

Family Medical Leave Act.................................................................................................................................14 C.O.B.R.A.........................................................................................................................................................14 Healthy Kids Now!............................................................................................................................................14 Basic Health of Washington..............................................................................................................................14 School Employee’s Retirement Systems............................................................................................................15 Deferred Compensation Information................................................................................................................15 Tax Sheltered Annuities....................................................................................................................................15

Insurance Company and Support................................................................................................................... Back Cover

The information herein is not a contract. It is a summary of the benefits available. It is not intended to be an all-inclusive description of Plan benefits, limitations or exclusions, and should not be used in lieu of a Plan book. Be sure to consult your Plan booklet, or consult with the insurance company representative before making your selection. If there are any discrepancies between this summary and the official Plan documents and booklets, the official Plan documents and booklets prevail. Questions may be directed to Michelle Williams at (425) 335-1511 or The Partners Group at (877) 455-5640. This summary was printed on September 5, 2013 . Any further information, revision by bargaining units or by insurers after this date could change or modify the information contained herein.

Summary Prepared by The Partners Group for the Lake Stevens School District 12309 22nd Street N.E. Lake Stevens, WA 98258

How to Select a Medical Plan You have a choice of 7 medical plans, which offer a variety of plan designs. An explanation of each plan design and plan names follow: PREFERRED PROVIDER ORGANIZATION type plans contract with a large number of providers. If you choose to receive your care through a preferred provider, the insurance company will pay a very high percentage of the charges. If you choose to go to a non-preferred provider, then the insurance company will pay a lower percentage of the charges. Preferred Provider Plan Choices: • MODA Health Plans 1, 2, 3, 4 and 5 HIGH DEDUCTIBLE HEALTH PLAN (HDHP) type plans have a high deductible, and require that the deductible be met prior to the insurance company making payment for any service except for preventive services. These plans are eligible to be paired with a Health Savings Account (HSA) that enables the member to pay for healthcare with pre-tax dollars. These plans are also PPO plans, which contract with a large number of providers. If you choose to receive your care through a preferred provider the insurance company will pay a very high percentage of the charges. If you choose to receive care through a non-preferred provider, then the insurance company will pay a lower percentage of the charges. HDHP-HSA Plan Choices: • MODA Health Plan 6 QHDHP HEALTH MAINTENANCE ORGANIZATION (HMO) type plans provide you with managed benefits and usually at a lower cost at the time of service. However, these plans require that you select a primary care provider (PCP) from their list of providers. Your PCP will then either provide or coordinate all of your care (except in the case of medical emergency). HMO Plan Choice: • Group Health Cooperative “Traditional” Plan

All enrollment forms must be completed and returned to Michelle no later than 09-24-13 to be effective by 11-01-13. These forms are available at the ESC. Special Enrollment Rights Description: If you need to enroll outside of open enrollment you must contact payroll immediately. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the school district plans, provided that you request enrollment within 30-60 days (depending upon carrier) after your other coverage ends. Request for enrollment of a new child by birth, adoption or placement for adoption must be made within 60 days of the date of birth, adoption or placement for adoption. Request for enrollment of all other newly eligible dependents must be made within 30-60 days (depending upon carrier) of the dependent’s attaining eligibility. Unless the above applies, understand that you may not be able to obtain coverage under the group insurance plan until the next open enrollment period. Obtaining coverage in the future will be subject to administrative rules and laws in force at that time. See your HR Department for specific timelines Special Note regarding pooling for enrollments outside of Open Enrollment: No monies will be available for medical enrollments received after “Open Enrollment” has closed with the exception of newly hired employees. Any enrollment changes that increase the health benefit premium, made after “Open Enrollment” will be paid in full by the employee. Please note: New employees are eligible for group mandatory and voluntary benefits beginning on the 1st of the month following 10 working days. Eligibility for participation varies by individual collective bargaining agreements. Please refer to your collective bargaining agreement to determine the minimum hours you must work to become eligible for benefits.

3

Benefit changes for 2013 – 2014

Washington State Allocation State allocation for employee benefits will remain at $768.00. The Retiree Medical Carve out (HCA) amount will be $64.40. The HCA provides school district retirees and their dependents medical insurance options when they retire. For more info go to www. hca.wa.gov. MODA Health • MODA Health plans are replacing all Regence Blue Shield and Premera Blue Cross plans for Classified employees and Administrators. • See Medical rate page for new rates for this plan year. Group Health Cooperative Benefit changes include: • No benefit changes. • 2.98% rate increase WEA – Washington Dental Service • Due to the plan year changing to November 1, Washington Dental Service (WDS) will be extending the benefit year by one month. All enrollees will receive a set dollar amount of approximately 1/12th of the $2,000 annual benefit maximum for the month of October. This “extra” benefit of $170 will be available in addition to any remaining balance of your 2012-13 benefit maximum. The full 2013-14 annual benefit year maximum will be available effective November 1. • No Benefit Changes. • No Rate Changes. WEA - Willamette Dental • No Benefit Changes. • No Rate Changes. NBN Vision Plan • No Benefit Changes. • No Rate Changes. WEA – VSP Plan D (Admin & Non Rep) • Replaced with NBN Vision. Washington Teamster Trust (Dental) • Rate increased by 3.4% as of 1/1/13. • Rates may change 1/1/14 (to be determined). Washington Teamster Trust (Vision) • No rate change as of 1/1/13. • Rates may change 1/1/14 (to be determined). CIGNA Long Term Disability • No benefit changes. • 5% Rate decrease WEA-Select Voluntary Short Term Disability Plans – American Fidelity Assurance Company (AFA) • No Benefit Changes. • No Rate Changes.

4

Lake Stevens School District No. 4

Medical Premiums 2013 – 2014 (monthly premium)

Classified Staff Medical Insurance

MODA Plan 1 PPO

MODA Plan 2 PPO

MODA Plan 3 PPO

MODA Plan 4 PPO

MODA Plan 5 PPO

MODA Plan 6 HDHP* PPO

$887.72

$768.81

$689.57

$649.05

$561.39

$566.08

Subscriber & Spouse

$1,686.66

$1,460.75

$1,310.18

$1,233.19

$1,066.64

$963.06

Subscriber & Child(ren)

$1,207.29

$1,045.59

$937.81

$882.71

$763.49

$724.87

Subscriber & Family

$2,006.24

$1,737.52

$1,558.43

$1,466.85

$1,268.74

$1,121.85

Subscriber

*HDHP: Your premium dollars include a monthly contribution of $125 towards your HSA. An HSA account must be opened by the employee before the contribution can be sent for your enrollment in the HDHP plan. Medical Insurance

Group Health Cooperative “Traditional” Plan

Subscriber

$708.51

Subscriber & Spouse

$1,364.85

Subscriber & Child(ren)

$986.81

Subscriber & Family

$1,643.20

2013 – 2014 State Allocation = $768.00 for full time employees (varies depending on pooling outcome by bargaining unit). From the above state allocation come the following premiums: Group Dental, Group Vision and Group Long Term Disability. The remaining amount, depending on the pooling outcome goes toward medical premiums. It is recommended that all employees read this sheet. Because of rate increases this year, you may now have payroll deduction costs or your current costs may increase with your present medical plan. Please Note: For Exclusions, Limitations and Clarifications see the individual plan booklet. This comparison is not a contract.

BENEFITS NOTES: To verify contract status with Moda Health Plans visit www.modahealth.com, Click Find Care. To receive in-network benefits, you must choose a Preferred Provider to receive the highest level of benefits.

5

6

30 visits PCY

Chiropractic Services:

Up to a 90 Day Supply $20 – Generic $40 – Preferred Brand $60 – Non-Preferred Brand Subject to deductible and $150 per day ($450 max) per individual PCY. Covered at 90% thereafter. Subject to deductible and $50 copay.

Mail Order

Inpatient Hospital: (PCY – Per Calendar Year)

Outpatient Hospital:

Out of Pocket Maximum: (Does not include co-pays)

Annual Deductible:

Up to a 34 Day Supply $10 – Generic $20 – Preferred Brand $30 – Non-Preferred Brand

Retail

$1000 per person $3000 per family

$300 per family.

$100 per individual.

Covered at 90% thereafter.

At Participating Pharmacies

Prescription Drugs:

$20 copay then 100%; Deductible Waived.


MODA Health First Choice Network PPO Plan 1

Physician Office Visit:

Medical Insurance

Benefits are paid at the percentage of allowable charges.




$200 per individual. $600 per family.

Subject to deductible and $100 copay. Covered at 80% thereafter.



Subject to deductible. Covered at 80% thereafter.

Subject to deductible Covered at 80% thereafter.



Subject to deductible and $300 per day ($900 max) per individual PCY. Covered at 80% thereafter.


30 visits PCY $30 copay then 100%; Deductible Waived.





Deductible Waived.

$25 copay then 100%;


BRIEF Comparison of In-Network Benefits






$250 Ded 30 Day Supply $15 – Generic $25 – Preferred Brand $40 – Non-Preferred Brand





7


$1000 per individual

Annual Deductible:

Out of Pocket Maximum: (Does not include co-pays)

Subject to deductible. Covered at 80% thereafter

Outpatient Hospital:


$3000 per family.


Inpatient Hospital: (PCY – Per Calendar Year)

$250 Ded 30 Day Supply $15 – Generic $25 – Preferred Brand $40 – Non-Preferred Brand Up to a 90 Day Supply $30 – Generic $50 – Preferred Brand $80 – Non-Preferred Brand

Mail Order

Retail

At Participating Pharmacies Subject to Med & RX Ded 30 Day Supply $15 – Generic $30 – Preferred Brand $50 – Non-Preferred Brand


Prescription Drugs:


$1500 per individual $3000 per family.

Subject to deductible. Covered at 80% thereafter


30 visits PCY Subject to deductible Covered at 80% thereafter.


Chiropractic Services:


MODA Health First Choice Network PPO Plan 6 HDHP



Physician Office Visit:

Medical Insurance

Benefits are paid at the percentage of allowable charges.

$2,000 per individual. $4,000 per family

No annual deductible

$20 copay then 100%.

$200 copay ($600 max) per Member per admission. Covered at 100% thereafter.

Up to a 90 Day Supply 2x Copay from the applicable prescription drug cost share for each 90 day supply or less.

Up to a 30 Day Supply $15 – Generic drugs $30 – Preferred Brand name drugs


Limited to 10 visits PCY. $20 copay then 100%.

$20 copay then 100%

Group Health Medical Insurance

BRIEF Comparison of In-Network Benefits

HDHP-HSA PLAN QUESTIONS AND ANSWERS This is a brief overview and is not inclusive of all tax laws regarding HSAs. More information can be found at www.treasury.gov, in IRS Publication 969, or consult your tax professional. How does the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) work? On the HDHP, the deductible must be met prior to your medical plan making payment for any service, except for preventive care. All services including prescriptions must be paid for in full until the deductible is met. You can use the funds in your HSA to pay for services and prescriptions. Once the deductible is met, you are responsible for coinsurance including prescription drugs. If there is family coverage, the entire family deductible must be met prior to your medical plan making payment. Who is eligible to participate in an HSA? •

In order to be eligible for an HSA, you must be covered by a HDHP and you or your enrolled spouse cannot be also covered under another medical plan unless the other plan is also an IRS qualified HDHP. If a spouse is covered by the school district, and is also covered by their employer or on an individual basis with a non-HDHP plan, they must choose only one of the medical plans.

•

If you are no longer covered by a High Deductible Health Plan, or you enroll in Medicare, you cannot continue to contribute to the HSA, but you can continue to use the funds to pay for qualified medical expenses.

•

You may not participate in an HSA if you can be claimed as a dependent on another person’s tax return.

•

Any person covered under the HDHP cannot participate in a Flex-Spending Account (FSA) or Health Reimbursement Account (HRA), including VEBA, unless it is a non-medical FSA, such as a daycare reimbursement FSA, or an HRA, VEBA or FSA that is limited to non-medical expenses. If your spouse has an FSA that could cover your medical expenses, you cannot participate in an HSA.

•

As the HSA is a bank account, you must be eligible to open a bank account, this process may include a credit check.

Procedure: 1. When going to the doctor or a pharmacy for a prescription, always present your medical insurance card at the time of service. 2. Your doctor will then bill your medical plan, or the pharmacy will apply your insurance information to the prescription. Your medical plan will process the claim, applying the charges to the deductible. If you go to a participating doctor or pharmacy, any discounts your medical plan has negotiated will apply and will reduce your out of pocket costs. You will also receive an Explanation of Benefits (EOB) from your medical plan, which will explain what your responsibility is and how much of the charges have been applied to your deductible. 3. You can now pay the provider with your HSA debit card. Many providers will bill you and provide space on the bill for you to write in your HSA debit card number to pay for the charges. If a provider or pharmacy does not allow credit card payments, you will need to submit your receipt for reimbursement. Contributions: •

You (and/or your employer) can contribute to your HSA up to the federal annual limit. The total allowed contributions for 2013, including employer contributions, is $3,250 for an individual only; and $6,450 for a family-when the HDHP coverage is employee plus dependent(s). The limit increases to $3,300 for individual and $6,550 for family for 2014. If you are over age 55, you may contribute an additional $1,000 per calendar year. A married couple with two separate Health Savings Accounts is limited to a total of $6,550 between the two accounts if one of the spouses has a HDHP with employee + dependent(s) coverage.

•

To contribute the full limit, you must be enrolled in a HDHP on December 1 of the calendar year. If you are not enrolled in a HDHP on December 1 of a calendar year, you may only contribute 1/12 the annual limit times the number of months you were covered on a HDHP.

•

Your contributions to your HSA will be deducted from your paycheck on a pre-tax basis and deposited by the school district.

8

HDHP-HSA PLAN QUESTIONS AND ANSWERS, Continued Distributions: •

Any time you go to the doctor or fill a prescription before your deductible is met, you can use the funds from your HSA. In addition, you are allowed to use your HSA for any “qualified medical expense” for medical, dental, vision, or other items that are allowed according to IRS Publication 502. For example, if you have a child who will need braces, you are allowed to contribute to your HSA with pre-tax dollars to pay for the braces. Over-the-counter drugs (with the exception of insulin) are not eligible expenses unless you have a written prescription from a physician.

•

Any distribution that is not a qualified medical expense is subject to a 20% tax penalty and income taxes.

Important facts about your HSA •

The HSA is a bank account in your name that belongs to you. If you leave the school district, the account goes with you, and you can continue to use the account for qualified medical expenses. Any monthly bank fees for the HSA bank account are your responsibility and will be deducted directly from your HSA.

•

Unlike an FSA, you can only use funds that have been already been deposited into your HSA account. If you have a bill for $400, but only $200 deposited to date in your HSA, you only have the $200 available to you.

•

If you use HSA funds for anything that is not a qualified medical expense, there is a 20% tax penalty, and you must report the amount to the IRS as regular income. You should keep all receipts for purchases made with your HSA card, to prove the purchases were a qualified medical expense in case you are audited by the IRS.

•

If you choose to go to a pharmacy that participates with the IIAS system, charges will be auto-adjudicated at the time of purchase. (a list of participating merchants is available at www.sig-is.org)

•

You cannot use your HSA funds for any item or service prior to your effective date on the plan. For example, if your plan was effective 10/1/13 and dentist performed a crown for you on September 5, 2013, and your portion is $400 of the cost of the crown, you cannot use your HSA funds for this service.

•

You can use HSA funds for qualified medical expenses for any tax dependent, even if they are not covered by your HDHP. However, you cannot use HSA funds for qualified medical expenses for someone who is not a dependent according to the IRS, for example, a child who is over age 26, or a domestic partner who is not a tax dependent.

•

All deductibles for HSA eligible High Deductible Health Plans reset on January 1 of each calendar year. There is no carryforward of deductibles met in the prior year. Therefore, if you join a HDHP November 1, your medical expenses will be subject to the entire annual deductible for November and December and the entire deductible will reset on January 1.

9

Employee Assistance Program

(Provided and paid for by the Lake Stevens School District) APS HealthCare: The EAP is a voluntary and confidential program providing free professional counseling, legal and financial consultation for all eligible employees, their dependents, wherever they reside and anyone living in the employee’s household (related or unrelated). On the counseling side, the EAP offers up to five (5) face-to-face sessions per incident and a 24 hour crisis hotline, staffed by master level counselors. The EAP services are provided by staff and contracted licensed/certified professionals who provide: 1) Assessment to help clients identify the core issues; 2) Education to improve employee/client’s health and lifestyle; 3) Brief Counseling regarding the primary and secondary presenting issues/problems; and 4) Referral as needed, to services for longer term treatment (e.g., depression; chemical dependence; eating disorders; etc.) EAP professionals carefully follow federal laws and regulations regarding confidentiality. Information regarding your contact with the EAP cannot be released without your written consent, except in the following situations: by imminent threat of harm to self or others; court order; or in situations of abuse (such as child or elder abuse). Legal services are also on a per issue basis and consist of up to 30 minutes of telephone or in person consultation with an attorney, for employees, dependents and anyone living in the employee’s household. (*Employment law issues and second opinions are excluded.) If the client decides to retain the attorney for further services the lawyer will charge a special 25% reduced rate from their regular fees, because you were referred through APS. If for any reason you would like to use another lawyer, APS will provide another referral resource. Clients with financial concerns also call the same toll free number and can be connected to a Certified Financial Planner or CPA – approximately 30 minutes, per issue – who is able to discuss these concerns and provide suggestions regarding a course of action. This phone consultation is on a per issue basis, and is provided free of charge to the employee, their dependents or household members. New Enhancement Effective October 1, 2012 Child/Elder Care and Daily Living Consultation and Referral Services are also available to employees. Work life consultants are available 24/7 to help individuals find the resources and services they need for child care, eldercare, education, adoption, wellness, and a wide variety of daily living issues. Access to Work life experts by telephone at your toll free 1-800-9991077. Referrals that are matched to each person’s unique needs and personal criteria for the resource needed. Also included is APS HelpLink giving you access to information and resources to enhance your life management skills. For information on parenting, managing change, self-assessments, online training modules and financial calculators, log onto www.apshelplink.com and enter our Company Code: lkstevens. Administrators and supervisors also have consultative services available with a senior staff regarding performance issues or any other work-related concerns; services are unlimited and can be over the phone or face-to-face. Program level services (trainings; orientations and brown bag sessions) are included, as well as critical incident intervention subsequent to a critical incident. All promotional materials (brochures, wallet cards, posters, monthly electronic tip Sheets and electronic newsletters) are all included. The EAP does not provide health or medical treatment, nor is it meant to provide long-term continuing services. It is designed for short-term relief and assistance. To access the EAP you may call APS Healthcare 24/7 and one of the APS clinicians will answer the phone directly: at (800)-999-1077. The 24-Hour Crisis Line is staffed 24-7 by Masters level clinicians and is the same number – (800) 9991077

10

EMPLOYEE ASSISTANCE PROGRAM CIGNA’s Life AssistanceSM Program helps all covered employees and their immediate family members (living in their household) to better balance their work and personal lives with access to online tools, in-person behavioral health assistance and live telephonic counseling - 24 hours a day, seven days a week. This program focuses on providing consultation, information, success planning, and referral to resources for a variety of concerns, including: Life Events Information, Research, and Referral Topics Research and up to 3 qualified referrals within 12 business hours (6 for emergencies) Parental Care Parenting (Includes online resources) Child Care (Includes online resources) This program’s unique advantages include:

Adoption (Includes online resources) Summer Care Special Needs Senior Care (Includes online resources)

Education (Includes online resources) Pet Care (Includes online resources) Legal Services Financial Information

• Proactive Outreach - Important outreach features in the claims process promote usage of CIGNA’s Life AssistanceSM program when employees need it most. Outreach includes reminders at the time of claim. • Emphasis on Personal Interaction - CIGNA’s Life AssistanceSM offers 24- hour, live, telephonic access to CIGNA’s licensed behavioral clinicians, and up to three, free face-to-face behavioral counseling sessions with independent specialists when needed. • Most Extensive Network of Behavioral Health Resources Available – Proximity and quick response are key during critical times. CIGNA Behavioral Health’s network of more than 54,000 contracted licensed behavioral health provides prompt, local access to support. • Comprehensive Life Events Services – The program offers information and referrals on a wide variety of topics, such as finding qualified child care, summer care, and senior care facilities, research and information on education programs, adoption, and financial information, plus a 30-minute free legal consultation for most legal issues. • Unique Healthy Rewards® Program - CIGNA’s Life AssistanceSM includes Healthy Rewards®, which offers discounts (up to 60%) on a range of health and wellness-related services and products, including discounts on Jenny Craig and smoking cessation programs, chiropractic care, fitness club memberships, hearing and vision care, massage therapy, acupuncture, pharmacy, vitamins, and more. A Password is required to use this benefit; Password: savings. • Assessment and Counseling - Up to three (3) in-person counseling sessions for employees and family members for assessment, problem solving, and referral to resources.

For further information: www.cignabehavioral.com/cgi Or 1-800-538-3543

11

Voluntary Benefits Voluntary programs are paid in full by the employee with after tax premiums. Enrollments are accepted all year. Contact the appropriate Company for more information. American Fidelity: Description: Eligible Classes: Enrollment Contact:

Voluntary Short Term Disability/WEA Salary Insurance Any bargaining group member working at least 17.5 hours per week Payroll Department (425) 335-1511 or American Fidelity (866) 576-0201 or www.americanfidelity.com For Administrative and Clerical Employees (Brochure SB-25660)

Benefit Amount: Waiting Period: Benefit Period:

Up to 66 2/3% of your monthly income to a maximum of $7,500/month 0 days for injury / 7 days for sickness (benefits begin on the 8th day for sickness)

60 days or 90 days depending on bargaining group* For Non-Clerical Educational Support Personnel (Brochure SB-25659)

Benefit Amount: Waiting Period: Benefit Period:

Up to 66 2/3% of your monthly income to a maximum of $7,500/month 0 days for injury / 7 days for sickness (benefits begin on the 8th day of sickness)

60 days or 90 days depending on bargaining group*

These plans include a limitation to offset with other sources of income. Participants will be eligible to receive up to 70% of their monthly earnings, which includes other income received, such as sick pay or unemployment compensation. Injury or Sickness arising out of or in the course of any occupation for wage or profit for which you are entitled to Worker’s compensation will not be covered under the plans. SB-26244-0713

*You are eligible for the plan which matches your specific group LTD Elimination/Waiting Period. AFLAC: Description: Eligible Classes: Enrollment Contact:

Supplemental Insurance covering such incidents as Accident, Sickness, Cancer, Short-Term Disability, Life Insurance and more Members of the following bargaining groups who work 19 or more hours per week Administrators, PSE-Office Professionals, Custodians, Non-Represented Gail Berg (206) 650-0450 or [email protected]

12

Flexible Benefit Spending Account / Section 125 (The open enrollment period is from September 1st through October 31st each year for an effective date of November 1st.) American Fidelity Assurance Company: There are three ways to save by participating in the Section 125 Plan – by pre-taxing eligible insurance premiums, by participating in the dependent day care expense reimbursement account, and by participating in the unreimbursed medical expense account. Section 125 enables participating employees to reduce their tax liability by setting aside pre-tax dollars from their earnings to pay for eligible out-of-pocket premiums, health care and dependent care costs. Consider the following reasons to participate: • Tax Advantages – The plan helps you lower the amount you pay in taxes and thereby, increase your take-home pay. • Control – You decide how much to put into the plan. • Out-of-Pocket Medical / Dental Expenses – You can pre-tax eligible medical and dental expenses, such as orthodontia, copayments, deductibles, etc. You must have a medical practitioner’s prescription on file in order to be reimbursed for over-the-counter drugs and medicines. • Dependent Care Expenses – The dependent day care expense reimbursement account reimburses for certain eligible dependent care costs (e.g., daycare) with pre-tax dollars and thus reduces your taxable income. The eligible insurance plans include dental, health and vision insurance premiums. These benefits will automatically be placed under the plan. If an employee does not want to participate in this plan, they must sign and return a “Premium Payment Plan Refusal” form to Michelle Williams BY September 24®th, 2013. Elections made under the Section 125 plan must remain in place for the length of the plan year unless the employee experiences an allowable election change event mid-plan year (consult your employer for more details). An employee cannot change or revoke their unreimbursed medical expense account election during the contract year. Cancellation or changes for this account are allowed only during the next annual open enrollment period. To take advantage of either or both of the unreimbursed medical expense account or dependent day care expense reimbursement account, you must meet with the American Fidelity representative during September/October to enroll. Check with your building secretary in September for the dates a representative will be in your building. Employees currently participating in either of the flexible spending accounts need to re-enroll for the November 1, 2013 to October 31, 2014 plan year with the American Fidelity Representative when they are in your building. Grace Period: The plan allows for a 70 day grace period for the unreimbursed medical expense account immediately following the end of each plan year during which unused benefits or contributions remaining may be reimbursed to plan participants for qualified medical expenses incurred during the grace period. At the end of the grace period, the plan allows for an additional 20 day runoff period during which the participant can submit claims incurred during the preceding plan year and/or grace period for reimbursement.

13

Family Medical Leave Act of 1993 (FMLA) The Federal Family and Medical Leave Act (FMLA) was signed into law in February 1993. The law took effect on August 5, 1993 and guarantees up to 12 weeks of unpaid leave each year to workers who need time off for birth or adoption of a child, to care for a spouse or immediate family member with a serious illness, or who are unable to work because of a serious health condition. FMLA is an employer law for groups with 50 or more employees; it covers employees and affects many of their job-related rights. This law also affects the health benefit plans maintained by employers who are required to comply. Employers are required by FMLA to continue to provide group health benefits at the same level and under the same conditions as if the employee had continued to be actively at work. A person who fails to return from an FMLA leave may be entitled to continuation of coverage under COBRA. Very Important: This Act is not intended to be used for any purpose other than to assist employees who take UNPAID family leave. Qualifications to receive FMLA benefits require that specific conditions (outlined in bold above) MUST be met. For specific questions and/or qualifications, contact the Human Resources Department or contact the Department of Labor for a copy of the FMLA law.

C.O.B.R.A. and Continuation of Coverage COBRA Notification, Rights and Responsibilities for Employees and Dependents COBRA Notices and Further Information. If you or a qualifying family member have any questions about notices provided to you by your employer, or questions about COBRA, please contact your employer representative below. Michelle Williams, Benefits Department Lake Stevens School District 12309 22nd Street N.E., Lake Stevens, WA 98258 (425) 335-1511

Healthy Kids Now! Free or Low-Cost Health Insurance for Kids & Teens in Washington State

Infants through teenagers can receive free or low-cost health insurance. Many families in Washington State qualify and don’t know it. These programs are flexible and cover kids in many types of households. This health insurance program covers a full range of services that all children need to stay healthy. For more information, please call 1-877-543-7669 or visit www.insurekidsnow.gov.

BASIC HEALTH OF WASHINGTON Basic Health is a low cost health insurance program offered through the State of Washington, for residents who qualify. If you qualify for a subsidized rate (depending upon total family monthly income and family size) you could receive health insurance coverage for your children at a low cost through this program. Parents do not have to enroll in Basic Health in order to enroll their children. For more information on Basic Health, please call 1-800-660-9840 or visit www.basichealth.hca.wa.gov.

14

School Employee’s Retirement Systems Questions regarding PERS / SERS / TRS benefit information please contact the Department of Retirement Systems @ 800-547-6657. Department of Retirement Systems Internet Site Address: www.drs.wa.gov TRS 3 / SERS 3 – Employee Contribution information – contact ICMA-RC at 888-711-8773

Washington State Deferred Compensation Program (DCP) What is the Deferred Compensation Program? The Deferred Compensation Program (DCP) helps you save for retirement on a pre-tax basis, offering the options you need to develop a personal investment strategy. With DCP, you authorize your employer to postpone or defer a part of your income, before taxes are calculated and have that money invested in your DCP account. Both the income you save and the earnings on your investments grow tax-deferred to add to your future retirement and Social Security benefits. With DCP, you decide how much money you want deducted from each paycheck. That can be as little as $360 per year or as much as the annual legal maximum of $17,500 if you are under age 50 and $23,000 if you are over age 50 for 2013. How does Deferred Compensation Work? With DCP, you may elect to defer a portion of your salary until retirement or separation from service. Automatic payroll deduction makes savings easy as the amount you choose to defer is taken from your gross income before taxed. For example, if you are in the 15% tax bracket, for every $100 you earn, you keep only $85 because $15 is withheld for federal income taxes. If you elect to defer $100 into a DCP account, however, your take home pay is only reduced by $85 because the $100 is deferred before taxes are calculated. When deciding how much to save, consider adding that extra income to your deferral amount. It can have a significant impact at the time you retire. Should you have questions or would like more information on the Washington State Deferred Compensation Program call the DCP information line at 1-888-327-5596. Representatives are available Monday through Friday, 8:00 am – 5:00 pm. Contact DCP by email: [email protected] You can also write them at the following address: Department of Retirement Systems Deferred Compensation Program PO Box 40931 Olympia, WA 98504-0931

403(b) Tax Sheltered Annuities Lake Stevens School District has 403(b) tax sheltered annuities available for employees who wish to set aside additional monies for retirement. For more information or to enroll contact our third party administrator, CPI Qualified Plan Consultants, Inc at 1-877-488-4040 or [email protected] or the payroll department at 425335-1511 for a list of approved vendors.

15

Lake Stevens School District No. 4 Insurance Committee Members Mike Hampton, Teamsters Custodians

CinDee Herndon, Non-Represented

Mike Schindler, Teamsters Custodians

TBD, Non-Represented

Ken Collins, Administration

Debbie Eichner-Hatch, PSE Office Professionals

Reen Doser, PSE of Lake Stevens

Pam Wicken, Human Resources

Debbie Speirs, LSEA

Michelle Williams, Benefits Specialist

Bob Ingraham, LSEA

Jennifer Spencer, The Partners Group

Dee Mackie, Transportation

Karen Anglin, The Partners Group

TBD, Transportation

Benefit Support Benefits Specialist

Michelle Williams

(425) 335-1511

Payroll Specialist

Kim Ostlund

(425) 335-1609

Human Resources Certificated

Pam Wicken

(425) 335-1555

Human Resources-PSE & Non-Reps

Kathy McCreary

(425) 335-1500 Ext: 2021

Human Resources-Teamsters

CinDee Herndon

(425)335-1500 Ext: 2035

Insurance Consultants

The Partners Group

(877) 455-5640

Benefit Representatives Medical MODA Health PPO 1, 2, 3, 4, 5 and Plan 6 QHDHP Medical Customer Service: (855) 522-9807 Pharmacy Customer Service: (866) 940-0360 (www.modahealth.com)

Voluntary Products American Fidelity Salary Insurance, cancer, accident Customer Service - (866) 576-0201 (www.afadvantage.com)

Group Health Cooperative Traditional HMO Plan Customer Service – (888) 901-4636 (www.ghc.org)

American Fidelity Flexible Spending Account Customer Service – (866) 576-0201 (www.afadvantage.com) Enrollment: Paul Loweecey (425) 894-2211 [email protected]

Dental Washington Dental Service Washington Education Association Customer Service - (800) 554-1907 (www.deltadentalwa.com)

AFLAC Supplemental Insurance Gail Berg (206) 650-0450 [email protected]

Willamette Dental Washington Education Association Patient Relations – (800) 360-1909 Appointments – (800) 359-6019 (www.willamettedental.com)

Employee Assistance Program APS HealthCare Employee Assistance Program Customer Service – (800) 999-1077 (www.apshealthcare.com)

Vision Northwest Administrators Northwest Benefit Network - Vision Customer Service - (800) 732-1123 (www.nwadmin.com)

“Additional” Employee Assistance Program CIGNA Behavioral Health Customer Service – (800) 538-3543 (www.cignabehavioral.com/cgi)

Life, Disability CIGNA Life & Long Term Disability Insurance Customer Service – (800) 362-4462 (https://dmswebintake.group.cigna.com)

16