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Employee

Benefit Guide

UPLAND UNIFIED SCHOOL DISTRICT

Presented by DPIS Benefits

What's Inside

Health Plan Changes for 20-21 4 Employee & Dependent Eligibility 5-7Participation Requirements 8Mid Year Change 9Hearing Aid Services Benefit 10Term & Supplemental Life 11403B Retirement Savings 12Flexible Spending Account 13Employee Resources 14-15Frequently Asked Questions 16-22Carrier Contact Information 23-24Mandated Notices 25

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R E M E M B E R T H I S :

"The greatest medicine ofall is to teach people how

not to need it."Anonymous

Health Plan Changes

for 2020-21

This year employees will continue to enjoy medical, dental, vision and life benefits at no extracost. While the cost of the medical plans went up 7% on average, the District was able toabsorb the entire increase.

However, there will be some changes in benefits. Those enrolled in TRIO and Kaiser will have a$5 increase in office copayments. Also, inpatient hospitalizations will have a $250 deductibleper admission.

Those enrolled in Blue Shield's full network HMO will be changed to Blue Shield's Save NetHMO network. Please check with the District to see how this will affect you. Further, BlueShield's PPO plan will have a $35 office copay and a $4000 out-of-pocket annual maximum.

There will be no changes to the dental, vision and life plan.


Employees are eligible for coverage on the firstday of the month following their date of hire.

Active full time are those contract employeeswho work 100% of the applicable work schedule.

Active part time are those contract employeeswho work 50% or more of the applicable workschedule.

EMPLOYEE ELIGIBILITY

Exception: Employees hired during July and August will be effective September 1st.

DEPENDENT ELIGIBILITYThe definition of dependent includes your spouse, domestic partner (must be registered with theCalifornia State Registry or the County in which you reside) and child(ren) under the age of 26. Child(ren) includes stepchild(ren), child(ren) placed under a “qualified medical child support order”,(QMCSO), adopted child(ren) or child(ren) placed for adoption.


An unmarried dependent child may continue eligibility beyond age 26 if:

a) He or she is incapable of self-sustaining employment because of a physically or mentally disabling injury, illness or condition that began prior to reaching the limiting age;b) He or she is chiefly dependent on the eligible employee for support; and

Your effective date, or The first of the month following the date you

c) Proof of dependent’s disability is provided 60 days prior to the request. Such proof will be made from time to time according to each insurance carrier’s guidelines. Eligibility will continue if the dependent relies on the eligible employee for support because of the disabling condition.

Your dependent’s effective date is on the latest of:

acquire our dependent.

DEPENDENT ELIGIBILITY (Continued)

For your spouse, bring a copy of the marriage certificate; For a domestic partner, a certified copy of the Declaration of Domestic Partnershipfrom either the State or the County in which you reside; For child(ren), a copy of the birth certification or adoption decree.

If you are enrolling a new spouse, domestic partner or dependent child on yourmedical plan, you will need to submit a copy of one of the following documents withyour enrollment form. If you do not submit a verification document, yourdependent will not be enrolled for the 2020-21 plan year.

E L I G I B I L I T Y R E Q U I R E M E N T F O R C E R T I F I C A T E D &M A N A G E M E N T M A R R I E D E M P L O Y E E S

NEW DEPENDENT VERIFICATION

Beginning November 1, 2017, a Certificated or Management employee of Upland

Unified School District who is married to another District employee is no longer

eligible for dual coverage and must obtain coverage as a dependent under their

spouse’s plan.


PARTICIPATION REQUIREMENTS

Employees who work 90% or more of the full-time equivalent for the applicable jobclassification are required to enroll in the health benefits unless proof of coverageelsewhere is provided.

WHO MAY DECLINE COVERAGE

An eligible employee who works less than 90% of the full-time equivalent or receives lessthan 90% of the amount that is contributed towards an 8-hour full-time employee, mayenroll when first eligible, or decline coverage.

Further, if you are enrolled on your spouse's coverage and can show proof, you may alsodecline coverage. Should you lose that coverage, you will be eligible to reenroll in theDistrict's plan.

If you decline coverage, you must complete a Waiver of Health Coverage Form which can beobtained from Human Resources.


RULES FOR MID YEAR BENEFIT CHANGESOther than during annual open enrollment, you may make changes to your benefit electionsif you experience a qualifying event or qualify for a “special enrollment”. If one of theseoccur, you may be required to submit proof of the change or evidence of prior coverage. Submission of documents must be within 30 days of the event date to Human Resources.


Change in legal marital status, including marriage, divorce, legal separation, annulment,and death of a spouse;Change in number of dependents, including birth, adoption, placement for adoption, ordeath of a dependent child;Change in employment status that affects benefit eligibility, including the start or terminationof employment by you, your spouse, or your dependent child;Change in work schedule, including an increase or decrease in hours of employment by you,your spouse, or your dependent child, including a switch between part-time and full-timeemployment that affects eligibility for benefits;Change in a child's dependent status, either newly satisfying the requirements for dependentchild status or ceasing to satisfy them.

Qualif ied Changes in Status Include:

- Get reimbursed for most Hearing Aid Services by submitting a receipt- Services by licensed provider, audiologist or hearing aid dispenser

- Covers hearing aid exams, ear molds, fittings and counseling- Includes the hearing aid instrument, the initial battery & cord

- Up to $1500 per individual per year, $3000 family max

HEARING AIDSERVICES BENEFITHEALTH REIMBURSMENTARRANGEMENT

Administered by

GROUP TERM & SUPPLEMENTAL LIFE INSURANCEAll full-time employees working 5 hours a day or 20 hours a week (50% employee) areeligible for a District-paid Term Life Insurance in the amount of $50,000. This basic lifepolicy includes a $1,000 benefit for every spouse and child. An employee who works at least 15 hours a week can purchase Supplemental LifeInsurance for yourself, your spouse and your children. Newly hired employees are offeredGuarantee Issue up to $200,000, $50,000 for your spouse, and $10,000 for your childrenunder age 26.


- Get the power of tax advantaged growth- Administered by the nation's largest school-based credit union

- Provides a healthy supplement to your pension- A smart way to reach your retirement goals

403B RETIREMENTSAVINGS

CONVENIENT PAYROLL DEDUCTIONS

Administered by

Make the most of your benefits by stretching every benefit dollar.

FLEXIBLE SPENDING ACCOUNTS

- Make the most of your benefits by stretching every benefit dollar

- Tax free money goes from your paycheck into your Flex Account

- Submit claims and get reimbursed

EAP is a comprehensive behaviora l heal thserv ices program that of fers you someoneto ta lk to and resources to consul twhenever and wherever you need them. A to l l - f ree number g ives you d irect , 24/7access to a Guidance Consul tant , who wi l lanswer your quest ions and, i f needed, referyou to a counselor or other resources . Log on today to connect dai ly wi th aGuidance Consul tant about your issues orto consul t art ic les , podcasts , v ideos andother helpful tools .

EMPLOYEE ASSISTANCE PROGRAMOFFERED BY VOYA

Online: guidanceresources.comApp: GuidanceResources® Now

Web ID: My5848i

CALL: 877.533.2362

OTHER RESOURCES & SUPPORT FROM VOYA

Attorneys can help with familylaw matters, divorce, custody,child support and adoption,

bankruptcy, real estate &foreclosure, landlord-tenantissues, wills and living trusts

L E G A L G U I D A N C E

CPA's and Financial Plannerscan help with budgeting & debt

management, retirementplanning, investment options,tax and real estate questions,

mortgages, loans & refinancing.

F I N A N C I A L A D V I C E

Trained clinicians will listen toyour concerns and refer you toin-person counseling or otherresources for anxiety, stress,

depression, grief, loss, lifeadjustments and conflicts.

E M O T I O N A L S U P P O R T

Frequently Asked QuestionsSeeing the Whole Picture

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Getting married is a qualifying life event that allowsyou to add a spouse outside of open enrollment. Within one month of your marriage, you will needto complete new forms. Bring the completed formsto Human Resources, along with a copy of yourmarriage certificate. Your spouse will be enrolledthe 1st of the month following date of marriage.

If you divorce, your spouse is no longer eligible for coverage. You can obtain a change form onthe District’s website. Please sign and date the form and bring it to Human Resource. Coveragewill terminate at the end of the month of the date of divorce. Unenrolled spouses will receive aCOBRA notification to continue coverage from PayPro.

IF I GET MARRIED, HOW DO I ADD MY SPOUSE?

IF I GET A DIVORCE, MUST I REMOVE MY FORMER SPOUSE FROM MYCOVERAGE; AND IF SO, WHAT DO I DO?

Having a child is a qualifying life event and allowsyou to add them outside of open enrollment.Within one month of the birth/adoption, you willneed to complete new forms. Bring thecompleted forms to the Human ResourcesDepartment, along with a copy of your child’s birthcertificate. Your child will be enrolled the first ofthe following month following date of birth oradoption date.

IF I HAVE A BABY, WHAT DO I DO?

IF I HAVE A CHANGE OF ADDRESS, WHAT DO I DO?

If you have recently moved, you will need to update your address with the Certificated orClassified personnel specialist. Once your address has been updated with Human Resources,your new address will be changed with the insurance carriers. If you need help, please emailMelissa Barrios at [email protected].


Due to the Health Care Reform Act enacted in March 2010, all dependent children are eligible forcoverage until reaching the age of 26 regardless of their marital, job, or school status. Themedical carrier will automatically unenroll your child / dependent on the first day of the monthfollowing the day they reach age 26. If you have an adult child who is disabled and is close to turning 26, please contact HumanResources for steps to take so they can remain on your coverage.

Children can continue their

coverage under COBRA (at

their expense) for 36 months.

A COBRA notification package

explaining options will be sent

in the mail.

HOW LONG CAN I COVER MY DEPENDENTS?

Open Enrollment takes place every year during August to the middle of September, at which timeyou may change carriers or benefits, add dependents, or make other changes. Notices will be sentout through District email with dates and times. Benefits renew every year on October 1st, sochanges need to be submitted before October 1st to allow time for processing.

The Summary of Benefits for all medical,dental and vision plans are listed in thisbooklet. If you have questions regarding benefits,you can call Melissa Barrios in HumanResources at 909.985.1864 Ex 21101 oremail [email protected].

WHAT AND WHEN IS OPEN ENROLLMENT?

HOW CAN I FIND OUT WHAT MY BENEFITS ARE?


All full-time employees are eligible for $50,000 in group term life insurance benefits. This benefitis fully paid for by the District and lasts for the duration of your employment. Should you retire orterminate your employment with the District, please contact Human Resources for information onhow you can either terminate, port or convert your coverage.

WHAT ARE MY LIFE INSURANCE BENEFITS?

WHO CAN I CONTACT REGARDING MY VOLUNTARY BENEFITS WITH SCHOOLSFIRST, CHAFFEY FEDERAL, OR AMERICAN FIDELITY?

If you are interested in any voluntary/supplemental benefits, you can contact one of the servicerepresentatives listed on the Carrier Contact Information page in this booklet.

Certificated employees need to contact CalSTRS atwww.calstrs.com and Classified employees need tocontact CalPERS at www.calpers.ca.gov. Employees who are 55 or older and have worked a totalof ten years with the District are eligible to continuedcoverage as an Early Retiree. Be aware that there may be some changes to theserequirements every year. Specific details about yourbenefits after retirement will need to be discussed withHuman Resources. Please contact Melissa Barrios at 909.985.1964 Ex 21101or email at [email protected].

WHO CAN I CONTACT IF I AMTHINKING ABOUT RETIREMENT?


Vendor & Carrier Information We're Happy to Help.



Our Carrier PartnersTHEY 'RE HERE TO HELP!

HMO-PPO (888) 256-1915TRIO (855) 829-3566

blueshieldca.com(800) 464-4000www.kp.org

(866) 499-3001deltadental ins .com

Mandated NoticesWe've Got You Covered.

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AFFORDABLE CARE ACT (ACA)Beginning January 1, 2014, the ACA prohibits insurers from imposing pre-existing conditionexclusions. Further, the law stipulates that employers must offer coverage to full timeemployees that is considered Affordable, has Minimum Value, and covers Minimum EssentialCoverage. The District’s plan is considered qualifying.

NOTICE OF AVAILABILITY OF HIPAA PRIVACY NOTICEWe are required by federal and state law to protect the privacy of your individually identifiablehealth information and other personal information. Upland Unified School District iscommitted to maintaining and protecting the confidentiality of our employees’ personal andsensitive information.



THE WOMEN'S HEALTH AND CANCER ACT

All stages of reconstruction of the breast on which the mastectomy was performed;Surgery and reconstruction of the other breast to produce asymmetrical appearance;Prostheses; andTreatment of physical complications of the mastectomy, including lymphedema

The Women’s Health and Cancer Rights Act (WHCRA) requires employer groups to notifyparticipants of the group health plan, of their rights to mastectomy benefits under theplan. Participants have rights to coverage which is provided in a manner determined inconsultation with the attending physician for:

These benefits are subject to the same deductibles and co-payments applicable to othermedical and surgical benefits provided under the plan. You can contact your health plan’s Member Services for more information.


PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENS'HEALTH INSURANCE PROGRAM (CHIP)If you or your children are eligible for Medicaid or CHIP and you're eligible for healthcoverage from your employer your state may have a premium assistance program that canhelp pay for coverage using funds from their Medicaid and CHIP programs. If you or yourchildren aren't eligible for Medicaid or CHIP, you won't be eligible for these premiumassistance funds but you may be able to buy individual insurance coverage through theHealth Insurance Marketplace. For more information visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and live in a State listedbelow, contact your State Medicaid or CHIP office to find out if premium assistance isavailable.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you thinkthat you or any of your dependents might be eligible for either of these programs contactyour State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov tofind out how to apply. If you qualify, ask your State if it has a program that might help youpay the premiums for an employer-sponsored plan.

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENS'HEALTH INSURANCE PROGRAM (CONTINUED)If you or your dependents are eligible for premium assistance under Medicaid or CHIP,as well as eligible under your employer, your employer must allow you to enroll in youremployer's plan if you aren't already enrolled. This is called a 'special enrollment'opportunity and you must request coverage within 60 days of being determined eligiblefor premium assistance. If you have questions about your employer plan, contact theDepartment of Labor as www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

Depending on the state in which you reside, you may be eligible for assistancepaying your employer health plan premiums. A complete list of states along withcontact information as of January 31, 2015 is posted on the District's website. Formore information on eligiblility, contact your state.


IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICAREPlease read this notice carefully and keep it where you can find it. This notice hasinformation about your current prescription drug coverage with Upland Unified SchoolDistrict and about your options under Medicare’s prescription drug coverage.

This information can help you decide whether you want to join a Medicare drug plan. Ifyou are considering joining, you should compare your current coverage, including whichdrugs are covered at what cost, with the coverage and costs of the plans offeringMedicare prescription drug coverage in your area. Information about where you can gethelp to make decisions about your prescription drug coverage is at the end of thisnotice.

There are two important things you need to know about your current coverage andMedicare’s prescription drug coverage:


IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE(CONTINUED)Medicare prescription drug coverage became available in 2006 to everyone withMedicare. You can get this coverage if you join a Medicare Prescription Drug Plan or joina Medicare Advantage Plan (like an HMO or PPO) that offers prescription drugcoverage. All Medicare drug plans provide at least a standard level of coverage set byMedicare. Some plans may also offer more coverage for a higher monthly premium.

Upland USD has determined that the prescription drug coverage offered by both BlueShield and Kaiser is, on average for all plan participants, expected to pay out as much asstandard Medicare prescription drug coverage pays and is therefore consideredCreditable Coverage. Because your existing coverage is Creditable Coverage, you cankeep this coverage and not pay a higher premium (a penalty) if you later decide to join aMedicare drug plan.


IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE(CONTINUED)When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and eachyear from October 15th to December7th. However, if you lose your current creditableprescription drug coverage, through no fault of your own, you will also be eligible for atwo (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage If You Decide to Join a Medicare DrugPlan? If you decide to join a Medicare drug plan and drop your current Upland UnifiedSchool District prescription drug coverage, be aware that you and yourdependents may not be able to get this coverage back.

Please contact our office for more information about what happens to your coverage ifyou enroll in a Medicare prescription drug plan.


IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE(CONTINUED)When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? You should also know that if you drop or lose your current coverage with UplandUnified School District and don’t join a Medicare drug plan within 63 continuous daysafter your current coverage ends, you may pay a higher premium (a penalty) to join aMedicare drug plan later. If you go 63 continuous days or longer without creditableprescription drug coverage, your monthly premium may go up by at least 1% of theMedicare base beneficiary premium per month for every month that you did not havethat coverage. For example, if you go nineteen months without creditable coverage,your premium may consistently be at least 19% higher than the Medicare basebeneficiary premium. You may have to pay this higher premium (a penalty) if you haveMedicare prescription drug coverage. In addition, you may have to wait until thefollowing October to join.


IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE(CONTINUED)For More Information About This Notice or Your Current Prescription DrugCoverage… Contact the Human Resource Department listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you canjoin a Medicare drug plan, and if this coverage through Upland Unified School Districtchanges. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription DrugCoverage… More detailed information about Medicare plans that offer prescription drug coverageis in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail everyyear from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage: Visitwww.medicare.gov.

IMPORTANT NOTICE FROM UPLAND UNIFIED SCHOOL DISTRICTABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE(CONTINUED)Call your State Health Insurance Assistance Program (see the inside back cover of yourcopy of the “Medicare & You” handbook for their telephone number) for personalizedhelp Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescriptiondrug coverage is available. For information about this extra help, visit Social Security onthe web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Date: August, 2019Name of Entity: Upland Unified School District

Contact: Human Resources Department Address: 390 N Euclid Avenue, Upland CA 91786

Phone Number: (909) 985-1964, Ex 226


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