UASD Open Enrollment 2021
UASD Benefits Open Enrollment Period: May 3 - May 28, 2021
Special Edition of the Employee Newsletter April 30, 2021
OVERVIEW
Annual Open Enrollment is your opportunity to review your benefits and make any changes for the year ahead, if needed. Health benefits remain one of the most valuable components of any employee compensation program. As in the past, Upper Adams School District is dedicated to offering you a comprehensive medical plan, while also contributing toward the cost of your premium.
To ensure continued coverage for you and your dependents, or to enroll in district coverage, see "What Should I Do?" in the next section.
The annual Open Enrollment period begins May 3, 2021. The deadline for all enrollment/change forms, and Spousal Eligibility forms to be returned to Tina Fair is May 28, 2021.
Insurance summaries, SBC's (Summary of Benefits Coverage), enrollment/change forms, spousal eligibility forms, etc. are all provided in this newsletter and can be accessed by clicking the appropriate link for the information/form.
(Contact Tina Fair to request paper copies of this newsletter and/or any documents within it.)
- If you are not making any changes to your health, dental, or vision insurance: Review all your benefits in your Staff Portal, and confirm that all information for yourself, and your dependents is correct. Your benefit elections will remain in effect for the 2021-2022 benefit year which is July 1, 2021 - June 30, 2022. If you have a spouse on your health insurance coverage see the Spousal Eligibility information below. If you do not have a spouse on your health insurance, there are no other forms for you to complete, however, please read the rest of this newsletter so that you are informed about your district benefits. To receive a paper copy of any forms or information in this Open Enrollment Notice, please contact Tina Fair at t.fair@upperadams.org.
- Spousal Eligibility Forms: Your spouse must meet the Spousal Eligibility each benefit year, whether they are newly enrolled or have been enrolled in the district health insurance. You are required to complete a spousal eligibility form each benefit year, and send the employer form to your spouse's employer for completion. Click the appropriate link below for a Spousal Eligibility form, and return it to Tina Fair, by May 28, 2021:
Administrator/Professional Spousal Eligibility form
Classified Spousal Eligibility form
- To enroll yourself, or add a spouse or dependent(s): You may enroll your dependent(s) when you enroll yourself. Proof of dependent eligibility may be requested upon enrollment. Spouses must meet Spousal Eligibility (see above). To enroll in or change insurance, you must complete an Enrollment/Change form, and return it to Tina Fair, no later than May 28, 2021.
Dependents who are eligible include:
Your legally married spouse (pending qualification)
Your dependent children (to age 26) (special rules for disabled children age 26 and over)
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QUALIFIED LIFE EVENTS
The choices you make during Open Enrollment will be in effect for the 12-month plan year from July 1, 2021 through June 20, 2022. However, you may make changes during the year if you experience a qualified life event. If you need to report a life event during the year, you must contact Tina Fair with the necessary changes within 31 days of the event. Some examples of life events are:
- Birth or adoption* of a child
- Marriage*
- Divorce and/or legal separation*
- Death or loss of a dependent (including loss of dependent status)*
- Change in your spouse's employment status causing loss or gain of benefits coverage*
- Change in your own employment status*
- Change in residence that affects the benefits offered to you*
- Eligibility for Medicare*
CONTACT PERSON FOR YOUR DISTRICT BENEFITS
Tina Fair, Human Resources Coordinator
Phone: 717-677-7191, extension 2721
Email: t.fair@upperadams.org
Office Hours: Monday - Friday, 7:30 a.m. - 4:00 p.m.
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MEDICAL AND PRESCRIPTION DRUG BENEFITS
Medical Insurance
The district will continue to provide medical coverage through Highmark Blue Shield with the option to choose between the PPO Blue Plan or the PPO Blue QHDHP (Quality High Deductible Health Plan) with an HSA (Health Savings Account). Both plans give you the freedom to choose your own doctors or hospitals. You will maximize your coverage by choosing participation providers within the BlueCross/BlueShield PPO network. Under the Highmark Blue Shield Program, you do not need to select a Primary Care Physician (PCP) or need to obtain a referral for services. However, if you receive care from a provider out of the BlueCross/BlueShield network, the plan pays a lower percentage of covered services and you will have higher out-of-pocket expenses, such as lower co-insurance.
Prescription Drug Coverage
Members in both the QHDHP and the PPO Blue plan automatically have prescription coverage. Express Scripts is the prescription drug benefit manager. With Express Scripts member receive the following benefits:
- Retail pharmacies. A network of over 60,000 participating independent and chain pharmacies nationwide.
- Convenient Home Delivery services through the express Scripts Pharmacy. You can have up to a 90-day supply of most maintenance medications delivered directly to you. Maintenance medications are those taken to treat an ongoing condition, such as high blood pressure, high cholesterol or diabetes.
- Online resources. You can go to https://www.highmarkblueshield.com/home/ for useful health and benefit information, along with online pharmacy services.
- Express Scripts Customer Service. Representative are available to you by phone 24 hours a day, 7 days a week (except Thanksgiving and Christmas). Pharmacists are also available around the clock for consultation.
- Specialist Pharmacists. These pharmacists are available 24/7 by phone to help you and your doctors make sure that your medications act safely together and work well for you. Each has had specialized training in the medications used to treat a specific long-term condition, such as diabetes, high blood pressure, and asthma.
To access your prescription benefits log in to your Highmark account at www.highmarkblueshield.com.
Click on the summary of benefits in the link below to see more information about prescription drug coverage for each plan.
HIGHLIGHTS OF EACH PLAN
What is an HSA?
An HSA is a tax-advantaged account that is used in combination with a qualified high deductible health (QHDHP) insurance plan. The money you put into your health savings account can help pay your health insurance plan's annual deductible, as well as any other qualified medical expenses that may not be covered by your health insurance plan after you meet your deductible Contributions to your HSA account cannot be used to pay for health insurance premiums.
QHDHP (Quality High Deductible Health Plan)
WITH AN HSA (Health Savings Account)
Annual Deductible: $1,400/single and $2,800/family.
Lower Bi-weekly Employee Cost
UASD Contribution Toward Annual Deductible: $1,150/single and $2,300/family
This contribution is deposited monthly into the members HSA account. The total contribution amount is divided by 12 months at the start of the benefit year. For enrollments after the start of the benefit year, the total contribution amount will be divided by the remaining months in the benefit year at that time.
Co-pays and prescriptions do not apply until the deductible has been met
Click here for the QHDHP SBC 2021 (Summary of Benefits and Coverage)
Click here for the QHDHP Summary of Benefits Coverage 2021
To enroll in this plan, complete the Enrollment/Change Form, and send it to Tina Fair.
To request to contribute or change your current contribution amount into your HSA, complete the HSA Payroll Deduction Form, and send it to Tina Fair.
Employees enrolled or who wish to enroll in the HSA: The provider for the Health Savings Account, will be changing from Health Equity to American Fidelity. More information is forthcoming and will be shared with all members in the HSA from American Fidelity.
District Change to Benefit Summary
QHDHP Plan: Urgent Care Copay $40 (reduced from $75)
Members will receive a new membership card in the mail due to this change.
What Expenses are Applied Toward Your Deductible?
(information below is for in-network services, information varies when using out-of-network providers). Under the QHDHP, any services received with the exception of Preventative Care, are applied towards your deductible. This includes (but is not limited to): office visits, hospitalization, emergency room visits/care, lab tests and prescription drug coverage.
Keep in mind that the deductible must be satisfied each year before the insurance company pays on any medical claims.
See more information about this plan below in "Benefits of Enrolling in the QHDHP with an HSA" article.
PPO BLUE PLAN
Annual Deductible: $500/single and $1,000/family
Higher Bi-weekly Employee Cost
UASD Contribution Toward Annual Deductible: $0
Most co-pays and prescriptions are not subject to the deductible
Click here for the PPO Blue SBC 2021 (Summary of Benefits and Coverage)
Click here for the PPO Blue Summary of Benefits Coverage 2021
To enroll in this plan, complete the Enrollment/Change Form, and send it to Tina Fair.
2021 Federal Changes to the Insurance Plans
- PPO Total Maximum Out of Pocket: $8,550/Single, $17,100/Family (no change from 2020)
- QHDHP Minimum Deductible: $1,400/Single, $2,800/Family (no change from 2020)
- QHDHP Maximum Total Maximum Out of Pocket: $7,000/Single, $14,000/Family (increase of $100/Single, $200/Family
- HSA Contribution Limit (Employer/Employee): $3,600/Single, $7,200/Family (Increase of $50/Single, $100/Family)
- HSA Catch up contribution over age 55: $1,000 (No change from 2020)
Benefit Costs for 2021
Benefits costs will not increase for the 2021 benefit year. To view the cost of your benefits, click the appropriate sheet below:
Administrator Benefit Cost Sheet 2021-2022
Benefits of Enrolling in the QHDHP Plan with a Health Savings Account (HSA)
An HSA is a tax-advantaged account that is used in combination with a qualified high deductible health insurance plan. The money you put into your health savings account can help pay your health insurance plan’s annual deductible, as well as any other qualified medical expenses that may not be covered by your health insurance plan after you meet your deductible. Contributions to your HSA account cannot be used to pay for health insurance premiums.
Benefits of an HSA
- Pretax contributions: If you are an HSA-eligible individual, you can make tax-free contributions to your HSA, up to the statutory maximum.
- Tax-free withdrawals: Withdrawals are tax-free when HSA funds are used for qualified medical expenses.
- Portability: Your HSA stays with you, even if you change employers or health plans.
Who is eligible to establish an HSA?
You are eligible to open a HSA provided you have met the following criteria:
- Must be enrolled in a QHDHP and not also be covered by another health plan that is not a QHDHP
- Not listed as a dependent on another person’s tax return
- Not be entitled to benefits under Medicare
What expenses are applied towards your deductible?
(information for in-network services: information varies when using out-of-network providers) Under the QHDHP, any services received with the exception of Preventative Care, are applied towards your deductible. This includes (but is not limited to): office visits, hospitalization, emergency room visits/care, lab tests and prescription drug coverage. Keep in mind that the deductible must be satisfied each year before the insurance company pays on any medical claims.
Single vs. Family Deductible
Under the QHDHP, if you are covering any dependents, the entire family deductible must be met prior to the plan paying for coverage. For example, if an Employee and Spouse are enrolled in coverage, between the two members, the full family deductible amount must be paid out-of-pocket prior to the plan paying for coverage.
Contributing to your HSA Account
The maximum amount you can contribute to your HSA account during the 2021 plan year is $3,600 for single and $7,200 for family. The contributions maximums are set by the IRS at the beginning of each year. (Remember, you must include the amount that Upper Adams School District contributes when calculating for the max contribution allowed). Upper Adams School District will contribute $1,150.00/single and $2,300/family into an HSA account for the 2021-2022 benefit year for members.
Click here for a short video on how an HSA works: HDHP Overview 2021
For the duration of the contract for the Act 93 and the UA-PSEA , the deductibles for the QHDHP Plan shall be the mandatory government minimums. The district shall contribute annually to the employees health savings account (HSA), an amount equal to $250 less than the IRS mandatory minimum deductible for single coverage or an amount equal to $500 less than the IRS mandatory minimum deductible for family coverage, depending on the coverage elected. The District’s annual contribution to the employee’s HSA shall increase annually, if necessary, corresponding with the IRS mandatory minimum deductible such that the District contribution to the HSA remains only $250 less than the deductible for single coverage or $500 less than the deductible for family coverage.
If you are married and your spouse has a family HDHP, then both spouses are determined to have family coverage. This is true even if one spouse has a family plan and the other has a self-only plan. Each spouse may have an HSA, and together you may contribute up to the family limit. You may not each contribute up to the family limit.
If you are age 55 and older you may contribute an additional $1,000 to your HSA. This is a “catch up” contribution that may be made each year that you are eligible for a HDHP. Once you enroll in Medicare you may no longer do this.
DID YOU KNOW?
All Highmark members can register for an account at https://www.highmarkblueshield.com/home/ . Members should use the member ID located on their member card when creating the account. Once an account has been created the member will have access to be able to:
- Use My Care Navigator to search for providers, and schedule appointments, transfer medical records, and more
- Access Virtual Medicine
- Access forms
- Access special member discounts
- Access SmartShopper
- Print or order a new insurance card for any member on their insurance
- View and print claim forms
- Refill mail order prescriptions (Express Scripts)
- View the Coverage Summary and full Benefits Booklet
- View the status of prior authorization
- View information about the Diabetes Prevention Program
SMART SHOPPER - SAVE AND EARN REWARDS!
Do you consider yourself a "smart shopper"? When you go to the grocery store, do you compare the cost of certain items to save money? When you shop for a specific item online, do you compare the cost of a product between different companies? Would you like to save money and earn rewards for doing so?
Then you should try the SmartShopper program available to you with your Highmark insurance coverage. SmartShopper can save you money and help you earn cash when you and your family use your medical benefits, by comparing medical procedures, lab tests, x-rays, etc. at different health care facilities. When you save money on routine medical care, Upper Adams School District saves money too which helps to keep the cost of your benefits premiums down. Registering your email is quick and easy. Click the link to SmartShopper or call the Personal Assistant Team at 1-866-285-7475. Call SmartShopper before having a test/procedure to see how you can save money.
SmartShopper can also be accessed in your Highmark account if you have registered for one. If you should have any questions, please reach out to anyone on the insurance committee. We hope you find this program beneficial!
Click the SmartShopper Example to see an example of a compared procedure between 3 healthcare facilities, the estimated cost for the procedure, and the SmartShopper reward.
WOMEN'S PREVENTIVE HEALTHCARE
The health care reform law (Affordable Care Act) requires health plans to cover certain preventive care services for women without any cost-sharing, such as deductibles, copayments or coinsurance. The following items are included in this coverage:
- Well-woman visits (annual preventive care visit in which adult women obtain recommended preventive services)
- Gestational diabetes screening for women 24 to 28 weeks pregnant, and women at high risk
- Human papillomavirus (HPV) testing for women 30 and older, once every three years
- Annual counseling for HIV and sexually transmitted infections, plus annual HIV testing for all sexually active women
- Contraceptives and contraceptive counseling.
- Breastfeeding support, supplies and counseling
- Domestic violence screening and counseling
Be sure to check your plans specific rules before receiving care. Though plans are required to provide these services free of charge, they do have the option of using cost-control measures, such as requiring to you pay for a brand name drug if a comparable generic drug is available, or charging a copayment for preventive services received at out-of-network facilities.
DENTAL INSURANCE
Upper Adams School District will continue dental benefits through Delta Dental for the upcoming plan year. Choose a PPO Dentist to receive the most out of your benefits. The Delta Dental website is easy to use and provides the most up to date and complete information for program participants:
- Locate a nearby participating provider, verify eligibility for you or a dependent.
- View benefit program and specific details
- Review claims and print ID cards.
View the full Benefits Summary Chart for PPO and Premier Dentists
Delta Dental - Virtual Consult
Virtual Consult connects Delta Dental members and dentists for real-time video appointments. Click the Delta Dental Virtual Consult flyer for more information.
Connect with a Dentist From Home with Toothpic!
Toothpic is a photo-based teledentistry app for PPO and Premier plan members that offers virtual dental screenings from a Delta Dental dentist. Click the Toothpic flyer for more information.
VISION INSURANCE
Upper Adams School District will continue to offer vision coverage through National Vision Administrators (NVA). Eligible dependents under 19 are entitled to receive a vision exam and one pair of lenses once every plan year and a frame once every two plan years or contact lenses and contact lens evaluation/fitting once very plan year. If you choose a frame, you will not be eligible for contact lenses for two plan years.) Eligible members and dependents 19 & over are entitled to receive a vision exam and one pair of lenses and a frame or contact lenses and contact lens evaluation/fitting once every two plan years.
The NVA website is easy to use and provides the most up to date and complete information for program participants:
- Locate a nearby participating provider by name, zip code, or City/State
- Verify eligibility for you or a dependent
- View benefit program and specific details
- Review claims
- Print ID cards.
View the full National Vision Administrators Plan Specific Details.
OTHER BENEFITS PROVIDED BY UASD
403b Plan Option
Employees may request voluntary tax deferred deductions from their pay into a 403(b) plan. These plans provide for funds later in life, while taking advantage of tax savings today. The employee must work with the representative of the plan they choose to make investment decisions. A list of 403(b) investment providers and the 2021 Universal Availability Notice can be found here. If you decide to contribute to one of the plans, please be sure to contact Lois Swope in the business office when you have set up your account with the provider.
Public School employees' Retirement System (PSERS)
Several retirement planning opportunities are available to employees each year through PSERS. Employees are encouraged to participate in these sessions, despite the number of years an employee may be from retirement to learn about this important retirement benefit. PSERS is a thorough and complex plan with many benefits. Employees should contact PSERS directly at 1-888-773-7748 or visit their member self service portal at www.psers.state.pa.us for more information.
Group Term Life Insurance
Term life insurance will be paid in full by the district for any employee who works at least 16 hours per week. This insurance terminates when the employee terminates employment with the district. Upon retirement, the provider may be contacted to convert the insurance to a regular insurance policy. Each category of employee has its own benefit coverage. To change a beneficiary for your life insurance, you must complete a new beneficiary form. For more information contact Tina Fair.
Wellspan Employee Assistance Program (EAP)
We all struggle from time to time with problems resulting from life demands and pressures. Some issues can be solved alone; others require help. These problems can affect our emotional well-being, job performance, home life and health. WellSpan EAP provides confidential, professional care to help individuals identify and resolve personal and workplace issues. UASD pays the cost for up to three visits to the EAP for all employees and immediate family members. No information on who receives counseling through the EAP is shared with the District. If you are struggling, think about contacting Wellspan EAP. They are there to help. Visit their website at Wellspan EAP for more information and providers.
IMPORTANT REGULATIONS AND REQUIRED NOTICES
DO YOU HAVE QUESTIONS ABOUT YOUR BENEFITS?
Contact the appropriate vendor directly for questions regarding benefits, claims processing, choosing a doctor, ID cards and copayments and deductibles.
Highmark Blue Shield
Member Service: 1-866-727-4943
Blues on Call: 1-888-258-3428
Website: www.highmarkblueshield.com
Claims Address: Highmark Blue Shield
PO Box 890173
Camp Hill, PA 17089-0173
All insurance cards are sent to the member directly from Highmark. The member must contact Highmark to request a new card if it is lost or stolen. The card also includes the information to fill/refill prescriptions at the pharmacy.
Prescription - Express Scripts
Phone: 1-800-903-6228
To access your information, and your prescription coverage, visit the Highmark website at www.highmarkblueshield.com.
Health Equity (HSA)
Changing to American Fidelity 7/1/2021 (more information to follow)
Customer Service: 1-866-346-5800
Website: https://aetna.healthequity.com
American Fidelity
Contact: AJ Galagher at 484-643-2881or by email at: aj.gallagher@americanfidelity.com
Delta Dental
Customer Service: 1-800-932-0783
Website: www.deltadentalins.com
Claims Address: PO Box 2105
Mechanicsburg, PA 17055-6999
National Vision Administrators (NVA)
Customer Service: 1-800-672-7723
Claims Address: PO Box 2187
Clifton, NJ 07015
Website: www.e-nva.com
Delta Dental and NVA do not send insurance cards to members. Members can print cards from their member account.