Total Education Solutions Benefits Guide 2024
2024 Benefits Guide YOUR BENEFITS JOURNEY
YOUR JOURNEY ENROLLMENT TO STARTS HERE HOW TO USE THIS GUIDE Whenyou seetheiconsbelow,click to link out to websites, downloaddocuments,orlearnmore! Carrier Learn ? Logos More
ENROLLMENT & ELIGIBILITY Employee Eligibility All full-time employees working 30 or more hours per week are eligible for company offered benefit plans on the first of the month following 30 days of employment. Nayya Benefits Dependent Eligibility Guide Employees who are eligible to participate in the Total Education Solutions benefit program may also enroll their dependents. For the purposes of our benefit plans, your dependents are defined as follows: Enroll • Your spouse or domestic partner • Your dependent children to age 26 Here Mid-Year Changes Once your enrollment window closes, the only time you are allowed to make changes to your benefits elections in the middle of the year is if you experience a qualifying life event. Examples may include getting married or divorced, having a baby or adopting, or gaining or losing coverage. You must notify Human Resources within 30 days of the qualifying life event to be eligible to change your elections. Your Human Resources Contact: Adriana Avitia Cody Iverson [email protected] [email protected] 323-341-5883 213-607-4356
NAYYA BENEFITS DECISION GUIDANCE TOOL
MEDICAL Y O U R J O U R N E Y T O HEALTH Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hoverovertheinsurancetermsbelowtolearnwhattheymean! Anthem Classic PPO 500/30/50/20 Anthem EPO 3000/25/50/20 DEDUCTIBLE Individual: $500 Individual: $3,000 Family: $1,500 Family: $6,000 Primary Care: $30 copay Primary Care: $25 copay OFFICE VISITS Specialist: $50 copay Specialist: $50 copay REVIEW Urgent Care: $30 copay Urgent Care: $25 copay Inpatient: *20% Coinsurance Inpatient: *20% Coinsurance PLAN SBC’S PROCEDURES Outpatient: *20% Coinsurance Outpatient: *20% Coinsurance Emergency Room: $150 copay Emergency Room: $150 copay then *20% coinsurance then *20% coinsurance Tier 1A: $5 (retail) / $10 (home delivery) Tier 1A: $5 (retail) / $10 (home delivery) Tier 1B: $15 (retail) / $30 (home delivery) Tier 1B: $20 (retail) / $40 (home delivery) PRESCRIPTIONS Tier 2: $30 (retail) / $75 (home delivery) Tier 2: $40 (retail) / $100 (home delivery) Tier 3: $50 (retail) / $125 (home delivery) Tier 3: $60 (retail) / $150 (home delivery) Tier 4: 30% coinsurance up to $250* Tier 4: 30% coinsurance up to $250* OUT-OF-POCKET Individual: $4,000 Individual: $7,350 MAXIMUM Family: $8,000 Family: $14,700 *Deductible applies first. The benefits and rates in this guide are for illustrative purposes only. Please refer to the Summary of Benefits and Coverage for specific benefits. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
MEDICAL Y O U R J O U R N E Y T O HEALTH Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hoverovertheinsurancetermsbelowtolearnwhattheymean! Anthem Value DedHMO 2000/30/60/25% Select HMO Anthem Classic HMO 20/40/500 admit/250 OP (California Employees Only) (California Employees Only) DEDUCTIBLE Individual: $2,000 Individual: $0 Family: $4,000 Family: $0 Primary Care: $30 copay Primary Care: $20 copay OFFICE VISITS Specialist: $60 copay Specialist: $40 copay REVIEW Urgent Care: $30 copay Urgent Care: $20 copay PLAN SBC’S Inpatient: *25% Coinsurance Inpatient: *25% Coinsurance PROCEDURES Outpatient: No charge Outpatient: No charge Emergency Room: $200 copay Emergency Room: $125 copay then *25% coinsurance Tier 1A: $5 (retail) / $10 (home delivery) Tier 1A: $5 (retail) / $10 (home delivery) Tier 1B: $20 (retail) / $40 (home delivery) Tier 1B: $15 (retail) / $30 (home delivery) PRESCRIPTIONS Tier 2: $50 (retail) / $125 (home delivery) Tier 2: $30 (retail) / $75 (home delivery) Tier 3: $75 (retail) / $188 (home delivery) Tier 3: $50 (retail) / $125 (home delivery) Tier 4: 30% coinsurance up to $250* Tier 4: 30% coinsurance up to $250 OUT-OF-POCKET Individual: $3,500 Individual: $2,500 MAXIMUM Family: $7,000 Family: $5,000 *Deductible applies first. The benefits and rates in this guide are for illustrative purposes only. Please refer to the Summary of Benefits and Coverage for specific benefits. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
MEDICAL Y O U R J O U R N E Y T O HEALTH Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hoverovertheinsurancetermsbelowtolearnwhattheymean! Kaiser Permanente DHMO 750 Kaiser Permanente DHMO 5500 (Northern/Southern California) (Northern/Southern California) Individual: $750 Individual: $5,500 REVIEW DEDUCTIBLE Family: $1,500 Family: $11,000 PLAN SBC’S Primary Care: $25 copay Primary Care: $50 copay OFFICE VISITS Specialist: $25 copay Specialist: $50 copay Urgent Care: $25 copay Urgent Care: $50 copay Inpatient: *20% Coinsurance Inpatient: *40% Coinsurance PROCEDURES Outpatient: *20% Coinsurance Outpatient: *40% Coinsurance Click on the links below for Emergency Room: *20% Coinsurance Emergency Room: *40% Coinsurance Kaiser resources: Tier 1: $10 (retail) / $20 (home delivery) Tier 1: $15 (retail) / $30 (home delivery) • National Enrollment Guide PRESCRIPTIONS Tier 2: $30 (retail) / $60 (home delivery) Tier 2: $40 (retail) / $100 (home delivery) • Health & Wellness Resource Guide Tier 3: $30 (retail) / $60 (home delivery) Tier 2: $40 (retail) / $100 (home delivery) • Healthy Resources Guide Tier 4: 20% coinsurance up to $250 Tier 4: 40% coinsurance up to $250 Individual: $3,000 Individual: $7,500 • Maternity Care Flyer OUT-OF-POCKET • Mental Health Resources MAXIMUM Family: $6,000 Family: $15,000 • Care Away From Home *Deductible applies first. The benefits and rates in this guide are for illustrative purposes only. Please refer to the Summary of Benefits and Coverage for specific benefits. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
EMPLOYEEASSISTANCE PROGRAM (EAP) WELLBEING You encounter more than just health concerns If you think your physical health alone is related to throughout your life. Manage life’s curveballs your overall performance, think again. Total Wellbeing with a confidential and complimentary as a whole is comprised of 5 elements: physical, program designed to provide counseling, financial, communal, emotional, and purpose. To support, and resources for a variety of build your overall wellbeing, you have to make sure all personal issues like stress and anxiety, of these elements are being “exercised”. relationship struggles, substance abuse, eldercare, financial worries, and much more. Scroll over each of the icons below to learn more about wellbeing. Get the support you need today:
DENTAL Click Here to Find an In-Network Provider Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with our dental benefit plan. Hoverovertheinsurancetermsbelowtolearnwhattheymean! ESSENTIAL CHOICE PPO ANNUAL DEDUCTIBLE Individual: $50 REVIEW Family: $150 PLAN SDBC PREVENTIVE SERVICES 100% BASIC SERVICES 90% MAJOR SERVICES 60% ANNUAL PLAN MAXIMUM $2,000 ORTHO SERVICES 50% ORTHO LIFETIME MAXIMUM $1,000 The benefits and rates in this guide are for illustrative purposes only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
VISION Click Here to Find an In-Network Provider Protectyoursightandenjoythosesunsetsevenmore withvision insurance. Receivebothpreventiveandmaterialscoverage. Hoverovertheinsurancetermsbelowtolearnwhattheymean! BLUE VIEW VISION Single: $0 LENSES Bifocal: $0 REVIEW PLAN Trifocal: $0 SUMMARY FRAMES $150 Allowance, then 20% off any remaining balance Elective Non-disposable: $150 Allowance, CONTACT then 15% off any remaining balance LENSES Elective Disposable: $150 Allowance Medically Necessary: Covered in full FREQUENCY Lenses: 1 X 12 months OF SERVICES Frames: 1 X 24 months Contact Lenses: 1 X 12 months The benefits and rates in this guide are for illustrative purposes only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
LIFE INSURANCE You can't put a price tag on your life, but you can protect your loved ones with life insurance in the event of a premature loss. BASIC LIFE AND AD&D -You are automatically enrolled in this employer-paid coverage. EMPLOYEE $25,000 VOLUNTARY LIFE INSURANCE For additional coverage, the following benefits are available: VOLUNTARY LIFE AND AD&D -You must submit an application and be approved to be enrolled in this employee-paid coverage. EMPLOYEE Increments of $10,000 up to 5x your earnings; $500,000 Maximum Guaranteed Issue Amount: Lesser of 3X Annual Earnings Or $100,000 SPOUSE Increments of $5,000 up to 50% of Employee Amount up to $250,000 Guaranteed Issue Amount:$30,000 CHILD $10,000 Guaranteed Issue Amount:$10,000
VOLUNTARY DISABILITY Accidents and illnesses happen and often when we least expect them. Ensure you are financially prepared to stay afloat during a medical condition with disability insurance. VOLUNTARY SHORT-TERMDISABILITY Class 1: California Employees — STD Voluntary Class 2: Non-California Employees — STD Voluntary BENEFIT Class 1: 20% of your Earnings to a Maximum of $1,600 a Week Class 2: 60% of your Earnings to a Maximum of $1,600 a Week DURATION 12 Weeks for Sickness 12 weeks for Accident WAITING Illness: 7 Days PERIOD Accident: 7 Days VOLUNTARY LONG-TERMDISABILITY—100% employee paid BENEFIT 60% of your earnings to a maximum of $7,500 a Month DURATION Up to Social Security Normal Retirement Age Disability 101 WAITING 90 Days PERIOD
VOLUNTARY BENEFITS ACCIDENT View Additional Information Here Even with medical insurance, you could still be subject to unexpected out-of-pocket expenses in the form of copays, deductible, and coinsurance. These Voluntary Benefits provide lump sum payments to be used towards your health care expenses, or however you see fit. Click the icons to the right to learn more about each of these benefits. CRITICAL ILLNESS View Additional Information Here HOSPITAL INDEMINITY View Additional Information Here
Contact Information Medical Medical Dental Anthem Kaiser Permanente Anthem 800-676-BLUE (2583) 1-800-464-4000 800-676-BLUE (2583) www.anthem.com healthy.kaiserpermanente.org/ www.anthem.com southern-california/support Vision Life HR Contact Anthem Symetra Adriana Avitia 800-676-BLUE (2583) 1-800-796-3872 323-341-5883 www.anthem.com www.symetra.com/customer- [email protected] service/how-can-we-help-you/email-us/ Cody Iverson 213-607-4356 [email protected] EAP Disability Voluntary Benefits Symetra Symetra Symetra 1-800-796-3872 1-800-796-3872 1-800-796-3872 www.symetra.com/customer- www.symetra.com/customer- www.symetra.com/customer- service/how-can-we-help-you/email-us/ service/how-can-we-help-you/email-us/ service/how-can-we-help-you/email-us/
Employee Notices Click Here to View Please review the following required employee notices detailing your rights and options. You can also request a paper copy of any of these notices at any time.
