2020-12 academica nevada benefits guide

BENEFIT ENROLLMENT GUIDE Plan Year: 12/01/2020 – 11/30/2021

Doral Academy of Nevada / Doral Academy of No. Nevada / Mater Academy of Las Vegas / Mater Academy of No. Nevada/ Pinecrest Academy of Las Vegas / Pinecrest Academy of No. Nevada

SLAM / Somerset Academy of Las Vegas / Support Staff LLC / Troop LLC

1

BENEFITS GUIDE Academica

PICK THE BEST BENEFITS FOR YOU AND YOUR FAMILY.

Academica Nevada and its affiliate schools strive to provide you and your family with a comprehensive and valuable benefits package. We want to make sure you’re getting the most out of our benefits—that’s why we’ve put together this Benefit Enrollment Guide.

This guide will outline all the different benefits offered, so you can identify which are best for you and your family.

The information in this guide is effective 12/1/2020 to 11/30/2021.

TABLE OF CONTENTS Health Insurance .................................................................................................................. 04 Dental Insurance .................................................................................................................. 05 Vision Insurance ................................................................................................................... 06 Life & Accident, EAP, AFLAC ................................................................................................. 07 Your Cost ............................................................................................................................. 07 Locating Medical Providers In Network ............................................................................... 08 Online Member Center ........................................................................................................ 10 Urgent Care or Emergency Room? ...................................................................................... 12 Points of Care / Know Where You Can Go .......................................................................... 13 Telemedicine / Now Clinic Virtual Visits .............................................................................. 14 Dispatch Health Mobile Urgent Care .................................................................................. 15 Locating Dental / Vision Providers In Network .................................................................... 16 EAP (Employee Assistance Program) ................................................................................... 17 Questions & Answers ........................................................................................................... 18 Contact Information ............................................................................................................. 19

2


WHO IS ELIGIBLE? If you’re a full‐time employee at Academica Nevada and its affiliate schools and have met your new hire waiting period (first of the month following your full‐time date of hire), you’re eligible to enroll in the benefits outlined in this guide. Full‐time employees are those who work 30 or more hours per week. In addition, spouses, state registered domestic partners and dependent children (up to age 26) of employees are eligible for medical, dental, and vision coverage.

HOW TO ENROLL OR MAKE CHANGES Please refer to the online enrollment instructions provided by your office manager. Representatives from Distinctive Insurance will be available to help answer any questions you may have about your benefits for this upcoming year and assist with online election questions.

Elections need to be made through the School Payroll Services website. All employees should have an account created. If you are unsure of your log‐in information, please ask your office manager to assist you.

Website: https://online8.asurehcm.com/

Once all your information is up to date, it’s time to make your benefit elections. The decisions you make during open enrollment can have a significant impact on your life and finances, so it is important to weigh your options carefully.

Once you have made your elections, you will not be able to change them until the next company‐wide open enrollment period, unless you have a qualified change in status.

WHEN TO ENROLL OR MAKE CHANGES Returning Employees Open Enrollment‐ Open Enrollment starts 11/03/2020 and will end on 11/11/2020. The benefits you choose during Open Enrollment are effective December 1st.

New Hires‐ The benefits you choose during your enrollment period will become effective first of the month

following your date of hire. You must enroll or waive coverage within 30 days of hire.

HOW TO MAKE CHANGES You cannot make changes outside of the open enrollment period unless you experience a life‐changing qualifying event. Qualifying events include things like:

Marriage, divorce or legal separation

Birth or adoption of a child

Change in child’s dependent status

Death of a spouse, child or other qualified dependent

Change in employment status or a change in coverage under another employer‐sponsored plan

3


HEALTH INSURANCE

There are 3 Medical Plans available. 1 HMO plan and 2 PPO Plans. The following chart outlines the in‐network medical benefits available to you during the 2020‐2021 year: Please note if you choose the HMO plan you must select a PCP (primary care physician) at www.myhpnonline.com. If you do not select a PCP you will be automatically assigned to Southwest Medical Associates.

Please see the comparison chart below:

Medical Benefits Health Plan of Nevada (HMO) Sierra Health & Life (PPO) www.myhpnonline.com www.myshlonline.com Customer Service: 1‐800‐777‐1840 Customer Service: 1‐800‐888‐2264

4


DENTAL INSURANCE

In addition to protecting your smile, dental insurance helps pay for dental care and usually includes regular checkups, cleanings and X‐rays. Several studies suggest that oral diseases, such as periodontitis (gum disease), can affect other areas of your body—including your heart.

Receiving regular dental care can protect you and your family from the high cost of dental disease and surgery.

There have been no changes with your groups United Healthcare Dental Plan or Dental Plan Provider.

The following chart outlines the dental benefits offered:

Dental Benefits

www.myuhcdental.com Customer service: 877‐816‐3596 Provider Locator: 866‐633‐2446

Dental Plan Analysis

United Healthcare

100/80/50 w/ $1,500 Max

In‐Network Out‐of‐Network

DEDUCTIBLE & OUT‐OF‐POCKET MAXIMUMS

Individual Deductible $50 $50

Family Deductible $150 $150

Annual Benefit Maximum $1,500 $1,500

Child Orthodontia Lifetime Maximum (up to age 19) $1,500 $1,500

COINSURANCE Type A – Preventative 100% 100%

Type B ‐ Basic 80% 80%

Type C ‐ Major 50% 50%

Type D ‐ Orthodontia 50% 50%

BENEFIT DETAILS Root Canal Basic

Periodontal Surgery Basic

Complex Oral Surgery Basic

OTHER FEATURES Waiting Periods None

Out‐of‐Network Claim Payment Basis Maximum Allowable Charge

5


VISION INSURANCE Driving to work, reading a news article and watching TV are all activities you likely perform every day. Your ability to do these activities, though, depends on your vision and eye health. Vision insurance can help you maintain your vision as well as detect various health problems.

Academica’s vision insurance entitles you to specific eye care benefits. Your policy covers routine eye exams and other procedures, and provides specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses.

If you seek the services of a provider listed in the UHC Spectera Provider directory, your benefits include the following:

Vision Benefit www.myuhcvision.com

Customer Service: (800) 638‐3120 Provider Locator: (800) 839‐3242

Vision Plan Analysis

United Healthcare

$10 / $25 12/12/24

In‐Network Out‐of‐Network

COPAYS

Exams $10 Up to $45

Lenses for Glasses $25 Allowance Varies

Frames Up to $130 Up to $70

Elective Contact Lenses Covered contact selection: up to 4 boxes of contact lenses plus the fitting/evaluation fees and up to two follow‐up visits are covered in

full after $25 materials copay Non‐Selection contacts: $105

allowance (material copay waived)

Up to $105

FREQUENCIES Exams Every 12 Months

Lenses Every 12 Months

Frames Every 24 Months

OTHER FEATURES Network UHC Spectera

6


BASIC LIFE INSURANCE Academica Nevada provides $25,000 in group Basic Life and Accidental Death & Dismemberment (AD&D) insurance at no cost to all full‐time employees.

EMPLOYEE ASSISTANCE PROGRAM (EAP) There can be times when balancing work and the demands of everyday life can be challenging. That’s why you and your family have access to support through The Life Connection Employee Assistance, Work‐Life Resource and Referral Program. The Life Connection program is free of charge to all Academica Nevada and its affiliate schools’ employee and all in their households. Further information on this can be found on page 19.

SUPPLEMENTAL INSURANCE (AFLAC) Academica Nevada has partnered with AFLAC to provide employees with a variety of plan options. Rates and plans vary; contact Distinctive Insurance for more information or to meet directly with the AFLAC rep. These benefits are 100% funded by the employee and can be deducted pre‐tax from your paycheck.

YOUR COST

Despite the continual rise in premiums, Academica Nevada continues to provide reputable plan options for employees, cover a significant portion of the cost, and remain compliant with the Affordable Care Act. Every effort has been made to make these plan options rich in benefit while remaining as affordable as possible. You can find the plan premium rates when you login to the School Payroll Services Online Enrollment Portal.

7


LOCATING PROVIDERS IN‐NETWORK

Medical for NEVADA based Providers

Find a Provider You can locate a doctor or facility through Health Plan of Nevada(HMO) or Sierra Health & Life’s(PPO) online directory. Please keep in mind that the availability of any particular provider cannot be guaranteed.

If you enroll in the HMO plan: 1. Go to www.myhpnonline.com 2. Click on FIND A DOCTOR/PHARMACY 3. From the drop‐down menu, select Doctor or Provider

4. Select the “Employer Plans” icon

5. Select the type of plan “HMO”

6. Select the region of choice, which then directs you to the online provider search in a separate window.

7. For PCP (Primary Care Physician) codes look for the 8 digit Provider ID by selecting the “View Enrollment Information” under the provider name. Use their 8 digit code to assign your PCP. You can assign your PCP online after registering at www.myhpnonline.com or by calling member services on the back of your ID Card.

If you enroll in the PPO plan:

1. Go to www.myshlonline.com 2. Hover on FIND A DOCTOR/PHARMACY 3. From the drop‐down menu, select Doctor or Provider

4. Select the “Employer Plans” icon

5. Select the type of plan “PPO”

6. Select the region of choice, which then directs you to the online provider search in a separate window.

8


Medical for Providers Outside of Nevada

Find a PPO Provider Outside the State of Nevada Sierra Health & Life provides a different PPO network for employees not working in Nevada and/or those on the PPO plan needing to use the Nationwide Network. You will use United Healthcare’s online directory to locate in‐network providers. Please keep in mind that the availability of any particular provider cannot be guaranteed.

1. Go to https://choiceplus.welcometouhc.com/find-a-doctor

2. Click on Search the network: The Choice Plus Plan

3. Enter the location of your search, then enter the provider you wish to search.

9


10


11


12


13


14


15


Dental

Find a Provider & Register Online By registering online, you can view/print Explanations of Benefits (EOBs) and ID Cards. You can locate a provider by using the enhanced Dentist Search with Google® Map directions.

1. Go to www.myuhcdental.com 2. On the right‐hand side of the home page, click “Find a Dentist” to search for providers 3. Select the “National Options PPO 20” network

Vision Find a Provider 1. Visit www.myuhcvision.com 2. On the left‐hand side of the page, use the “Provider Quick Search” *To ensure you are viewing the network associated with your plan, current members should sign in prior to searching for a provider.

Register Online By registering for an account online, you can view benefits, print ID card, find a provider, check claim status, mail order contacts, and more.

1. 1. Visit www.myuhcvision.com 2. 2. Click “Register Now” on the left‐hand side 3. 3. Enter your information and register for an account

4. If you get stuck, there is a helpful “How Do I Register” video

16


17


QUESTIONS & ANSWERS

WHAT CHANGES ARE EFFECTIVE DECEMBER 1, 2020? Medical plans with HPN/SHL will remain the same with with no changes.

Dental/Vision/Life AD&D/EAP plans will remain the same with no changes.

WHAT ACTIONS MUST BE COMPLETED FOR YOUR ENROLLMENT? To complete your elections, you must login to your School Payroll employee portal and select desired coverages. Instructions

on how to enroll online are available from your office manager if you have not received them yet.

WHERE DO I FIND THE SCHOOL PAYROLL SERVICES ENROLLMENT PORTAL? https://online8.asurehcm.com/

WHEN ARE MY OPEN ENROLLMENT ELECTIONS DUE?

For Open Enrollment; elections must be completed no later than November 11th

For New Hires Enrollment; elections must be completed no later than 30 days from date of hire.

WHO DO I CONTACT IF I AM HAVING TROUBLE LOGGING IN OR TROUBLE WITH THE ONLINE PORTAL WHILE TRYING TO MAKE ENROLLMENT ELECTIONS?

[email protected] or by phone (702)‐552‐0256

WHO DO I CONTACT IF I HAVE BENEFIT PLAN QUESTIONS? If you have benefit plan questions such as need help finding a network provider, questions about plan copays and out of

pocket cost, claims, or ID card questions contact Sandra Camp at [email protected] or direct line 702‐990‐9106.

CAN I ENROLL MY DEPENDENTS IN DIFFERENT BENEFITS OR MUST ALL ELECTIONS BE THE SAME?

As long as you the employee are enrolling in a benefit you can put your dependent(s) on the plan in any variation. Forexample, you the employee elect Medical, Dental and Vision Coverages. You choose to enroll your children on the medicalleaving your spouse off the medical, but on the Dental and Vision Coverage you add them all children and spouse.

IF I HAVE COVERAGE THROUGH MY SPOUSE CAN I ENROLL AND HAVE DOUBLE COVERAGE? Yes, if you have coverage through your spouse that you want to keep you can also enroll in your own employers group plan.

When you choose to be double covered, your own employer plan coverage will become your primary benefit and yourspouse plan will become secondary. In these situations, we recommend that if your spouse has an HMO that you choose theHMO or if your spouse has a PPO plan that you choose the PPO plan. HMO and PPO plans do not match up so if you do nothave the same type of plan this situation may not be beneficial to you.

WILL I GET NEW ID CARDS? WHAT ID CARDS SHOULD I HAVE?

Medical coverage provides ID Cards. If you make a new Medical Election you will get a new ID Card. This year everyoneenrolled on the medical plan will receive new updated ID Cards whether you make a change or not. You can continue usingyour current ID. ID Cards generally take 7‐10 days to arrive after the change is processed with the carrier.

Dental coverage provides ID Cards. If you make a new Dental Election you will get a new ID Card. If you are not making a newDental election change, you will not be sent a new ID Card. You can continue using your current ID. ID Cards generally take 7‐10 days to arrive after the change is processed with the carrier.

Vision coverage DOES NOT send ID cards. You WILL NOT receive a Vision ID card. You must register online atwww.myuhcvision.com to print your vision ID or contact Distinctive Insurance for assistance to get your member ID.

18


Contact Information Questions regarding eligibility, benefits, claims, and ID cards can be directed to the following insurance resources:

Carrier/Resource Phone Website

Enrollment & Online Portal

Email:

[email protected] Phone: 702-552-0256

https://online8.asurehcm.com/

Distinctive Insurance Benefits Account Manager: Sandra Camp, 702-990-9106

Email: [email protected]

Health Plan of Nevada (HMO Plan)

Group# 60002463

Member Services: 1-800-777-1840 24 Hour Nurse Advice: 1-800-288-

2264 Southwest Medical Associates: 1-

800-720-7253

www.myhpnonline.com

Sierra Health & Life (PPO Plan)

Group# 60002463

Member Services: 1-800-888-2264 24 Hour Nurse Advice: 1-800-288-

2264 Southwest Medical Associates: 1-

800-720-7253

www.myshlonline.com

Outside of Nevada PPO Provider Link:

https://www.providerlookuponline.com/uhc/po7/Search.aspx

Optum Rx Member Services: 1-855-816-6618 https://www.optumrx.com/RxSolWeb/mvc/home.do

Now Clinic (Virtual Visits/Telemedicine)

https://nowclinic.com/landing.htm

United Healthcare (Dental)

Group# 0906521 Customer Service: 1-877-816-3596

www.myuhcdental.com

United Healthcare

( Vision) Group# 0906521

Customer Service: 1-800-638-3120

www.myuhcvision.com

The Life Connection-Employee Assistance Program (EAP)

Customer Service: 1-800-280-3782 www.bhoptions.com

AFLAC Lisa Edlin: 702-338-5152

Email: [email protected]

The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your Guide, contact Human Resources.

19

2020-12 academica nevada benefits guide

Documents