Comprehensive Employee Benefits Overview
This orientation provides detailed information on employee benefit eligibility, making changes during the year, medical plans including Kaiser Permanente options, and PeakMed Direct Primary Care services. Eligibility criteria, dependent coverage, and key enrollment timelines are outlined. The medical plans offer varying benefits like lower deductibles, out-of-pocket costs, and alternative health options. PeakMed services include unlimited primary care, chronic disease management, mental health support, and more. Stay informed to make the most of your employee benefits package.
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Presentation Transcript
NEW HIRE ORIENTATION PRESENTED BY: EMPLOYEE BENEFITS
Eligibility All Full-Time employees working at least 30 hours per week are eligible on the 1stof the month following date of hire. All teachers working at least .41 FTE or 17 hours per week. Eligible dependents: An eligible employee s spouse (unless legally separated) including common law spouse An eligible employee s current same-gender domestic partner An eligible employee s current partner in a civil union An eligible employee s dependent child from birth to the end of the calendar month in which they turn 26 years of age
Making Changes During the Year In most cases, your benefits remain in effect for the entire plan year (July 1 through June 30). During each open enrollment period, you will have the opportunity to review your benefit elections and make changes for the coming year. You can make mid-year changes only if you have a Family Status Change: Marriage, divorce, or legal separation Birth, adoption, court order, disability, death, marriage, or reaching the dependent age limit. Changes in your spouse s employment affecting benefit eligibility Changes in your spouse s benefit coverage with another employer that affects benefit eligibility
Making Changes During the Year You have 31 days from the date of the of a Family Status Change to turn in a completed enrollment/change form and supporting documentation to Employee Benefits. If you fail to turn in your documentation within 31 days, you will have to wait until the next open enrollment period to make changes. The effective date of the Family Status Change is the day of the event. Example: you are married on 9/25, you will add your spouse effective 9/25.
Medical Plan Kaiser Permanente Commercial Plan 2 Plans- Buy-Up Plan and the Base Plan Buy-Up Plan: Lower deductibles and out-of-pocket costs , lower co-pays and more alternative health options, including Acupuncture, Chiropractic and Massage Therapy. Base Plan: Lower premiums with higher deductibles/MOOP, Acupuncture and Chiropractic, and same access to physicians as the Buy-Up Plan Both plans include Out of Network Benefits and membership to PeakMed Direct Primary Care offices and services. 75/25 split with D11 paying 75% of the employee medical premium on the Buy-Up Plan 85/15 split with D11 paying 85% of the employee medical premium on the Base Plan
PeakMed Direct Primary Care Direct Primary Care Service includes, but is not limited to the following: $0 Cost Unlimited Primary Care No deductibles No waiting for appointments Thorough consultations Coordination with your Kaiser Medical Plan Adult & Pediatric Care Chronic Disease Management: High blood pressure, diabetes, etc. Mental Health & Wellness Sports Medicine, including InBody 570 body composition analysis On-Site Pharmacy with wholesale pricing Blood draws with low-cost test results Wound care, including stitches, staples and/or surgical glue Dermatology procedures: skin tag and wart removal, skin biopsies Annual & School Sports Physicals EKG & Pulmonary Function Testing
Pharmacy Benefits GETTING PRESCRIPTIONS FILLED WITH KAISER PERMANENTE You are automatically enrolled in the prescription drug program, administered by Kaiser Permanente, when you enroll in the Colorado Springs School District 11 medical plan. The prescription drug program provides both retail and mail-order pharmacy coverage. Your medical and prescription cards are combined into one card, which will come from Kaiser. Learn more at kp.org/mobile. There you will find links to download the Kaiser Permanente mobile app, which will include your digital ID card. 30-day Copay 90-Day Copay GENERIC $10 $20 BRAND NAME $30 $60 NON-FORMULARY $45 $90 SPECIALTY / INJECTABLES / IV 20% coins. up to $250 per RX Not Available
Dental Plans Dental Plan Provider- Delta Dental of Colorado PPO IN-NETWORK ONLY PLAN #9098 In-Network coverage only 100% coverage for preventative services (2 cleanings per year) 60% coverage for Basic Services (fillings, root canal, oral surgery) 40% coverage for Major Service (crowns, bridges, partials, dentures) 50% coverage for Braces- no age limit PPO + PREMIER PLAN #1563 Standard dental plan- you can see any dentist 100% coverage for preventative services (2 cleanings per year) 80% coverage for Basic Services (fillings, root canal, oral surgery) 50% coverage for Major Service (crowns, bridges, partials, dentures) 60% coverage for Braces- no age limit RIGHT START 4 KIDS PROGRAM- Covers children up to their 13th birthday at 100% with no deductible (for the same services outlined in the plan, up to the annual maximum, and subject to limitations and exclusions). The child must see a Delta Dental PPO or Premier provider to receive the 100% coinsurance. If an out- of-network provider is seen, the adult coinsurance levels will apply. Orthodontics, if selected as part of the group s plan, is not covered at 100% but at the plan s listed coinsurance.
Vision Plan Vision Provider- EyeMed Vision Care Up to $140 allowance for contacts annually Annual Exam- $10 Copayment Up to $140 allowance for frames every 12 months 15% off of Lasik 20% discount off of non- prescription sunglasses $25 copayment for lenses annually
Life Insurance Policy through Sun Life Financial BASIC LIFE INSURANCE 100% paid by D11 2 x annual salary with a minimum benefit of $50,000 Flat $50,000 for bus drivers and food service VOLUNTARY LIFE INSURANCE Elect up to $100,000 additional coverage for yourself, $25,000 for your spouse and $10,000 for each child up to age 26, guaranteed issue! Guaranteed issue during your initial eligibility period only. Election is also available during our next full open enrollment in April/May, but you will be required to answer health questions for all levels of coverage.
Voluntary Short-Term and Long-Term Disability Policy through Sun Life Financial SHORT-TERM DISABILITY Wage replacement for short-term injuries, illness or having a baby Elect to receive $50 per week up to 60% of your salary per week 15 day waiting period before benefits are paid 6-8 weeks paid for maternity LONG-TERM DISABILITY Wage replacement for long-term illness or accidents Pays 60% of your salary monthly 90-day waiting period before benefits are paid
Flexible Spending Account (FSA) Provider: Rocky Mountain Reserve 2 ACCOUNTS AVAILABLE Medical FSA Dependent Care FSA MEDICAL FSA Pay for out-of-pocket medical, dental and vision expenses incurred by you and your dependents with pre-tax dollars. $610 Annual Maximum Rollover/$20 Minimum Rollover DEPENDENT CARE FSA Pay for work-related childcare expenses with pre-tax dollars WHY FSA? Every dollar of earnings converted to from wages to tax-free benefits means fewer taxes (no PERA, Medicare, Federal, or State withholding taxes are subtracted from this money) which means more money for you!!
Profile EAP Confidential counseling for all employees and their dependents Appointments scheduled Monday Friday. A counselor is available 24 hours per day, 7 days per week for crisis assistance. Counseling Benefit (8) Eight sessions per person, per problem, per plan year (7/1-6/30)Legal/financial services Free consultation Discounted rates on additional services Unlimited access to information resources on www.ProfileEAP.org Click Signup to create and account. Use COMPANY CODE: CSD11 There is NO COST to employees or dependents! The EAP licensed professional counselors are there to help with life's problems. Relationship issues Family problems Grief Stress, depression or anxiety Substance abuse Workplace difficulties Almost any personal or professional problem is appropriate for seeking assistance through EAP. 24/7 Crisis Service If you need help handling a crisis, after hours, a counselor can be reached 24 hours a day.
D11 Website www.d11.org Employees Employee Benefits Access your Self-Service account to view your paycheck and benefit elections. View all benefit plan documents, Health Promotion Program information and much more. Provider contact information and websites
Questions Contact Your Employee Benefits Team! Andrea Palos Benefits Manager Ang Kammerer Benefits Specialist Mackenzie Minazumi Benefits Admin Monday-Friday from 8am-5pm 719.520.2178 Employee.Benefits@d11.org
