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BENEFITS
WORKBOOK
2015
Your Aspire Benefits Package
Table of Contents
Core Health Benefits
Introduction to Your 2015 Aspire Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Your Total Benefits Package at Aspire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Plan Provisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Glossary of Key Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Medical Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Dental Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Automatic Aspire Paid Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Tuition Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Additional Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Retirement Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Voluntary Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Benefit Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Per Pay Period Benefit Cost Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Aspire Public Schools | 2
Your Aspire Benefits Package
Introduction to Your 2015 Aspire Benefits
A
t Aspire, we understand how critical our teammates are to the success of our schools and making sure that all of our students are
achieving “College for Certain.” At the same time, we have to make sure we remain financially prudent to survive any future budget
cuts and address our continuing struggle with our tight bottom line. While Aspire has experienced an increase in costs for benefits year over
year, we were able to hold our teammate contributions for the last 4 years. This year, Aspire took a freshCore
look atHealth
the contributions
Benefitsby plan
and has adjusted the contributions to align with the actual costs of the plan while still offering a choice in each region for teammates to have
100% paid coverage, while continuing to meet our promise of taking care of our teammates with families.
In addition to the changes to teammate contributions, here are a few additional changes and items of importance for the 2015 plan year:
Aetna HMO for Memphis, Tennessee
UNUM Voluntary Benefits
Similar to our California teammates, we felt it was important for
To better serve our teammates with online enrollment and
Memphis teammates to have a true HMO option available. We
enhanced plan options, we are moving to UNUM for our Short
are pleased to offer the Aetna HMO in TN in placement of the
Term Disability, Critical Illness and Accident plans. The new
Premium PPO offered through Blue Shield.
plans offer tax free disability payments for Short Term Disability,
Customer Benefits Administrators (CBA) –
A New Partner for Our FSA!
CBA will administer our FSA for 2015, replacing MGIS. We
believe teammates will be excited about the online capabilities
and service enhancements that CBA offers. Similar to prior
years, if you wish to enroll in either the Health Care FSA or the
Dependent Care FSA, you need to make a new annual election.
increased cancer coverage for Critical Illness and increased
benefit payments under the Accident plans. If you are currently
enrolled in either the Transamerica or CAIC/AFLAC plans, here
is what will happen:
ƒƒ Transamerica – Aspire will no longer offer a Whole Life
Insurance plan. If you want to keep your Transamerica
plan, you can convert the plan to an individual plan.
Teammates will receive the option to do this directly from
Transamerica.
ƒƒ CAIC/ALFAC – Teammates currently enrolled in any of the
products offered through CAIC/AFLAC will be allowed to
enroll in the new programs through UNUM without having
to satisfy new evidence of insurability. If you are an existing
teammate not currently enrolled in CAIC/AFLAC, you can
still take advantage and enroll in one of the UMUM plans
with some guarantee issue of coverage. CAIC/AFLAC will
not allow teammates to convert these plans to individual
plans, therefore if you want to keep a policy for Short Term
Disability, Critical Illness or Accident Insurance, you will
need to enroll in one of the UNUM plans through bSwift.
Aspire Public Schools | 3
Your Aspire Benefits Package
Your Total Benefits Program at Aspire
To help you understand the full range of benefit options available to you, this workbook divides Aspire’s benefits into four categories:
Core Health Benefits
Savings and Reimbursement
Benefits
Core Health
Benefits
Aspire pays 100% of the base plan option and a portion of
Pre-tax plans that allow you to pay for eligible expenses and
all other options for you and your dependents. Pricing varies
save for retirement.
according to the plan option.
ƒƒ CBA FSA Health Care Reimbursement Account
ƒƒ Kaiser Permanente HMO – High and Low options
ƒƒ CBA FSA Dependent Care Reimbursement Account
ƒƒ Aetna HMO option – Memphis only
ƒƒ CBA FSA Commuter Benefit (Parking and Transit)
ƒƒ Blue Shield Medical – HMO and PPO options
ƒƒ American Funds 403(b) Retirement Account
ƒƒ Delta Dental – DHMO and PPO options
ƒƒ State Retirement Programs (mandatory, for eligible
teammates)
ƒƒ Vision Service Plan
ƒƒ Tuition Reimbursement
Automatic Aspire Paid Benefits
Teammate Funded Voluntary Benefits*
Aspire automatically pays 100% of your coverage. No sign-up
Additional insurance coverage is available for you to purchase
is required, except for tuition reimbursement.
to help provide financial support in the event you are unable to
ƒƒ CIGNA Life and AD&D
work due to injury, disability or death.
ƒƒ CIGNA Short Term Disability (STD)
ƒƒ CIGNA Voluntary Term Life
ƒƒ CIGNA Long Term Disability (LTD)
ƒƒ Unum Group Voluntary Short Term Disability (STD)
ƒƒ Claremont Employee Assistance Program
ƒƒ Unum Group Accident Insurance
ƒƒ BeyondWork Employee Discount Program
ƒƒ Unum Group Critical Illness Insurance
* These are post-tax benefits. This means that the amounts are deducted from your paycheck after regular payroll taxes have been applied, but you will not
pay income taxes on any benefits received.
Aspire Public Schools | 4
Your Aspire Benefits Package
Plan Provisions
Eligibility
Making Changes to Your Benefits
Full-time, regular teammates working a minimum of 30 hours
Remember, Open Enrollment is in November and changes
become eligible for benefits on the first of the month following
are effective on January 1. Coverage remains in effect for the
date of hire. Regular full-time teammates who have been with
Benefits
remainder of the calendar yearCore
unlessHealth
you have
a qualifying life
Aspire for at least one year, who have had a status change and
event, defined by the IRS as any of the following:
work between 20 and 29 hours, are eligible for partial benefits.
The following family members may be enrolled in the medical,
ƒƒ The addition of a dependent through birth, adoption or
marriage.
ƒƒ The loss of a dependent through divorce or death, or if your
child reaches the maximum age limit for coverage.
dental and vision programs:
ƒƒ Your legal spouse.
ƒƒ Your qualified domestic partner.
ƒƒ Your children to age 26 (regardless of student status,
marital status or residency).
ƒƒ Your qualified domestic partner’s children to age 26
(regardless of student status, marital status or residency).
ƒƒ Your dependent child who is incapable of self support
because of a mental or physical disability.
ƒƒ A change in your or your spouse’s employment status from
full-time to part-time or vice versa.
ƒƒ A substantial change in your benefits coverage or a
spouse’s coverage.
ƒƒ The addition or separation of a qualified domestic partner.
ƒƒ Change in eligibility for Medicaid or Children’s Health
Insurance Program (CHIP) subsidy.
Any benefit changes must be consistent with the type of event you
Domestic Partner
Benefit eligibility requirements for domestic partnerships are as
follows:
experience. If you add a dependent, you can add them to your
benefits but you cannot drop another dependent from benefits.
ƒƒ You must be in a committed, exclusive relationship and
intend to remain partners indefinitely.
For example, if you have a baby, you can add the baby to your
ƒƒ You must live together and share the same residence.
In order to make changes to your benefits due to a qualifying life
ƒƒ Neither you nor your partner is married to someone else
or is a member of another domestic partnership within the
last six months.
medical plan but you could not drop a spouse from the plan.
event, you must request the change within the first 30 days after
your life event.
ƒƒ You are responsible for each other’s basic living expenses
during the domestic partnership and share financial
responsibility for any debts incurred as a direct result of an
extension of benefits.
Declining Benefit Coverage With
Cash In-Lieu Option
ƒƒ You and your partner are not related by blood in a way that
would prevent you being married to each other in this state.
paycheck or $1,800 per year). Payroll taxes will apply. In selecting
ƒƒ You are both at least 18 years of age.
ƒƒ You are capable of consenting to the domestic partnership.
ƒƒ May be of the same or opposite sex.
Teammates electing to waive all Core Health Benefits are eligible
to receive cash back in the amount of $150 per month ($75 per
this option, you are verifying enrollment in another group medical
plan outside of Aspire Public Schools. Cash-in-lieu is not available
to teammates receiving state/federally funded benefits including
Medicare/Medicaid/or Medi-Cal, nor is it available to teammates
There are additional taxes associated with covering a Domestic
who are receiving coverage through a spouse/domestic partner
Partner or their children. Please see page 24 for additional
who is also employed by Aspire.
information on these costs.
Default Plan
Dependent Children
For the purpose of our benefit plans, eligible children include:
If you do not enroll in one of the Aspire medical plans when you
become eligible for coverage, Aspire will automatically enroll you
ƒƒ Natural and adopted children.
in the Cash-In-Lieu Option. Once enrolled, you cannot make any
ƒƒ Stepchildren who you support and who live with you in a
parent-child relationship.
changes to your coverage until next Open Enrollment unless you
have a qualifying event.
ƒƒ Any other children you support for whom you are the legal
guardian or for whom you are required to provide coverage
as the result of a qualified medical child support order.
ƒƒ A child who is your qualified IRS dependent.
Aspire Public Schools | 5
Your Aspire Benefits Package
Glossary of Key Terms
Balance Billing – The practice of billing a member for the
Guarantee Issue – The amount of coverage (benefit) the
difference between what an Out-of-Network physician or dentist
insurance company is willing to provide regardless of your health.
charges and what the insurance carrier has agreed to pay
Guarantee Issue only applies if you enroll in the program when
providers for specific services (see: Reasonable and Customary).
you are first eligible for coverageCore
as a new
hire.
Health
Beneficiary – The person you designate to receive your life
In- and Out-of-Network – All medical, dental and vision carriers
insurance proceeds in the event of your death.
have a designated network of doctors or dentists. If you seek care
Coinsurance – The member and insurance company share the
cost of covered procedures in a specific ratio (e.g., member pays
Benefits
from an In-Network provider, the benefits you receive will be at a
higher rate, resulting in less out-of-pocket cost.
20% and the insurance company pays 80%). This is primarily used
Mail Order – A benefit that allows you to order certain
in medical and dental PPO plans. Coinsurance does not apply
maintenance drugs at a reduced cost. You receive multiple
until the member has paid the deductible.
months’ worth of medication by mail.
Conditional Guarantee Issue – An amount above the regular
Non-formulary – Any brand name medication that is not included
Guarantee Issue (GI does not require a health assessment), that
on the formulary list.
can be provided without a full physical exam. There are generally
several health questions that are asked to receive this level of
benefit.
PCP – Primary Care Physician. A doctor who is your first point
of contact and who must coordinate your care and refer you to
specialists. Primarily required by medical or dental HMO plans.
Coordination of Benefits – When one person is covered by more
than one insurance plan, the two plans “coordinate” coverage
to determine which insurance carrier pays first and which pays
Premium – The per pay period and/or monthly cost of a benefit.
Pre-Tax – Employer contribution or employee money used to
pay for certain benefits that is deducted from your pay before it is
second.
Copay – A specific dollar amount you pay to the provider or
pharmacy when receiving services or prescriptions.
Deductible – The amount you must pay before most services are
taxed. Pre-tax benefits can increase your take-home pay.
Post-Tax – Employer contribution or employee money used to pay
for certain benefits that is deducted from your pay after it is taxed.
covered. The deductible is generally waived for services that are
Proof of Insurability and Proof of Good Health –
subject to a copay, including prescription drugs.
A questionnaire that insurance companies use to ask about the
health of a participant. Depending on the responses, this may lead
Dependents –
to the requirement of a physical exam. These forms are often used
ƒƒ Spouse or domestic partner.
ƒƒ Children up to age 26 regardless of student status, marital
status or place of residency.
ƒƒ Any dependent child who is incapable of self-support
because of a mental or physical disability that you claim on
your federal tax return.
Domestic Partner – To qualify for benefits, a domestic partner
if you apply for voluntary benefits outside of your initial eligibility
period or if you apply for an amount above the Guarantee Issue
amount.
Qualifying Life Event – A significant life change, as defined on
page 5, that allows you to make changes to your benefit choices
outside of Open Enrollment.
must meet all criteria listed on page 5. Additional tax liabilities
Reasonable and Customary – The range of usual fees
apply to coverage for domestic partners and their children. Refer
for comparable services charged by the medical or dental
to page 24 for more information
professionals in a geographic area. If your provider charges more
Formulary – A list of preferred medications identified by the
medical carrier. These medications are generally brand name
than the reasonable and customary fee, you may be responsible
for paying the difference (see: Balance Billing).
drugs. Generally these medications are covered at a higher rate by
the benefit provider. You can obtain a list of formulary medications
by visiting the carrier websites located on the Contacts page.
Aspire Public Schools | 6
Core Health Benefits
Your Health Plan Choices
It is important to Aspire that you make the best plan choices for you and your family. The following pages provide comparisons of each of
the health plans, as well as sample teammate scenarios for the medical options listed below. Read the information carefully and refer to
the Glossary of Key Terms on the previous page as needed. Please note, the Kaiser Permanente HMO and Blue Shield HMO plans are
only available to teammates residing in California, and the Aetna HMO plan is only available to teammates
residing
in Memphis.
Core Health
Benefits
Kaiser Permanente High vs. Kaiser Permanente Low
Jill lives in California and is interested in Kaiser Permanente’s one stop shopping and electronic medical records.
The main difference between these plans is the copay and monthly contributions. If Jill were single, she could select
Kaiser Permanente High ($10) plan and the lowest out-of-pocket costs for sick visits, but she would have a monthly
contribution as well. If Jill had a family, she would want to compare the cost of the monthly premiums versus the cost
Jill
of copays she would incur for sick visits to the doctor, as indicated below.
Kaiser Permanente High
($10 copay)
Kaiser Permanente Low
($30 copay)
$3,912
$1,573
$150
$450
$0
$250 per admission charge
Annual Contributions
Doctor visits (estimated 15)
Hospital Stay
Total annual expenses paid by Jill
$4,062
$2,273
Total paid annually on her behalf by Aspire
$14,153
$14,153
Aetna HMO vs. Blue Shield PPO
Jose’s wife is pregnant and he is trying to determine which plan would be best. He would spend less out of pocket
on the HMO; however, his wife’s OB/GYN is not part of the Aetna HMO network. They will have to decide if saving
$3,153.84 annually in monthly contributions and copays is worth having to change doctors for the delivery of their
new baby. If they wanted to keep his wife’s doctor and access specialists without approval of a Primary Care
Physician that are not in the Aetna network, they would need to select the Blue Shield PPO plan.
Jose
Annual Contributions
Doctor visits (estimated 15)
Hospital Stay
Aetna HMO
Blue Shield PPO
$1,959.12
$2,712.96
$150
$300
$0
$250 deductible plus 10% = $2,250
Total annual expenses paid by Jose
$2,109.84
$5,262.96
Total paid annually on his behalf by Aspire
$17,630.40
$15,372.48
Cash Back Option
Claire has the option to get coverage through her partner’s employer. As a result she declines all core health
benefits, which means she receives $1,800 cash back annually. This is a win for Claire because she and her
partner could use the additional $1,800 ($150 per month), as well as a win for Aspire because her school gets to
use the money they would have spent on benefits that Claire does not need.
Claire
Aspire Public Schools | 7
Core Health Benefits
Medical Plans for California Teammates
Kaiser Permanente HMO Plans: You must receive all services from a Kaiser Permanente physician at a Kaiser Permanente facility, except
in cases of medical emergency. Kaiser Permanente Low has lower premiums and higher copays. Kaiser Permanente High has higher
premiums and lower copays.
Core Health Benefits
Kaiser Permanente
Low Option ($30 Copay)
Kaiser Permanente
High Option ($10 Copay)
Lifetime Maximum
None
None
Annual Deductible
None
None
$1,500 per member;
$3,000 per family1
$1,500 per member;
$3,000 per family
Office Visit
100% after $30 copay
100% after $10 copay
Specialist Visit
100% after $30 copay
100% after $10 copay
Preventive Care
100%
100%
Lab & X-ray
100%
100%
Chiropractic
Not covered2
Not covered2
Acupuncture
100% after $30 copay; PCP referral required3
100% after $10 copay; PCP referral required3
100% after $30 copay
100% after $10 copay
50%
50%
Urgent Care
100% after $10 copay
100% after $10 copay
Emergency Room
(copay waived if admitted)
100% after $50 copay
100% after $50 copay
100% after $250 copay per admission
100%
Generic
100% after $10 copay; up to 30-day supply
100% after $10 copay; up to 30-day supply
Brand – Formulary4
100% after $25 copay; up to 30-day supply
100% after $20 copay; up to 30-day supply
N/A
N/A
Generic:100% after $20 copay
Brand name: $50 copay;
up to 100-day supply
Generic:100% after $20 copay
Brand name: $40 copay;
up to 100-day supply
General Plan Provisions
Annual Out-of-Pocket
Maximum
Outpatient Services
Outpatient Surgery
Fertility Services
(diagnosis & treatment of underlying cause)
Emergency Services
Inpatient Services
Hospitalization
Prescription Drugs
Brand – Non-formulary4
Mail Order
Excludes certain copays, amounts above Reasonable & Customary and items not covered. See Blue Shield’s Evidence of Coverage for more specific
exclusions.
2
There is no chiropractic benefit in the Kaiser Permanente Low or High plans or the Blue Shield HMO. However reduced rates are available for these
services. To learn more visit www.kp.org/choosehealthy or www.blueshieldca.com.
3
Reduced rates are available for these and other complementary and alternative treatments. To learn more visit www.kp.org/choosehealthy or
www.blueshieldca.com.
4
Formulary refers to a list of brand name drugs approved by the insurance carrier. For Blue Shield; Non-formulary drugs are not on the approved drug list
and are therefore subject to a higher copay. Visit www.blueshieldca.com to view the list of Formulary drugs. For Kaiser Permanente; visit www.kp.org to view
the list of Formulary drugs. When a Kaiser Permanente physician determines that a Non-formulary medication is medically necessary and prescribes it for
you, that drug will be covered under the terms of your drug plan.
5
All percentage coinsurance benefits on the PPO plan are after deductible. Out-of-network charges are also subject to Reasonable and Customary
allowances.
1
For more information visit www.kp.org
Aspire Public Schools | 8
Core Health Benefits
Medical Plans for California Teammates
Blue Shield HMO (Access+ HMO): With the Blue Shield HMO, you must select a Primary Care Physician (PCP) for you and for your
dependents. All care, except emergency services, must be coordinated through your PCP in order to receive the benefit. You may change
your PCP each month by calling Blue Shield Member Services.
Health
Benefits
Blue Shield PPO (Spectrum PPO 250-90-70): With the Blue Shield PPO, you have the flexibility atCore
the time
of service
to seek care
from an In-Network or Out-of-Network provider.
ƒƒ Choosing an In-Network provider – you will receive a higher level of reimbursement.
ƒƒ Choosing an Out-of-Network provider – less reimbursement for the same services, and you must pay any amount above the
Reasonable & Customary charges.
Benefits that are not subject to a copay are subject to a deductible and coinsurance. The deductible is the amount you pay before Blue
Shield starts paying benefits.
Blue Shield HMO
(Access+ HMO)
General Plan Provisions
Blue Shield PPO
(Spectrum PPO 250-90-70)
In-Network
Out-of-Network
Lifetime Maximum
Unlimited
Unlimited
Annual Deductible
None
$250 per member; $500 per family
Annual Out-of-Pocket
Maximum
$1,000 per member;
$2,000 per family1
$2,250 per member;
$4,500 per family1
$10,250 per member;
$20,500 per family1
100% after $10 copay
100% after $20 copay
Plan pays 70%; you pay 30%5
100% after $10 copay with PCP
referral; $20 self-referred visit
100% after $20 copay
Plan pays 70%; you pay 30%5
Preventive Care
100%
100%
Not covered
Diagnostic Lab & X-ray
100%
Plan pays 90%; you pay 10%
Preventive: Plan pays 100% after
$20 copay5
Plan pays 70%; you pay 30%5
MRI, PET scans, etc.
100%
Plan pays 90%; you pay 10%5
Plan pays 70%; you pay 30%5
Chiropractic (12 visits/year unless
stated otherwise)
Not covered2
$25 copay after deductible
Plan pays 70%; you pay 30%5
Acupuncture
Not covered 3
Not covered 3
Not covered
Outpatient Surgery
100%
Plan pays 90%; you pay 10%5
Plan pays 70%; you pay 30%5
Fertility Services (diagnosis &
treatment)
50%
Not covered
Not covered
Outpatient Services
Office Visit
Specialist Visit
Emergency Services
Urgent Care
Emergency Room (copay waived if
admitted)
100% after $10 copay;
$50 if outside service area
Free-standing facilities – 100% after $20 copay
Non-Free Standing facilities – plan pays 90%; you pay 10%5
100% after $100 copay
Plan pays 90%, you pay 10%5
Inpatient Services
Hospitalization
100%
Plan pays 90%, you pay 10%5
Generic
100% after $10 copay
100% after $10 copay
Brand - Formulary4
100% after $25 copay
100% after $25 copay
Plan pays 70%, you pay 30%5
Prescription Drugs
Brand - Non-formulary4
Mail Order
100% after $40 copay
100% after $40 copay
Generic: 100% after $20 copay
Formulary: $50 copay
Non-formulary: $80 copay
Generic: 100% after $20 copay
Formulary: $50 copay
Non-formulary: $80 copay
For more information visit www.blueshieldca.com
Aspire Public Schools | 9
100% after you pay 25% of
allowable amount & applicable
copay
Not covered
Core Health Benefits
Medical Plans for Tennessee Teammates
Aetna HMO: With the Aetna HMO, you must select a Primary Care Physician (PCP) for you and for your dependents. All care, except
emergency services, must be coordinated through your PCP in order to receive the benefit. You may change your PCP each month by
calling Aetna Member Services.
Health
Benefits
Blue Shield PPO (Spectrum PPO 250-90-70): With the Blue Shield PPO, you have the flexibility atCore
the time
of service
to seek care
from an In-Network or Out-of-Network provider.
ƒƒ Choosing an In-Network provider – you will receive a higher level of reimbursement.
ƒƒ Choosing an Out-of-Network provider – less reimbursement for the same services, and you must pay any amount above the
Reasonable & Customary charges.
Benefits that are not subject to a copay are subject to a deductible and coinsurance. The deductible is the amount you pay before Blue Shield
starts paying benefits.
Aetna
HMO
Blue Shield PPO
(Spectrum PPO 250-90-70)
General Plan Provisions
Lifetime Maximum
Annual Deductible
Annual Out-of-Pocket
Maximum
In-Network
Unlimited
Out-of-Network
Unlimited
None
$250 per member; $500 per family
$1,000 per member;
$2,000 per family1
$2,250 per member;
$4,500 per family1
$10,250 per member;
$20,500 per family1
Office Visit
100% after $10 copay
100% after $20 copay
Plan pays 70%; you pay 30%5
Specialist Visit
100% after $20 copay
100% after $20 copay
Plan pays 70%; you pay 30%5
Outpatient Services
Preventive Care
100%
100%
Not covered
Diagnostic Lab & X-ray
100%
100% after $20 copay5
Plan pays 70%; you pay 30%5
MRI, PET scans, etc.
100% after $100 copay
Plan pays 90%; you pay 10%5
Plan pays 70%; you pay 30%5
Chiropractic
100% after $20 copay
$25 copay after deductible
Plan pays 70%; you pay 30%;5
limited to 12 visits/year
Acupuncture
Not covered
Not covered 3
100%
Plan pays 90%; you pay 10%
Not covered
Not covered
Outpatient Surgery
Fertility Services (diagnosis &
treatment)
Not covered
5
Plan pays 70%; you pay 30%5
Not covered
Emergency Services
Urgent Care
Emergency Room (copay waived if
admitted)
Free-standing facilities – 100%
after $35 copay
Free-standing facilities – 100% after $20 copay
Non-Free Standing facilities – plan pays 90%; you pay 10%5
100% after $100 copay
Plan pays 90%, you pay 10%5
Inpatient Services
Hospitalization
100%
Plan pays 90%, you pay 10%5
100% after $10 copay
100% after $10 copay
100% after $25 copay
100% after $25 copay
100% after $40 copay
100% after $40 copay
Generic: 100% after $20 copay
Formulary: $50 copay
Non-formulary: $80 copay
Generic: 100% after $20 copay
Formulary: $50 copay
Non-formulary: $80 copay
Plan pays 70%, you pay 30%5
Prescription Drugs
Generic
Brand - Formulary
4
Brand - Non-formulary4
Mail Order
For more information visit www.blueshieldca.com
Aspire Public Schools | 10
100% after you pay 25% of
allowable amount & applicable
copay
Not covered
Core Health Benefits
Dental Plans for Teammates in All Locations
DeltaCare USA (DHMO): You must select a DeltaCare USA Primary Care
Dentist or Dentist Office for you and your dependents. All care, except
emergency services, must be coordinated through this Dentist or Office in order
to receive the benefit. You may change your Dentist or Office each month by
Core Health Benefits
calling Member Services.
Delta Dental PPO Plan: At the time of service, you have the flexibility to seek
care from an In-Network or Out-of-Network provider.
ƒƒ Choosing an In-Network PPO provider – You will receive a higher level of
reimbursement by selecting a Delta PPO dentist.
ƒƒ Choosing Delta Premier provider – While benefits are technically paid out
of network, Delta Premier dentists will not charge you more than Delta
allows for a particular service. This could potentially save you significant
dollars.
ƒƒ Choosing an Out-of-Network provider – You will likely receive less reimbursement for the same services, and you must pay any
amount above the Reasonable & Customary charges.
DeltaCare USA DHMO
General Plan Provisions
In-Network Only
Delta Preferred PPO
In-Network
Out-of-Network
Annual Deductible
None
$50 per member
Annual Maximum1
None
$2,000 per member
$1,500 per member
100%2
100%
100%
Type B – Basic Services
Includes: fillings, extractions,
endodontics, periodontics, oral
surgery, and sealants
Refer to DeltaCare USA2
schedule for copayments
Plan pays 80%; you pay 20%
Plan pays 80%; you pay 20%
Type C – Major Services
Includes: crowns, cast restorations,
bridges, dentures and implants3
Refer to DeltaCare USA2
schedule for copayments
Plan pays 50%; you pay 50%
Plan pays 50%; you pay 50%
Type D – Orthodontia
Refer to DeltaCare USA2
schedule for copayments
Plan pays 60%; you pay 40%
Plan pays 50%; you pay 50%
Coinsurance
Type A – Preventive Care
(No deductible)
Includes: x-rays, exams, and
semi-annual teeth cleaning
Orthodontia Lifetime Maximum
Adults & Children are covered
None
$1,500 per member
1
Annual Maximum for In-Network and Out-of-Network cross apply.
2
Copays are required for services and vary by procedure. Refer to the DeltaCare USA Schedule posted on MyAspire.
3
Dental implants are only covered under the PPO option. They are excluded from the DHMO.
For more information visit www.deltadentalins.com
Aspire Public Schools | 11
Core Health Benefits
Vision Plan for Teammates in All Locations
Vision Service Plan – VSP: With this plan you have the flexibility, at the time of service, to seek care from an In-Network or Out-of-Network
provider. If you receive care from an In-Network provider, you will receive a higher level of coverage. Choosing an Out-of-Network provider
will result in less coverage for the same services.
In addition to the benefits below, you have access to a number of discounts through VSP including:
Core Health Benefits
ƒƒ 35 – 40% savings on lens coatings.
ƒƒ 30% discounts on additional prescription (sun)glasses if purchased on the same day as the appointment, or 20% within the year.
ƒƒ Discounts on laser vision correction.
If you have had laser vision surgery, you can use your frame allowance to buy non-prescription sunglasses from a VSP provider.
In-Network
Out-of-Network
100% after $10 copay
You may pay any amount over the
$50 maximum benefit
Eye Glass Lenses
(one pair each 12 months per covered
member)
Single
Bifocal
Trifocal
100% after $25 copay
100% after $25 copay
100% after $25 copay
$50 maximum
$75 maximum
$100 maximum
Frames
(one pair each 24 months per covered
member)
$150 maximum; 20%
discount for amounts over $150
$70 maximum
100% after $25 copay
$210 maximum
$150 maximum
$105 maximum
General Plan Provisions
Eye Exam
(one exam each 12 months per covered
member)
Contact Lenses
(one order each 12 months per covered
member)
Necessary
Elective (covered in lieu of lenses and
frames)
Additional Savings
Average savings of 35-40% on lens options, including progressives, scratch-resistant
and anti-reflective coatings.
Glasses and Sunglasses
Receive a discount off the cost of additional glasses and sunglasses, including lens
options. 30% savings if purchased the same day of your eye exam and 20% savings if
purchased within the same year.
Contact Lenses
15% off provider professional services.
Laser Vision Correction
Save an average of 15% off the regular price or 5% off the promotional price from
facilities in VSP’s network. After surgery, you may use your frame allowance (if eligible)
for sunglasses from any VSP doctor.
Primary Eye Care
Benefit for Unexpected Eye Problems
As VSP members, if you or members of your family have a non-urgent medical eye
problem such as cataracts, sties or pink-eye, save time and money by visiting your VSP
doctor for diagnosis and treatment instead of going to the emergency room. A $5 copay
is required.
For more information visit www.vsp.com
Aspire Public Schools | 12
Automatic Aspire-Paid Benefits
Automatic Aspire Paid Benefits
The following Aspire-paid benefits are provided automatically to all benefit eligible teammates at no charge. No action required for enrollment
except completing a beneficiary form.
Group Term Life
with Accidental
Death &
Dismemberment
Insurance
(CIGNA)
Life and AD&D insurance provides some financial security to your dependents in the event of your death. If
Core Health Benefits
you don’t feel that the Aspire paid plan provides enough protection, you can increase the level of financial
protection by purchasing additional Life and AD&D insurance. Please refer to the Voluntary Benefits pages for
more information.
ƒƒ 1 times your annual salary rounded up to the next $1,000. Maximum benefit $75,000.
ƒƒ Accidental Death & Dismemberment (AD&D) provides an additional benefit to your beneficiaries if death
is the result of an accident. If you have a qualifying accident which results in the loss of limb(s) or
eyesight, you will receive a percentage of the AD&D amount.
ƒƒ It is your responsibility to keep your beneficiary information up to date, which you can do on the
online benefits system.
Short Term
Disability
(CIGNA)
Disability insurance replaces a percentage of your income during extended periods of illness or injury that prevent
you from performing your regular work. This benefit coordinates with any State benefit you would receive.
ƒƒ 66.67% of basic weekly earnings (total for California employees includes the amount paid by State
Disability Insurance), up to a maximum weekly benefit of $1,200.
ƒƒ Benefits begin on 8th calendar day of disability due to sickness or accident.
ƒƒ 13 week maximum benefit duration.
Long Term
Disability
(CIGNA)
If a disability continues for more than 90 days, you may be eligible to receive LTD for as long as you remain
disabled until the age you would retire.
ƒƒ 60% of basic monthly earnings (total for California employees includes the amount paid by State Disability
Insurance), up to a maximum monthly benefit of $5,000.
ƒƒ Benefits begin after 90 days of disability due to sickness or accident.
ƒƒ Benefits payable to age 65 or to established Social Security retirement age.
ƒƒ Employees will be responsible for paying the income tax on the value of the monthly premium Aspire
pays on your behalf. Any benefits received during a disability will not be subject to income taxes.
Employee
Assistance
Program
(Claremont)
This benefit provides confidential assistance with a variety of work/life issues including: child/dependent care,
legal or financial issues, stress management, mental illness or substance abuse.
ƒƒ Up to 8 free in-person counseling sessions, per incident, per family, per rolling 12 months. Any family
member may access these services.
ƒƒ A free initial 30 minute consultation with an attorney; one consultation per legal issue per rolling 12
months. A 25% discount is available for services beyond the initial consultation. Examples of legal issues
include landlord/tenant issues, family law, traffic law, personal injury, etc. Free “Simple Will” kits are
available upon request.
ƒƒ One free financial consultation, per financial issue, in a rolling 12 month period and free credit reports
upon request. Examples of financial issues include budgeting, retirement planning, debt consolidation,
auto and real estate purchasing, etc.
ƒƒ Unlimited referrals for nationwide services related child care, elder care, school, college, adoption and
convenience services (such as pet care, home care and wellness).
Aspire Public Schools | 13
Savings and Reimbursement Benefits
Tuition Reimbursement
Aspire Public Schools supports teammates who wish to continue
their education to secure increased responsibility and growth within
their professional careers. In keeping with this philosophy, Aspire
will reimburse regular, full-time and qualified part-time teammates
for related courses that offer growth in an area related to his or her
current position and career development or outstanding student
loans, up to a maximum of $1,500 per year (which is $125 monthly
or $62.50 per paycheck). Benefit eligible part-time teammates
can receive up to 75% of this amount (which is $93.75 monthly or
$46.88 per pay-period).
There are no retroactive payments for the months you were
eligible and did not submit any documents.
1. All reimbursements are Core
subjectHealth
to approval
by the HR
Benefits
department and your supervisor as needed.
2. Tuition Reimbursement appears on your semi-monthly
paycheck with the rest of your benefits as an earnings of
$62.50, which actually increases your take-home pay.
3. Tax implications apply to reimbursements for courses
taken prior to joining Aspire.
4. Incomplete requests or supporting documents will not be
processed.
Eligibility
Who?
ƒƒ Only regular full-time and part-time benefit-eligible staff are
eligible.
What?
ƒƒ For teammate tuition, books, lab or related fees for
Bachelor or Associate degrees, second degrees, graduate
degrees or courses in a relevant field of study.
ƒƒ Trainings or independent classes related to your work.
ƒƒ To receive any reimbursement, only successfully completed
courses will be considered, which means a passing grade
or obtaining a certification.
When?
ƒƒ You may apply for tuition reimbursement the first of the
month following course completion.
ƒƒ We will reimburse you the appropriate amount per payperiod. You only apply once and you will continue receiving
tuition reimbursement until the loan or bill is paid off.
How Do I Apply?
Go to “My Aspire” and download the Tuition Reimbursement
Guide and Enrollment application.
BE SURE TO:
1. Complete the enrollment
(510) 225-2300..
Important Information
application
and
fax
to
2. Submit documents showing evidence of tuition paid or
owed.
3. Submit evidence of satisfactorily completed coursework,
(transcript or completion certificate, originals not required).
5. Supervisor approval is required when class or course is not
part of the teammate’s career development.
For additional information, please contact the Benefits Team at
benefits@aspirepublicschools.org.
Additional Benefits
Wells Fargo
Aspire teammates are eligible for the Wells Fargo At Work program
– a valuable package of accounts, services, and special benefits
that may help you reach your financial goals. To find out more, call
1-800-TO-WELLS (1-800-869-3557) or stop by any Wells Fargo
banking location.
For additional information, please contact the Benefits Team at
benefits@aspirepublicschools.org.
Employee Discount Program (BeyondWork)
ƒƒ BeyondWork capitalizes on the speed, flexibility and
accessibility of the Internet to give you a convenient way
to address personal needs for leisure, recreation, fitness
and community.
ƒƒ Free online access to a huge selection of discounted
tickets, travel, recreation and gifts.
ƒƒ Discounts of 10% to 40% on products and services from
such premium brands as Disneyland and AMC Theatres.
ƒƒ Go to www.beyondwork.com and type in your work e-mail
ƒƒ address and “Aspire Public Schools.”
4. Submit evidence of required materials (e.g. course syllabus
with required materials list and receipt) if you are requesting
reimbursement that includes books and/ or lab fees.
Aspire Public Schools | 14
Savings and Reimbursement Benefits
Flexible Spending Accounts
Flexible Spending Accounts (FSA) allow you to set aside a
You may also qualify if your spouse is attending school full time
portion of your paycheck tax free to be used for eligible health
or actively seeking employment. Examples of eligible expenses
care, dependent care, and transit or commuter expenses. Our
include:
FSA provider is CBA.
ƒƒ Childcare services for children
the age
of 13.
Coreunder
Health
Benefits
Use it or Lose it
Plan carefully. Any unused amounts in your health care or
dependent care accounts at the end of the plan year will be
forfeited, as required by law. The Aspire plan allows teammates
an additional “grace” period to incur medical claims until
March 15 of the following calendar year and up to April 30 to submit
eligible expenses. Please note, you may not make any changes
to your FSA Health Care and Dependent Care Reimbursement
Account(s) unless you meet the requires under IRS regulations
for a Qualified Life Event. This provision does not apply to the
Commuter Benefit (Parking and Transit).
Domestic Partners
As stated in the Internal Revenue Code Section 125, Domestic
Partners and their children’s expenses do not qualify as eligible
expenses under these programs.
**Please note** If you participate in an FSA account, you
cannot take additional IRS tax deductions on these expenses.
Please check with your tax advisor if you have questions.
For 2015, you can set aside a maximum of $2,550 pre-tax dollars
in a health care spending account. This allows you to pay for
qualifying out-of-pocket health care expenses for yourself and
your dependents. The amount you choose to contribute will be
deducted from your pay in equal installments throughout the year.
Refer to the following page for a partial list of eligible expenses.
Please note, you may not make any changes to your FSA Health
Care account unless you meet the requirements under IRS
regulations for a Qualified Life Event.
For more information about eligible expenses or to estimate
possible
savings,
please
visit
CBA’s
ƒƒ Care for an adult dependent in an adult day care center.
ƒƒ Dependent care provided by a relative, as long as he or
she is not one of your dependents.
ƒƒ After school care or day camp.
Please note, you may not make any changes to your FSA
Dependent Care account unless you experience a Qualified Life
Event.
* The plan maximum of $5,000 per plan year applies if you
are a single parent or married and filing a joint tax return.
The plan’s maximum is split for those married and filing
separately.
Commuter Benefit (Parking and Transit)
Save money on your mass transit and parking expenses through
a pre-tax payroll deduction. The IRS allows you to set aside up
to $130 per month for mass transit expenses and/or $250 per
month in qualified parking expenses incurred when commuting
to or from work. You have the option to adjust the amount of your
Health Care Reimbursement Accounts
your
ƒƒ Nursery school/preschool for children under 5 years old
(note: expenses for kindergarten and higher grades are
not eligible expenses).
website
at
www.cbadministrators.com.
Teammates may elect to receive a flexible spending card which
allows you to pay for qualified expenses on the spot with a
contribution each month.
Eligible expenses include:
ƒƒ Any transit pass, fare card or similar item that entitles the
employee to transportation on a mass transit system to or
from work.
ƒƒ Qualified parking expenses for parking at or near the
employee’s jobsite or near a location from which an
employee commutes to work by mass transit, vanpool or
carpool.
This benefit does not include costs associated with fuel or
bridge tolls. If you cancel your account for any reason, funds
remaining in the account as of your last day of employment or the
date you elect to cancel coverage will be forfeited.
Debit Cards
convenient debit card.
Teammates who elect to enroll in either the Health Care
Dependent Care Reimbursement Account
receive a debit card from CBA allowing you to pay for services
IRS regulations allow families to set aside up to $5,000* on a
pretax basis to pay for eligible dependent care expenses. Eligible
dependent care expenses are those expenses you must pay for
dependent daycare so that you and your spouse can work.
Reimbursement Account or in the Commuter Benefit Account will
immediately. This card is not available for Dependent Care Expenses.
You can review your FSA Account information at any time by
visiting www.cbadministrators.com.
Aspire Public Schools | 15
Savings and Reimbursement Benefits
Using the Healthcare Reimbursement Account
As a reminder, the plan does not consider many Over the Counter (OTC) drugs as an eligible expense. There are two
exceptions to this rule: insulin and OTC’s that you have obtained with a prescription from a physician.
Below is a small sample of the types of items you can reimburse through your Health Care FSA account. Also listed are items that are NOT
Core Health Benefits
eligible.
SAMPLE EXPENSES
Covered Health Care Expenses
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
ƒƒ
Acupuncture
Alcoholism treatment
Ambulance
Chiropractic treatments
Deductibles and copays
Dental fees
Eye exams
Eye surgery
Hearing exams and hearing aids
Home health care
Hospital bills
Insulin
Laboratory fees
LASIK surgery
Medical supplies (e.g. band-aids)
Mileage incurred when going to or
from medical appointments
Obstetrics and fertility
Orthodontia expenses
Psychiatrist and psychologist’s fees
Prescription drugs
Smoking cessation programs (if
prescribed by your doctor)
X-rays and MRI
Covered Over the Counter Items
ƒƒ Ear/eye care
Contact lens solution
Eye drops
ƒƒ First aid
Band aids
First aid cream
First aid kits
Hot and cold packs
Medicated bandages
Contraceptives
Diabetic supplies
Reading glasses
ƒƒ Monitoring devices
Blood pressure monitor
Glucose meters
Pregnancy test
Over the Counter Items –
Covered With Prescription Only
ƒƒ Allergy and sinus
Allergy medications
Asthma medications
Sinus medications
ƒƒ Cough and cold
Cough & cold medications
Nasal decongestant
ƒƒ Pain relief
Aspirin
Anti-inflammatory medications
ƒƒ Skin care
Acne medications
Anti-itch medications
Cold sore medications
Diaper rash ointment
ƒƒ Stomach care
Digestion/gas aids
Anti-diarrhea medications
Laxatives
Health Care Flexible Spending Account
Cami considers the following when determining how much money to set aside for
her FSA:
ƒƒ Her husband’s daily medication costs about $50 every other month.
ƒƒ She usually takes her children to the doctor at least 4 times per year.
ƒƒ She also knows that she will need some dental work.
ƒƒ Her total estimate for expenses is about $700.
ƒƒ If Cami didn’t utilize the FSA she would have to earn about $900 in wages to
receive the same $700 after taxes were applied.
Cami’s Contributions for 2015 Health Care FSA
Prescriptions: $50 x 6 = $300
Doctors Appointments: $20 x 4 = $80
Dental work: $320
Total 2015 Contribution: $700
Aspire Public Schools | 16
Savings and Reimbursement Benefits
Mandatory Retirement Programs
As required by state law, all eligible California and Tennessee teammates will be enrolled in the California State Teachers’ Retirement System
(CalSTRS), the California Public Employees’ Retirement System (CalPERS), or the Tennessee Consolidated Retirement System (TCRS).
We encourage all teammates who are enrolled in one of these mandatory programs to also review the option to increase your retirement
Core
Health
savings through the 403(b) program shown on the following page. The amounts below are set by the State
and are
subjectBenefits
to change.
CalSTRS/CalPERS Benefit Retirement Plan For California Teammates
The California State Teachers’ Retirement System (CalSTRS) primary aim is to provide retirement related benefits and services to teachers
in public schools and community colleges. California Public Employees’ Retirement System (CalPERS) was established to allow public
agency and classified school employees the opportunity to participate in state retirement services. Teammates are automatically enrolled in
either CalSTRS or CalPERS upon hire depending on their status as certificated or classified.
Both systems base the retirement allowance on your service years in the retirement program and include a teammate contribution that
Aspire matches (see chart below). To be vested you must be in the program for 5 years. If you leave the retirement program before 5 years,
you will not get the employer match, nor will Aspire receive back our contribution. To stay in CalPERS if you are eligible for CalSTRS, or in
CalSTRS even though you are eligible for CalPERS, please email hr@aspirepublicschools.org to complete a ES372 form. You will not be
able to change once this election is made for the duration of your time at Aspire.
California State Teachers’
Retirement System
(CalSTRS)
Participants Prior to 1/1/13:
California Public Employees
Retirement System
(CalPERS)
New California Public
Employees’ Retirement
System (CalPERS)
Employee
8.15%
7%
6%
Employer
8.88%
11.771%
11.771%
www.calstrs.com
www.calpers.ca.go
www.calpers.ca.gov
800-228-5453
888-225-7377
888-225-7377
Contributions
Contact Information
Website
Phone
TCRS Benefit Retirement Plan For Tennessee Teammates
The Tennessee Consolidated Retirement System’s (TCRS) primary aim is to provide retirement related benefits and services to eligible
teaching positions.
TCRS retirement allowance is based on your service years in the retirement program and include a teammate contribution that Aspire
matches (see chart below). To be vested you must be in the program for 5 years. If you leave the retirement program before 5 years you will
not get the employer match, nor will Aspire receive back our contribution. A non-vested member must request a refund of their accumulated
contributions. Refund includes contributions made by the employee plus interest. They can leave their contributions in TCRS and gain 5%
for a maximum of 7 years.
For more information about TCRS please go to MyAspire or visit TCRS at http://treasury.tn.gov/tcrs.
Tennessee Consolidated Retirement System
(TCRS) – Current/Prior to 2014 Old Plan
Contributions
Defined Benefit
Defined Contribution*
Tennessee Consolidated Retirement
System (TCRS) – New Plan
Defined Benefit
Defined Contribution*
Employee
5%
Optional*
5%
2%
Employer
9.04%
0%
4%
5%
Contact Information
Website
Phone
http://treasury.tn.gov/tcrs
800-770-8277
* Can opt out or increase employee contribution
Aspire Public Schools | 17
Savings and Reimbursement Benefits
Optional Retirement Accounts for Teammates In All Locations
Aspire encourages all benefitted teammates to participate and invest according to their retirement goals, and to seek professional advice
when making their retirement investment choices. Our benefit program includes a quality, low fee 403(b) investment choice. This is not in
lieu of, but in addition to the mandatory state sponsored retirement programs (CalSTRS, CalPERS and TCRS). Regular teammates who are
not eligible to participate in CalPERS (JCA, Titan and Centennial Classified Teammates) and TCRS (all Classified
teammates)
who work 20
Core Health
Benefits
hours per week or more, have the option of receiving a discretionary match contribution of up to 5% through Aspire’s 403(b) program. The
following shows more information on each program.
403(b) Benefit Retirement Plan for both
California and Tennessee Teammates
Employer match percentages*
A 403(b) plan is a U.S. tax-advantaged retirement savings plan
Teammate
Contributions
available for public education organizations, some nonprofit
employers (only Internal Revenue Code 501(c)(3) organizations),
cooperative hospital service organizations, and self-employed
ministers in the United States. It has tax treatment similar to
a 401(k) plan, especially after the Economic Growth and Tax
Relief Reconciliation Act of 2001. Employee salary deferrals into
a 403(b) plan are made before income tax is paid and allowed
to grow tax-deferred until the money is taxed as income when
withdrawn from the plan. Aspire teammates have the opportunity
to make tax-deferred contributions to an American Funds mutual
1
Employer
Contributions
Total
Contributions
0%
0%
0%
1%
1%
2%
2%
2%
4%
3%
3%
6%
4%
4%
8%
5%
5%
10%
Employer contribution not to exceed 5% match. Teammate may
contribute beyond 5% up to the IRS maximum allowable amount.
As of November 2014, the only school sites that are non-CalPERS
eligible are JCA, Titan and Centennial.
fund of their choice.
Teammates who are scheduled to work 20 hours per week or
more and are not eligible to participate in CalPERS or TCRS
are eligible for an employer discretionary match contribution of
up to 5% Please refer to the chart to the right for details on the
employer / teammate contribution match.
Please note that 403(b) eligible teammates that are eligible for the
How Do I Apply?
To participate in the 403(b) Retirement Plan you will need to first
elect coverage through the benefit portal, bswift. Your election
will pend until you have completed a 403(b) New Participant
Enrollment Form. Please mail or fax New Participant Enrollment
Form attention:
discretionary match have 30 days from their date of hire to waive
participation in their respective 403(b) program. If participation is
not waived, there is an automatic 3% enrollment that will occur.
Aspire Public Schools | 18
Craig H. Barker, Stifel Nicolaus
985 Sun City Lane, #105, Lincoln, CA 95648
Phone: (916) 409-1309
Fax: (916) 253-3726
Teammate Funded Voluntary Benefits
Voluntary Supplemental Benefits
Aspire provides all eligible teammates with basic life, short term and long term disability insurance benefits at no charge (page 12). Teammates
also have the option to purchase additional life and disability insurance.
If you elect these benefits when initially eligible as a new hire, the insurance company will provide a certain level of benefit regardless of your
health. This is called Guarantee Issue. Amounts above Guarantee Issue are subject to approval.
Voluntary Term
Life Insurance
(CIGNA)
Core Health Benefits
Voluntary Term Life insurance provides your family with additional financial protection in the event of your death.
ƒƒ Coverage maximum: $500,000 for employee; one half (50%) of employee amount for spouse (not to
exceed $100,000) and $10,000 per dependent child.
ƒƒ Up to $100,000 Guarantee Issue for employee; $30,000 for spouse; $10,000 for dependent child.
Coverage in excess of these amounts is subject to proof of insurability and must be approved by CIGNA.
Guarantee Issue is only available to newly eligible teammates.
ƒƒ Purchase of additional Term Life insurance includes an equivalent amount of Accidental Death and
Dismemberment coverage.
ƒƒ Rates are based on age and will change every five years.
ƒƒ Coverage is portable; you can take it with you if you leave Aspire.
Individual Short
Term Disability
Insurance
(Unum)
Unum’s Individual Short Term Disability Insurance replaces a portion of your income if you are unable to work
due to a covered injury or illness. This coverage can pay a monthly benefit to provide some income during a
time of need. Common reasons people use this coverage include injuries, a covered pregnancy and surgeries.
Advantages of the plan
ƒƒ Coverage is available to eligible employees age 17 to 69 (to age 64 in CA) who are actively at work.
ƒƒ Choose a monthly benefit between $400 and $ 5,000 for covered disabilities due to injury or illness.
ƒƒ Coverage of up to 30% of your gross monthly salary may be offered.
ƒƒ This benefit will not be reduced by your employer Short Term Disability Plan or California State Disability.
ƒƒ The affordable premium is based on your age when you buy the insurance and will not increase as you
get older.
ƒƒ Your policy is guaranteed renewable, until age 72, as long as you pay the premiums on time.
ƒƒ Your plan includes a Waiver of Premium, included at no extra charge, for covered injuries and illnesses.
This means you don’t have to pay your premiums after 90 days of total disability or the elimination period
(whichever is longer). They’ll be waived as long as the disability continues, up to the maximum benefit
period.
ƒƒ This plan includes convenient payroll deduction, so you don’t have to remember to write a check for your
premiums.
ƒƒ You own the policy so you can keep this coverage if you leave the company or retire. Unum will bill you
directly.
ƒƒ Coverage becomes effective on the first day of the month in which payroll deductions begin.
Aspire Public Schools | 19
Teammate Funded Voluntary Benefits
Voluntary Supplemental Benefits
Group Critical
Illness Insurance
(Unum)
Unum’s Group Critical Illness Insurance can help protect your finances from the expense of a serious health
problem, such as a stroke, heart attack or cancer. You choose a lump-sum benefit from $5,000 to $50,000
that’s paid tax-free directly to you at the first diagnosis of a covered condition. You
can use
the benefit
any way
Core
Health
Benefits
you choose.
What Is Covered?
Heart attack
Coronary artery bypass surgery Permanent Paralysis
(pays 25% of lump-sum benefit)
Blindness
Benign brain tumor
Cancer
Major organ failure
Stroke
Carcinoma in situ (pays 25% of the
End-stage renal (kidney) failure
Coma
lump-sum benefit)
Advantages of the plan
ƒƒ Coverage is available to eligible employees who are actively at work.
ƒƒ You can buy coverage for your spouse ages 17 to 64 with purchase of employee coverage. Benefit
amount is from $5,000 to $30,000 in $1,000 increments.
ƒƒ All eligible dependent children ages newborn until their 26th birthday, regardless of marital or student
status, are automatically covered at 25% of the employee benefit amount at no additional cost. Eligible
children are covered for the same conditions as the employee and the following specific childhood
conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. Diagnosis
must occur after the child’s coverage effective date.
ƒƒ You can use this coverage more than once. If you receive a full benefit payout for a covered illness, your
coverage can be continued for the remaining covered conditions. The diagnosis of a new covered illness
must occur at least 90 days after the most recent diagnosis. Each condition is payable once per lifetime.
ƒƒ You get affordable rates when you buy this coverage through your employer, and the premiums are
conveniently deducted from your paycheck.
ƒƒ Coverage is portable. You may take the coverage with you if you leave the company or retire, without
having to answer new health questions. Unum will bill you directly.
ƒƒ Coverage becomes effective on the first day of the month in which payroll deductions begin.
ƒƒ Wellness Benefit – this benefit can pay $50 per calendar year per insured individual if a covered health
screening test is performed, including blood tests, stress tests, colonoscopies, chest X-rays. A full list of
covered tests will be provided in your certificate. There is no claim form required to claim this Wellness
Benefit.
Aspire Public Schools | 20
Teammate Funded Voluntary Benefits
Voluntary Supplemental Benefits
Accident
Insurance
(Unum)
Unum’s Accident Insurance can pay benefits based on the injury you receive and the treatment you need,
including emergency-room care, doctor’s office visits, physical therapy and related surgery. The benefit can help
offset the out-of-pocket expenses that medical insurance does not pay, includingCore
deductibles
andBenefits
copays. This
Health
tax-free benefit is paid directly to you.
Advantages of the plan
ƒƒ Coverage is available to eligible employees age 17 and up who are actively at work.
ƒƒ You can buy coverage for your spouse and dependent children.
ƒƒ There are no health questions to answer. If you apply, you automatically receive the base plan.
ƒƒ The Accident plan covers a wide variety of injuries and accident-related expenses such as hospitalization,
physical therapy, emergency-room treatment, doctor office visits, fractures and dislocations, transportation,
lodging and more.
ƒƒ Benefits are paid for accidents that occur on or off the job.
ƒƒ You own the policy so you can keep this coverage if you leave the company or retire. Unum will bill you
directly.
ƒƒ This plan includes convenient payroll deduction, so you don’t have to remember to write a check for your
premiums.
ƒƒ Coverage becomes effective on the first day of the month in which payroll deductions begin.
Aspire Public Schools | 21
Your Aspire Benefits Package
Benefit Contacts
Medical
Group #
Telephone #
Website
Kaiser North – CA only
95475
800-464-4000
www.kp.org
Kaiser South– CA only
230214
800-464-4000
Blue Shield HMO – CA only
H11768
800-424-6521 Claims & Eligibility
Blue Shield PPO – CA only
931632
800-331-2001 Claims & Eligibility
www.blueshieldca.com
Aetna HMO – TN only
805861
800-445-5299
www.aetna.com
Blue Shield PPO – TN only
976277
800-331-2001 Claims & Eligibility
800-810-2583 TN Provider Lookup
www.blueshieldca.com
DeltaCare USA DHMO
05898
800-422-4234
www.deltadentalins.com
Delta Dental PPO
03943
800-765-6003
www.deltadentalins.com
VSP Vision
30022449
800-877-7195
www.vsp.com
CIGNA Group Term Life & AD&D
FLX-963214
800-362-4462 Claims
800-732-1603 Customer Service
www.cigna.com
CIGNA Short Term Disability
LK-750759
800-362-4462 Claims
800-732-1603 Customer Service
www.cigna.com
CIGNA Long Term Disability
LK-962318
800-362-4462 Claims
800-732-1603 Customer Service
www.cigna.com
Claremont Employee Assistance Program
13530
800-834-3773
www.claremonteap.com
BeyondWork Employee Discount Program
N/A
877-319-8282
www.beyondwork.com
CBA Flexible Spending Accounts
800-574-5448 Customer Service
800-584-4591 Claims Fax
www.cbadministrators.com
American Funds 403(b) Retirement Account
916-409-1309 | Craig Barker
www.americanfunds.com
800-362-4462 Claims
800-732-1603 Customer Service
www.cigna.com
Unum Short Term Disability
800-635-5597
www.unum.com
Unum Accident Insurance
800-635-5597
www.unum.com
Unum Critical Illness
800-635-5597
www.unum.com
510-434-5062 Option #1, #1
510-225-2300 Fax
email:
www.kp.org
Core
Health Benefits
www.blueshieldca.com
Dental/Vision
Aspire-Paid Benefits
FSA and Retirement Plans
Voluntary Supplemental Benefits
CIGNA Term Life Insurance
FLX-963214
Aspire Benefits Team
Benefits Support Center
Aspire Public Schools | 22
benefits@aspirepublicschools.org
Your Aspire Benefits Package
Benefit Cost Information Per Pay Period
PART-TIME BENEFITTED TEAMMATES
REGULAR FULL-TIME TEAMMATES
Aspire Pays
Kaiser High HMO ($10 office visit) – California Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$218.42
$432.47
$393.15
$589.73
$32.49
$119.53
$108.66
$162.99
Kaiser Low HMO ($30 office visit) – California Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$218.42
$432.47
$393.15
$589.73
$0.00
$48.05
$43.69
$65.53
$282.57
$508.63
$459.54
$762.95
$0.00
$56.52
$51.06
$84.77
$282.57
$508.63
$459.54
$762.95
$11.60
$79.71
$72.01
$119.55
Aetna HMO – Tennessee Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$272.08
$489.74
$440.76
$734.60
$0.00
$54.42
$48.98
$81.63
$226.08
$427.02
$385.81
$640.52
$25.12
$75.36
$68.09
$113.04
$6.17
$9.00
$13.31
$0.00
$2.41
$6.07
Kaiser Low HMO – California Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$163.81
$324.35
$294.86
$442.29
$54.60
$156.17
$141.97
$212.96
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$211.93
$381.47
$344.66
$572.21
$82.24
$206.87
$186.90
$310.29
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$211.93
$381.47
$344.66
$572.21
$82.24
$206.87
$186.90
$310.29
$26.16
$36.51
$50.16
$3.73
$4.53
$5.34
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$204.06
$367.30
$330.59
$550.95
$68.02
$176.85
$159.17
$265.28
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
$169.55
$320.26
$289.35
$480.39
$81.64
$182.11
$164.54
$273.16
Employee only
Employee + 1
Employee + 2 or more
$4.73
$6.75
$9.98
$1.54
$4.66
$9.40
Delta Dental PPO – All Teammate Locations
$0.00
$11.87
$32.64
Employee only
Employee + 1
Employee + 2 or more
$19.62
$27.38
$37.62
$6.54
$21.00
$45.18
Vision Service Plan – All Teammate Locations
Vision Service Plan – All Teammate Locations
Employee only
Employee + 1
Employee + 2 or more
$87.09
$227.64
$206.95
$310.42
DeltaCare USA (DHMO) – All Teammate Locations
Delta Dental PPO – All Teammate Locations
Employee only
Employee + 1
Employee + 2 or more
Benefits
Blue Shield PPO – Tennessee Teammates
DeltaCare USA (DHMO) – All Teammate Locations
Employee only
Employee + 1
Employee + 2 or more
$163.81
$324.35
$294.86
$442.29
Aetna HMO – Tennessee Teammates
Blue Shield PPO – Tennessee Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
Blue Shield PPO – California Teammates
Blue Shield PPO – California Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
Kaiser High HMO – CaliforniaCore
Teammates
Health
You Pay
Blue Shield HMO – California Teammates
Blue Shield HMO – California Teammates
Employee only
Employee + spouse
Employee + child(ren)
Employee + family
Aspire Pays
You Pay
$0.00
$1.66
$4.89
Employee only
Employee + 1
Employee + 2 or more
$2.80
$3.40
$4.01
$1.54
$4.66
$9.40
Full-time, regular teammates working a minimum of 30 hours become eligible for benefits on the first of the month following date of hire.
Regular full-time teammates who have been with Aspire for at least one year, who have had a status change and work between 20 and 29
hours, are eligible for partial benefits.
Aspire Public Schools | 23
Your Aspire Benefits Package
Important Domestic Partner Tax Information
Because the IRS does not recognize domestic partners nor their children (unless they qualify as dependents under Section 152) for tax filing
purposes, we are required to “impute” the value of these benefits and report that amount as taxable income to the teammate. The applicable
amount will be added back into your gross pay as taxable income and you will pay taxes on that amount. In addition, the payroll contributions
you make on behalf of your domestic partner and/or their children will be taken on a post-tax basis.
Core Health Benefits
For example – if you are covering your Domestic Partner on the Kaiser Low Option, you will have the $48.05 taken on a post-tax basis AND
you will pay income taxes on $214.05 per pay period. If you are in a 25% tax bracket, this means the coverage for your Domestic Partner will
cost approximately $101.56 per pay period. That is 25% taxes on $214.05 plus the actual payroll deduction of $48.05.
Listed on the next page are the values for the various plan offerings through Aspire. If you have a California registered domestic partner, you
may be able to take a deduction on your California state return for the premiums you pay for your domestic partner. You should consult your
individual tax advisor to determine how to adjust your filings for any credits or liabilities.
See the Schedule of Per Pay Period Pre/Post Tax Contributions and Imputed Income for Full-Time Teammates with Domestic Partners and/
or children of Domestic Partners on the next page.
Aspire Public Schools | 24
Your Aspire Benefits Package
Schedule of Per Pay Period Pre/Post Tax Contributions and Imputed Income for Full-Time
Teammates with Domestic Partners and/or children of Domestic Partners
Per Pay Period
Pre-Tax
Contribution
Post-Tax
Contribution
Imputed
Core
Income
Health Benefits
Kaiser High HMO ($10 office visit) – California Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
$32.49
$108.66
$.32.49
$87.04
$54.33
$130.50
$214.05
$196.58
$371.31
$0.00
$43.69
$0.00
$48.05
$21.84
$65.53
$214.05
$196.58
$371.31
$0.00
$51.06
$0.00
$56.52
$33.71
$84.77
$226.06
$303.41
$480.38
$11.60
$72.01
$11.60
$68.11
$47.54
$107.95
$226.06
$303.41
$480.38
$0.00
$48.98
$0.00
$54.42
$32.65
$81.63
$217.66
$293.84
$462.53
$25.12
$68.09
$25.12
$50.24
$44.95
$87.92
$200.95
$254.71
$414.45
$0.00
$2.41
$0.00
$2.41
$3.66
$6.07
$2.83
$4.31
$7.14
$0.00
$11.87
$0.00
$11.87
$20.77
$32.64
$10.35
$13.65
$24.00
$1.66
$3.23
$4.89
$0.80
$0.81
$1.61
Kaiser Low HMO ($30 office visit) – California Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Blue Shield HMO – California Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Blue Shield PPO – California Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Aetna HMO – Tennessee Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Blue Shield PPO – Tennessee Teammates
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
DeltaCare USA (DHMO) – All Teammate Locations
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Delta Dental PPO – All Teammate Locations
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
Vision Service Plan – All Teammate Locations
Employee + DP
Employee + Child + DP
Employee + DP + DP’s Child
$0.00
$1.66
$0.00
Aspire Public Schools | 25
This overview shows only the highlights of your employee benefits.
This is not a complete detailed description, nor is it a contract of employment or a guarantee of benefits.
More detailed information is contained in the relevant Summary Plan Description (SPD).
Great care has been taken to ensure that this workbook is accurate.
However, oversights can occur or condensed summaries can be misinterpreted.
If there is a difference between this overview and the SPD or official plan documents
governing the plan, the plan documents will be followed.
Aspire Public Schools reserves the right to amend or terminate the program in whole or in part at any time.
This brochure provides an overview of your benefit plan choices. It is for informational purposes only. It is not intended to be an
agreement for continued employment. Neither is it a legal plan document. If there is a disagreement between this guide and the
plan documents, the plan documents will govern. In addition, the plans described in this brochure are subject to change without
notice. Continuation of any benefit plan or coverage is at the company’s discretion and in accordance with federal and state laws. If
you need additional information or have any questions about the benefit program, please contact Human Resources.
Copyright © Burnham Benefits Insurance Services, Inc. 2014 – All Rights Reserved