2016 CMS Benefit Guide CMS Benefit Guide.pdf · 5 What’s New for 2016? The State Health Plan has...

2016

E M P LOY E E B E N E F I T S

E N R O L L M E N T G U I D E

2

Annual Enrollment 2016: Ready! Set! Go! .......................... 3

Employee Self Service Instruc ons ..................................... 4

Highlights for 2016 Enrollment............................................ 5

Eligibility ............................................................................... 6

Health Benefits

Medical and Prescrip on Drug Plans ....................... 7

State Health Plan Rates .......................................... 8

State Health Plan Wellness Credits ........................ 9

Group Specified Disease Insurance ................. 10‐12

Group Hospital Indemnity ............................... 13‐15

Dental Plans ........................................................... 16

NEW CARRIER: Vision Plans .................................. 17

Flexible Spending Accounts ................................... 18

Financial Security Benefits

NEW OPTION: Disability Benefit Plans ........... 19‐23

Accident Insurance ................................................ 24

NEW CARRIER: Term Life Insurance ..................... 25

Premier Whole Life Insurance ......................... 26‐27

Permanent Life Insurance ................................ 28‐29

Important No ces ........................................................ 30‐31

Employee Programs & The Legal Plan .............................. 32

Carrier Contacts ................................................................. 33

Notes ............................................................................ 34‐35

This guide is intended to summarize the benefits you receive from Charlo e‐Mecklenburg Schools. The actual determina on of your benefits is based solely on the plan documents provided by the carrier of each plan. This summary is not legally binding, is not a contract, and does not alter any original plan documents. For addi onal informa on, please contact the Human Resources department.

Availability of Summary Health Informa on

As an employee, the health benefits

available to you represent a significant

component of your compensa on

package. They also provide important

protec on for you and your family in

the case of illness or injury.

Your plan offers a series of health

coverage op ons. Choosing a health

coverage op on is an important

decision. To help you make an

informed choice, your plan makes

available a Summary of Benefits and

Coverage (SBC), which summarizes

important informa on about any

health coverage op on in a standard

format, to help you compare across

op ons.

The SBC is available on the web at:

www.shpnc.org/myMedicalBenefits/

ppo/default.aspx

A paper copy is also available, free of

charge, by calling 1‐855‐859‐0966.

Your Guide to Your Benefits

3

Be READY! for this year’s Annual Enrollment. To help you get READY!, here is a checklist to follow: Review the Benefits Guide Re‐elect all benefits! All benefits must be re‐elected during Annual Enrollment to have coverage in

2016 Review your beneficiaries! CMS increased the employer paid Basic Life to $10,000. Know your username and password for eEnroll and write it down on the READY! worksheet. Complete your Health Risk Assessment NOW! You can find it at www.shpnc.org/myportal.

Get SET! Beat the rush! SET! your enrollment appointment early to make sure you get the me most convenient to you. Schedule your appointment by October 10th and be entered in a raffle for prizes including KindleFire, iPad, Visa® gi cards, Amazon gi cards and more! There are two easy op ons to SET! Your appointment at your work loca on:

1. Go to www.myenrollmentschedule.com/CMS and find your work loca on to choose the scheduled dates and mes.

2. Call 866.998.2915 from 8 AM to 6 PM Monday through Friday and a representa ve will assist you in making an appointment.

GO!

Take your READY! worksheet and GO! to your appointment. You will receive a printed confirma on

card of your elec ons and the updated CMS Wallet ID card.

READY! . . . SET! . . . GO!

The Annual Enrollment for all CMS benefit plans will end November 18, 2015.

Take advantage of the opportunity to select the plans you want for 2016.

4

Employee Self Service Instructions

Log into the CMS Intranet.

h p://my.cms.k12.nc.us

Note: If you work from a school loca on, you must change the Realm from

cmsdomain to cmssites.

In the blue box on the le , click “Check out your Benefits”

Click on “Employee Self Service”

Select either “Employee Self Service” or Employee Self Service Home”

Your Lawson username and password are the same as what you use to log in to your CMS email account (you will not use @cms.nc.us as a part of your username). Your ini al password is Cm$xxxxx (last 5 of your SSN).

5

What’s New for 2016? The State Health Plan has changes in Plan Design and Wellness Premium Credits.

CMS is increasing your Basic Life Insurance to $10,000—Review your beneficiaries.

Superior Vision will be the new Vision plan provider.

Guaranteed Issue (no health ques ons) is available for several plans.

A new Long Term Disability plan op on is being offered.

Benefits ‐ including Flexible Spending Accounts—must be re‐elected during Annual Enrollment to have coverage in 2016.

REGISTER FOR YOUR PERSONAL ENROLLMENT SESSION TODAY Go to www.myenrollmentschedule.com/cms or call 1‐866‐998‐2915. Counselors will be available onsite at each CMS loca on during the Annual Enrollment period. You may also schedule a phone appointment with a benefit counselor at your convenience. Benefit counselors will be available for some appointments at a select CMS loca on each Saturday.

Learn more about Annual Enrollment and the benefits offered through the following communica ons:

• This guide

• Our benefits website: h p://my.cms.k12.nc.us (Log in and click “Check Your Benefits” and then “Employee Self Service.”)

• Printed materials at your worksite

• Employee emails

• CMS Insider updates

• Your Benefit Counselor appointment

Highlights for 2016 Enrollment

6

Eligibility Explained

The chart below outlines the eligibility for the CMS sponsored plans for full‐ me and part‐ me employees. Employees must enroll in each benefit plan in order to have coverage, with the excep on of Basic Term Life Insurance that CMS provides.

DEPENDENT ELIGIBILITY If you are eligible to par cipate in the benefits offered by CMS, your eligible dependents may also par cipate. For most benefit plans, dependents include:

• Your legal spouse • Your children up to age 26 • Your children covered by the plan who are over the age of 26 and who are/were

physically or mentally incapacitated on the date they turn/turned 26

Plan Full‐Time Employees Part‐Time Employees

State Health Plan (Medical/Rx)*

Specified Disease Insurance with Op onal Cancer Benefit

Hospital Indemnity

Dental Plans

Vision Plans

Flexible Spending Accounts

Short Term Disability Insurance

Long Term Disability Insurance

Accident Insurance

Term Life Insurance*

Permanent Life Insurance

Legal Plan

* CMS pays for Basic Term Life and the cost of full‐ me employee‐only coverage in the SHP 70/30 plan.

Premier Whole Life Insurance

Supplemental Term Life

7

The State Health Plan of North Carolina offers three medical plans to CMS employees for 2016: a Consumer Directed Health Plan (CDHP), a Tradi onal PPO and an Enhanced PPO plan. The CDHP op on includes a high deduc ble health plan with a health reimbursement account, or HRA. The Enhanced Plan provides higher coverage levels in many categories compared to the Tradi onal Plan. The table below provides In‐Network highlights from each plan. Details about each plan are available on the State Health Plan website at www.shpnc.org.

CDHP w/HRA

Member In‐Network Expenses

Tradi onal Plan (70/30) Enhanced Plan (80/20)

$1,500 Individual $4,500 Family

$ 1,054 Individual $ 3,162 Family

$ 700 Individual $ 2,100 Family

15% of eligible expenses a er deduc ble



Out‐of‐Pocket Maximum $ 3,500 Individual $ 10,500 Family

Co‐insurance Maximum1 $ 4,282 Individual $ 12,846 Family

Co‐insurance Maximum1 $ 3,210 Individual $ 9,630 Family

15% a er deduc ble $ 39 Primary Care2 $ 92 Specialist2

$ 30 Primary Care2 $ 70 Specialist2

15% a er deduc ble $ 329 copay plus 30% co‐insurance a er deduc ble

$ 233 copay plus 20% co‐insurance a er deduc ble

15% a er deduc ble $ 329 copay plus 30% co‐insurance a er deduc ble

$ 233 copay plus 20% co‐insurance a er deduc ble

Plan Feature

Benefit Year Deduc ble (Jan. 1 ‐ Dec. 31, 2016)

Member Co‐insurance

Benefit Year Co‐insurance or Out‐of‐Pocket Maximum

Office Visit Copays

Emergency Room

Inpa ent

For full details on the State Health Plan, visit the Plan’s website at www.shpnc.org.

1The Tradi onal 70/30 has an addi onal Rx $3,294 out‐of‐pocket maximum and the Enhanced 80/20 Plan has an addi‐onal Rx $2,500 out of‐pocket maximum.

2In‐network hospital owned or operated prac ces may be subject to deduc ble and co‐insurance. Contact your

physician’s office to determine if their prac ce is hospital owned or operated.

PRESCRIPTION DRUGS: Copay for 30‐day supply for In‐Network Pharmacy

Plan Tier 1 Tier 2 Tier 3 Tier 4 Tier 5

CDHP with HRA

Tradi onal (70/30) $15 $46 $72 25% up to $100 25% up to $132

Enhanced (80/20) $12 $40 $64 25% up to $100 25% up to $132

Subject to deduc ble; then 15% coinsurance

Medical & Rx Drug Plans

8

For 12 month, Full‐Time Employees

CDHP with HRA

Tradi onal 70/30

Enhanced 80/20

Monthly Rate

HRA Fund Amount

Monthly rate Monthly rate

Employee $80.00 $600 $0.00 $104.20

Employee + Spouse $569.14 $1,800 $543.46 $750.52

Employee + Child(ren) $269.82 $1,800 $210.92 $384.72

Family $600.96 $1,800 $578.86 $789.42

Other Cost Saving Opportuni es CDHP Enhanced 80/20 Plan

Visit your PCP (listed on your ID Card) $25 added to your HRA fund Copay reduced by $15

Visit a Blue Op ons Designated Specialist $20 added to your HRA fund Copay reduced by $10

Receive Inpa ent Care in a Blue Op ons Designated Hospital

$200 added to your HRA fund $233 copay is not applied

Wellness Ac vity Premium Credits Available (will reduce the premium amounts above)

CDHP with HRA Tradi onal

70/30 Enhanced

80/20

Tobacco Free $40 per Month Not applicable $40 Per Month

Health Assessment $20 per Month Not applicable $25 Per Month

Select a PCP & Watch Video

$20 per Month Not applicable $25 Per Month

Total Credits Available $80 per Month Not applicable $90 Per Month

YOUR MONTHLY COST

Please see page 9 for more informa on.

2016 State Health Plan Rates

9

2016 State Health Plan

CDHP with HRA Tradi onal

70/30 Enhanced 80/20

A est to being tobacco‐free or enroll in QuitLineNC

A esta on must be completed during Annual Enrollment, even if you a ested last year.

$40 N/A $40

Choose Primary Care Provider (PCP) and watch a video to learn more about Pa ent‐Centered Medical Homes*

The video must be viewed during Annual Enrollment. If you selected PCPs during last Annual Enrollment or at some other me throughout this year, you will receive the premium credit.

$20 N/A $25

Take the Health Assessment**

If you have taken or updated your Health Assessment between November 1, 2014 and October 31, 2015, it will count.

$20 N/A $25

Total Credits Available for 2016 $80 N/A $90

WELLNESS PREMIUM CREDITS

10

If you or someone in your family suffers a serious disease, you can be hit hard with immediate medical expenses and reduced income from being out of a job. Health benefits will pay part of the medical bills, and disability insurance coverage can help ensure a con nuing income. However, many immediate expenses may not be covered. Unum Specified Disease Insurance with Op onal Cancer benefit directly pays you a lump sum benefit at the diagnosis of a covered illness, such as a heart a ack, stroke, major organ failure, or permanent paralysis. Cancer can also be covered for an addi onal premium. You choose the level of coverage (see Highlights table below). The benefit you receive depends on the category of your illness, and may be used as you see fit. You can use this coverage more than once, and you may receive up to 100% of the benefit amount for each category (1, 2, or 3).

Group Specified Disease Insurance with Op onal Cancer Benefit may be right for you if...

• You want to consider treatment op ons from doctors or hospitals outside your area of residence

• You need to provide transporta on and /or lodging for family member in the event of a cri cal illness

• Your home is not adapted for a person with limited mobility for medical reasons.

You would need addi onal funds if you are unable to work during your recovery period.

Group Specified Disease Insurance

ILLNESSES COVERED The following illnesses are covered under the plan: Base Covered Condi ons (Category 1) Heart a ack, stroke, coronary artery bypass surgery* Base Covered Condi ons (Category 2) Benign brain tumor, major organ failure, end state renal failure, blindness Base Covered Condi ons (Category 3) Coma, occupa onal HIV, permanent paralysis Op onal Cancer Condi ons (Category 4) You may choose to select this benefit for an addi onal premium. Cancer, Carcinoma in situ* (pays 25% of the lump sum benefit ) and coronary artery bypass (pays 25% of the lump sum benefit).

*Payout of the coronary artery bypass surgery and carcinoma in situ, which are paid at 25% of the benefit amount and payable once per covered individual,

reduces the remaining amount payable for another specified disease in the same category. Carcinoma in situ is defined as cancer that involves only cells in the

ssue in which it began and that has not spread to nearby ssues.

Please refer to the policy for the complete defini ons of covered specified diseases. You can use this coverage more than once and you may receive up to 100% of the benefit amount for e ach category. If you receive a full benefit payout for a covered illness, your coverage can be con nued for the remaining specified diseases if listed under another category and medically unrelated.

with Optional Cancer Benef i t

11


Plan Features Benefit to You

Eligibility All employees who are ac vely at work, spouses ages 17 through 64 and child(ren) newborn un l age 26, dependent upon the employee for support.

Coverage Op ons Employee and Children, Employee, Spouse and Children.

Benefit Amount Employee: Guaranteed Issue—up to $30,000 benefit and simplified issue up to $50,000 benefit. Spouse: Guaranteed Issue—up to $15,000 benefit and simplified issue up to $30,000 benefit. Dependent Children: All eligible children are automa cally covered at 25% of the employee benefit amount at no addi onal cost.

Recurrence Benefit This benefit can provide an addi onal payout for a second occurrence of: – a benign brain tumor – coma – heart a ack – stroke Note: 12 months must elapse between occurrences of the same condi on. A benefit payout of 100% will be paid for the second occurrence of one of the covered condi ons listed above.

Addi onal Child(ren) Coverage

Eligible children are covered for the same condi ons as employee and the following specific childhood condi ons: Category 1: Down syndrome Category 2: Cerebral palsy, cys c fibrosis, and spina bifida Category 3: Cle lip or palate

Wellness Benefit This benefit can pay $75 per calendar year per insured individual if a covered health screening test is performed, including: • Blood tests • Chest X‐rays • Stress tests • Mammograms • Colonoscopies A full list of covered tests will be provided in your cer ficate.

Pays for Expenses Not Paid by Other Insurance

• Family income replacement during recupera on • Out‐of‐network treatment • Medical insurance copays and deduc bles • Altera ons to home or car • Child care and housekeeping expenses • Special transporta on or housing expenses • Nursing care and experimental treatment or drugs

Portability Coverage is portable upon request, which means you may take the coverage with you if you leave employment or re re (subject to plan provisions).

PLAN HIGHLIGHTS


12

If you choose to cancel your coverage under the policy,

your coverage ends on the first of the month following

the date you provide no fica on to your employer.

Otherwise, your coverage under the policy ends on the

earliest of the:

• Date the policy is cancelled;

• Date you are no longer in an eligible group;

• Date your eligible group is no longer covered;

• Date of your death;

• Last day of the period for which you made

any required contribu ons; or

• Last day you are in ac ve employment.

However, as long as premium is paid as

required, your coverage will con nue if you

elect to con nue coverage under the

Portability provision or in accordance with

the Layoff and Leave of Absence provisions of

the policy.

• Coverage on your dependent children ends

on the earliest of the date your coverage

under the policy ends or the date a

dependent child no longer meets the

defini on of dependent children.


UNUM GROUP SPECIFIED DISEASE INSURANCE SAMPLE RATES

Age Weekly Rate for $25,000 of Coverage

30 $3.23

40 $6.00

50 $10.96

Sample weekly rates for employee only and dependent children, non‐tobacco coverage, without the cancer

benefit:

Employees must be legally authorized to work in the US and ac vely working at a US loca on. Spouses and dependents must live in the US to receive coverage. Unum will

provide coverage for a payable claim which occurs while you are covered under this policy. CE‐13597 (8‐15)

Underwri en by: Unum Life Insurance Company of America, Portland, Maine. Unum is a registered trademark and marke ng brand of Unum Group and its insuring

subsidiaries.

LIMITATIONS AND EXCLUSIONS

TERMINATION PROVISIONS

Unum will not pay benefits for a claim that is caused by, contributed to b or occurs as a result of:

• Par cipa ng or a emp ng to par cipate in a felony or being engaged in an illegal occupa on;

• Commi ng or trying to commit suicide or injuring oneself inten onally, whether sane or not;

• Par cipa ng in war or any act of war, whether declared or undeclared;

• Being under the influence of or addicted to intoxicants or narco cs. This would not include physician‐

prescribed medica on, take in the prescribed dosage.

THIS IS A LIMITED POLICY.

This informa on is not intended to be a complete descrip on of the insurance

coverage available. The policy has exclusions and limita ons which may affect

any benefits payable. For complete details of coverage, please refer to Policy

Form CI‐1 or contact your Unum representa ve.


13

Group Hospital Indemnity Unum’s Group Hospital Indemnity Insurance can complement your health insurance to help pay for the costs

associated with a hospital stay. Benefits can be used to pay for the out‐of‐pocket expenses your medical plan

may not cover, such as coinsurance, copays and deduc bles, or however you wish.

How does it work? The insurance pays a benefit when you are admi ed to the hospital for a covered accident

or sickness.


Eligibility All employees who are ac vely at work, spouses ages 17 through 64 and child(ren) newborn un l age 26, dependent upon the employee for support.*

Coverage Op ons Employee; Employee and Spouse; Employee and Child(ren); Employee, Spouse and Child(ren). Employee must have coverage in order for spouse and child(ren) to have coverage.

Guaranteed Acceptance No medical ques ons required for coverage if you apply during the 2015 enrollment period or when you are first eligible.

Hospital Admission Benefit Amount

$1,000 per insured, per confinement

Daily Hospital Confinement Benefit

$100 each day of the insured’s covered hospital stay, up to 15 days per confinement

Hospital Intensive Care Unit Confinement

$200 each day the insured spends in intensive care, up to 15 days per confinement

Emergency Room Treatment ‐ Accident Only

$150 per visit. Maximum of one per person per calendar year.

Ambulance Transport $100 per trip. One trip per covered person per year. Must be due to a covered accident.

Air Ambulance Transport

$500 per trip. One trip per covered person per year. Must be due to a covered accident.

Portability Coverage is portable upon request, which means you may take the coverage with you if you leave employment or re re without having to answer new health ques ons. Unum will bill you directly.

Pre‐Exis ng Condi on Limita on

Benefits for a pre‐exis ng condi on (defined as a sickness or injury for which medical advice, diagnosis, care or treatment was received or recommended during the 12 months just prior to your effec ve date) will not be paid if the date of the covered loss occurs during the first 12 months a er your effec ve date.

PLAN HIGHLIGHTS

*Eligible employees must be ac vely at work to apply for coverage. Being ac vely at works means on the day the employee applies for coverage, the individual must be

working at one of his/her company’s business loca ons, or the individual must be working at a loca on where he/she is required to represent the company. If applying for

coverage on a day that is not a scheduled workday, the employee will be considered ac vely at work as of his /her last scheduled workday. Employees are not considered

ac vely at work if they are on a leave of absence. CE‐13597(8‐15)

14

Group Hospital Indemnity UNUM GROUP HOSPITAL INDEMINITY INSURANCE SAMPLE RATES

Age Weekly Premium

17 ‐ 49 $4.48

50 ‐ 59 $6.29

60 ‐ 64 $8.97

65+ $12.89

Sample weekly rates for employee only coverage.

LIMITATIONS AND EXCLUSIONS

Unum will not pay benefits for a claim that is caused by, contributed to b or occurs as a result of:

• Benefits for a pre‐exis ng condi on (defined as a sickness or injury for which medical advise, diagnosis, care or

treatment was received or recommended during the 12 months just prior to your effec ve date) will not be

paid if the date of the covered loss occurs during the first 12 months a er your effec ve date.

• Par cipa ng in a war or act of war, whether declared or undeclared;

• Treatment for alcoholism or drug addic on unless the insured is addicted to a narco c taken on the advice of a

physician;

• Treatment for dental care or dental procedures, unless treatment is the result of a covered accident;

• Elec ve procedures and / or cosme c surgery or reconstruc ve surgery, unless it is a result of trauma,

infec on, congenital defects or other diseases;

• Par cipa ng or a emp ng to par cipate in a felony or being engaged in an illegal occupa on;

• Any pregnancy of a dependent child, including services rendered to her child a er birth;

• Commi ng or trying to commit suicide or injuring oneself inten onally, whether sane or not;

• Hospital confinement caused by, contributed to by, or resul ng from mental illness. However, demen a as a

result of stroke, trauma, viral infec on, Alzheimer’s Disease or other condi ons not listed which are not usually

treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or

other similar methods or treatment are covered under this policy;

• Any hospital confinement of a newborn following the birth unless the newborn is sick or injured.

THIS IS A LIMITED POLICY.

This informa on is not intended to be a complete descrip on of the insurance

coverage available. The policy has exclusions and limita ons which may affect

any benefits payable. For complete details of coverage, please refer to Policy

Form CI‐1 or contact your Unum representa ve.

15

Group Hospital Indemnity

• If you choose to cancel your coverage under the policy, your coverage ends on the first of the month following

the date you provide no fica on to your employer. Otherwise, your coverage under the policy ends on the

earliest of the:

• Date the policy is cancelled;

• Date you are no longer in an eligible group;

• Date your eligible group is no longer covered;

• Date of your death;

• Last day of the period for which you made any required contribu ons; or

• Last day you are in ac ve employment. However, as long as premium is paid as required, your coverage

will con nue if you elect to con nue coverage under the Portability provision or in accordance with the

Layoff and Leave of Absence due to injury or sickness provisions of the policy.

Underwri en by: Unum Life Insurance Company of America, Portland, Maine

Unum is a registered trademark and marke ng brand of Unum Group and its insuring subsidiaries.

Unum complies with state civil union and domes c partner laws when applicable.

This informa on is not intended to be a complete descrip on of the insurance coverage available. The police or its provisions may vary or be unavailable in some states. The

policy has exclusions and limita ons which may affect any benefits payable. For complete details of coverage and availability, please refer to policy form GHI‐1, or contact your

Unum representa ve. Unum.com

©2015 Unum Group. All rights reserved. Unum is a registered trademark and marke ng brand of Unum Group and its insuring subsidiaries.

CE‐13597 (8‐15)

TERMINATION PROVISIONS

16

NO CHANGE!

Eligible CMS employees have a choice between three dental plans ‐ 2 dental PPOs and 1 dental HMO ‐ insured by Cigna. Eligible services, coverage levels and premium rates vary by plan. Plan design features and monthly rates will not be changing in 2016. To make the best plan selec on for you, review the highlights shown in the table below and the more detailed benefit summaries and monthly premium rates on h p://my.cms.k12.nc.us. You will also find instruc ons for loca ng Cigna par cipa ng in‐network den sts.

Effec ve January 1, 2016, the PPO Standard Dental Plan In‐Network providers will include both Advantage DPPO and DPPO Cigna / par cipa ng providers.

Plan Feature

Dental HMO PPO Basic Plan PPO Standard Plan

In‐Network Only1

In‐ Network

Out‐of‐Network

In‐Network Out‐of‐

Network

Plan Year Benefit Maximum None $750 $750 $1,500 $1,000

Plan Year Deduc ble Individual / Family

N/A $50 / $150 $50 / $150 $25 / $75 $75 / $225

Office Visit Fee (copay) $5 N/A N/A N/A N/A

Preven ve & Diagnos c Exams, Cleanings, X‐rays

Member copays apply.

See Cigna

Pa ent Charge

Schedule for

details.

100%, no deduc ble

100%, no deduc ble

100%, no deduc ble

100%, no de‐duc ble

Basic Restora ve Fillings, Extrac ons, Oral Surgery

80% a er deduc ble

80% a er deduc ble

90% a er deduc ble

80% a er deduc ble

Major Restora ve Crowns, Periodon cs, Dentures

50% a er deduc ble

50% a er deduc ble

60% a er deduc ble

50% a er deduc ble

Orthodon a22

Not covered Not covered 50%, no de‐

duc ble 50%, no de‐

duc ble

Orthodon a Life me Maximum

None N/A N/A $1,000 $1,000

1Each enrollee in the Dental HMO must select and u lize a Primary Care Den st in Cigna’s Dental HMO network.

2Child and adult orthodon a are covered under the Dental HMO; Child orthodon a is covered under the PPO Standard Plan.

Dental Plans

For 12 month, full‐ me

employees DHMO Basic Standard

Employee $17.00 $23.49 $35.24

Employee + Spouse $46.22 $64.11 $95.57

Employee + Child(ren) $44.03 $61.05 $97.77

Family $73.94 $102.64 $163.89

Y O U R M O N T H L Y COST

17

Vision Plans NEW CARRIER:

For 12 month, full‐ me employees Standard Premium

Employee $5.20 $9.24

Employee + Spouse $10.10 $19.68

Employee + Child(ren) $10.58 $20.62

Family $15.35 $28.91

Standard Plan Premium Plan

Co-Pays Co-Pays

Exam $10 Exam $10

Materials1 $20 Materials1 $20

Contact Lens Fitting $25 Contact Lens Fitting $25

Services/Frequency Services/Frequency Exam 1 per calendar year Exam 1 per calendar year

Frames 1 per 2 calendar years Frames 1 per calendar year

Contact Lens Fitting 1 per calendar year Contact Lens Fitting 1 per calendar year

Lenses 1 per calendar year Lenses 1 per calendar year

Benefits through Superior National Network

Contact Lenses 1 per calendar year Contact Lenses 1 per calendar year

In-Network Out-of-Network In-Network Out-of-Network

Exam (MD) Covered in full Up to $44 Covered in full Up to $44

Exam (OD) Covered in full Up to $39 Covered in full Up to $39

Frames $100 retail allowance Up to $40 $175 retail allowance Up to $70

Contact Lens Fitting (standard2) Covered in full Not covered Covered in full Not covered

Contact Lens Fitting (specialty2) $50 retail allowance Not covered $50 retail allowance Not covered

Lenses (standard) per pair

Single Vision Covered in full Up to $26 Covered in full Up to $26

Bifocal Covered in full Up to $34 Covered in full Up to $34

Trifocal Covered in full Up to $50 Covered in full Up to $50

Lenticular Covered in full Up to $76 Covered in full Up to $76

Factory scratch coat Covered in full Not covered Covered in full Not covered

Polycarb for dependent children Covered in full Not covered Covered in full Not covered

Anti-reflective coat Not covered Not covered Covered in full Not covered

Ultraviolet coat Not covered Not covered Covered in full Not covered

Tints, solid or gradient Not covered Not covered Covered in full Not covered

Progressive lens upgrade See description3 Up to $50 See description3 Up to $50

Contact Lenses4 $100 retail allowance Up to $100 $175 retail allowance Up to $175

Y O U R M O N T H L Y COST

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses

2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses are in lieu of eyeglass lenses and frames benefit *Standard Plan-polycarbs are covered in full for dependent children; Premium-polycarbs covered in full

Disclaimer: All final determina ons of benefits, administra ve du es, and defini ons are governed by the Cer ficate of Insurance for your vision plan. Please check with your Human Resources department if you have any

ques ons. Superior Vision Services, Inc. P.O. Box 967 Rancho Cordova, CA 95741 800.507.3800 SuperiorVision.com The Superior Vision Plan is underwri en by Na onal Guardian Life Insurance Company. Na onal Guardian Life

Insurance Company is not affiliated with The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life

CMS offers eligible employees the op on to purchase vision insurance plans. Our new vision carrier will be Superior Vision.

There are two available op ons ‐ the Standard Plan and the Premium Plan.

18

A Flexible Spending Account (FSA) allows you to put aside money for important expenses and help you reduce your income taxes at the same me. CMS offers two types of Flexible Spending Accounts ‐ a Healthcare FSA and a Dependent Care FSA. These accounts allow you to set aside pre‐tax dollars to pay for certain out‐of‐pocket health care or dependent care expenses.

You must actively re‐enroll in the FSAs each benefit year. You are not automatically re‐enrolled.

How Flexible Spending Accounts Work

1. Each year during Annual Enrollment, you decide how much to set aside for health and/or dependent care expenses.

2. Your contribu ons are deducted from your paycheck on a pre‐tax basis in equal installments throughout the year. A $48.00 annual administra ve fee is deducted along with your contribu ons.

3. A er you incur eligible expenses throughout the benefit year, submit a claim form for reimbursement. Your claim will be processed and you will be reimbursed from your account. For some healthcare expenses, you may also use your FSA debit card to pay at the point of sale.

Please note that the health and dependent care accounts are separate; you may choose to par cipate in one, both or neither. You may not use money from the Health Care FSA to cover expenses under the Dependent Care FSA or vice versa.

FSA Plan Maximum Annual Contribu on Examples of Eligible Expenses*

Health Care FSA $2,500 Medical, Rx, dental, vision copays,

deduc bles, coinsurance, etc.

Dependent Care FSA $5,000 ($2,500 if married and filing

separate tax returns) Day care, nursery school, elder care

* See IRS Publica ons 502 and 503 for a more complete list of eligible expenses.

Flexible Spending Accounts

19

Disability coverage provides a benefit in the event you cannot work due to a covered illness or injury. CMS employees have access to mul ple disability income replacement op ons depending on ves ng with the State Disability Program and elec on of supplemental coverage. Short Term and Long Term Disability benefits are provided by the North Carolina State Re rement System to employees who contribute to the Teachers’ and State Employees Re rement System (TSERS). You must meet the plan’s ves ng requirements before becoming eligible for coverage. The table below outlines some key features of these programs.

Benefit Feature Short Term Disability

Extended Short Term Disability

Long Term Disability

Maximum Benefit Period

Up to 1 year Up to an addi onal year Un l eligible for unre‐duced re rement

Benefit Amount (Taxable Benefit)

50% of 1/12th of annual pay up to $3,000/month

50% of 1/12th of annual pay up to $3,000/month

65% of annual pay up to $3,900/month*

Eligibility Members with at least 1 year of contribu ng ser‐vice

Members with at least 1 year of contribu ng ser‐vice with a temporary disability

Members with at least 5 years of contribu ng ser‐vice with a permanent disability

Elimina on Period 60 days A er Short Term Disabil‐ity benefits are exhausted

A er all Short Term Disa‐bility benefits are ex‐hausted

* See State Disability Program informa on for employees with less than 5 years of service.

Disability Plans—State Disability

20

Program Component Short Term Disability (STD) Long Term Disability (LTD) Long Term Disability (LTD)

Insurance Carrier Trustmark Unum (Choice #1) Unum (Choice #2)

Elimina on Period Choice of two op ons: 1) 0 Days Injury / 7 Days Illness 2) 14 Days Injury / 14 Days Illness

The later of 365 days or the end of your salary con nua on

The later of 365 days or the end of your salary con nua on

Maximum Benefit Period 12 months To normal re rement age for disabili es occurring before age 62

To normal re rement age for disabili es occurring before age 62

Maximum Benefit Amount (in increments of $100)

Vested in State STD: 25% of pay Not vested in State STD: 60% of pay

60% of pay 30% of pay

Monthly Benefit Maximum $6,000 $8,000 $8,000

Minimum Monthly Benefit $300 The greater of $100 or 15% of the monthly benefit

None

Rate Basis Age banded Age banded Age banded

Maternity Coverage? Yes Covered as any other illness Covered as any other illness

Premium Withholding Basis Post‐tax (for tax‐free benefit) Post‐tax (for tax‐free benefit) Post‐tax (for tax‐free benefit)

Benefits offset by other coverage payments?

No Yes, by other group or individu‐al LTD coverage and/or Social Security or any other offsets

There are no benefit offsets.

To supplement the state program, CMS offers the following Disability plan op ons:

Short Term Disability Income Insurance through Trustmark

Long Term Disability through Unum

How does it work? Disability Income insurance replaces part of your paycheck when you are disabled and unable to work. It can help you meet financial obliga ons when you don’t have a paycheck coming in. Your disability insurance benefits are yours to use any way you want. Before you are vested in the State Disability plans, or even a er you are vested, coverage through one of these programs may be beneficial for you and your family. The following table provides an overview of key components of each program and carrier.

Disability Plans—Supplemental

Note: UNUM’s Choice #1 is not available for employees with greater than 5 years of service who are covered under the NC TSERS disability plan.

Choice #1 and Choice #2 are available to employees with less than 5 years of service who are not covered under the NC TSERS disability pro‐

gram.

This is an outline of coverage provided and does no include all of the terms, coverage, exclusions, limita ons and condi ons of the actual contract language.

21

SHORT TERM DISABILITY INCOME INSURANCE Offered by Trustmark Insurance Company Short‐Term Disability income Insurance replaces part of your paycheck when you are disabled1 and unable to work. It can help you meet financial obliga ons when you don’t have a paycheck coming in. Your disability benefits are yours to use in any way you want. Use them to help with:

• Rent or mortgage

• Credit card and automobile payments

• Child care and housekeeping

• Medical insurance copays and deduc bles Short‐Term Disability Income Insurance benefits are paid in full regardless of other coverage3. You receive benefits for total and con nuous disability due to a covered non‐occupa onal injury or accident.

TOTAL DISABILITY DEFINED4 Totally disabled means you are:

• Unable to work at your job

• Not working at your current employer

• Under a doctor’s care for the injury or covered sickness

causing your disability

How Short‐Term Disability Income Insurance benefits add up:

Example: $1,000 monthly benefit Jake ruptured a disc and con nued to be disabled a er his elimina on period for another two months and 15 days.

Benefits Paid

Jake’s benefits following his elimina on period and his firth month of disability $1,000

Jake’s benefits for his second month of disability $1,000

Jake’s benefits for his last 15 days of disability $500

Total Benefits Paid5: $2,500

Short‐Term Disability Income Insurance may be right for you if you become totally dis‐abled2 due to:

• Non‐occupa onal sickness

• Non‐occupa onal injury

• Pregnancy6

• Complica ons of pregnancy

1 As defined by policy / cer ficate 2,3 Subject to terms and condi ons of coverage 4 Defini on may vary by state. See your policy or cer ficate for complete defini on in your state. 5 Benefits paid may vary. See your policy or cer ficate for details. 6 Pregnancy covered 10 months a er Effec ve Date for employees who previously applied for coverage that is no longer in force.


22


Eligibility Full‐ me employees, ages 17‐67, who are ac vely at work, working 30 or more hours per week.

Coverage Op ons Employee only.

Benefit Amount Guaranteed issue up to a $5,000 monthly benefit, except for employees hired prior to October 1, 2014 and except for employees who previously applied for coverage that is no longer in force. Coverage is available up to a $6,000 monthly benefit with medical ques ons. Amount is subject to Income Replacement percentages shown below.

Benefit Period Up to one year, while you remain disabled.

Recurrent Disabili es A new disability is subject to a new elimina on period and a new maximum benefit period applies. A disability that is considered a con nua on of a previous disability within 6 months is not subject to a new elimina on period, and a new maximum benefit period does not apply.

Elimina on Period Two op ons: 14/14 or 0/7 (injury/illness)

Income Replacement Op ons

Up to 25% if vested (1+ years of employment) in North Carolina Re rement System Short‐Term Disability Plan, up to 60% if not vested (less than 1 year of employment) in the North Carolina Re rement System Short‐Term Disability Plan.

Covered Maternity Benefits Total disability resul ng from a pregnancy or childbirth is covered the same as sickness.1

Waiver of Premium Waives premium if you remain disabled for 90 consecu ve days during the benefit period.

Guaranteed Renewable Guaranteed coverage to age 72, as long as premiums are paid. Consult your policy /cer ficate for your state’s exact terms and provisions.

Premiums Rates do not increase because of your age.

Portability Take your coverage with you and pay the same premium is you change jobs or re re.

Pre‐Exis ng Condi on Limita on

Pre‐exis ng condi ons have been waived for all CMS employees, except for employees who previously applied for coverage that is no longer in force.

PLAN HIGHLIGHTS


1 Pregnancy covered 10 months a er Effec ve Date for employees who previously applied for coverage that is no longer in force.

Pre‐exis ng condi ons limita on: If you have become disabled because of a pre‐exis ng condi on, the disability is not covered if it begins during the first 12 months a er the effec ve date of coverage. Pre‐exis ng condi on means

a sickness or physical condi on for which you were treated, received medical advice or had taken medicine within 12 months before the effec ve date of coverage. Pre‐exis ng limita ons may vary by state. See your policy for exact

terms.

Most insurance policies contain exclusions, limita ons and terms for keeping them in force. Your representa ve will be glad to provide you with costs and complete details. See plan DI‐902 for your state for exact terms and

provisions. This policy is designed to provide you with coverage for disabili es resul ng from covered accidents or covered sicknesses. It is not a Medicare supplement policy. It is not a police of workers’ compensa on insurance and

will not cover accidents or sickness covered by workers’ compensa on insurance. This policy is supplemental and not designed to cover all medical expenses. It is not a subs tute for a health benefit plan. This policy does not cover

basic hospital, basic medical or major medical expenses. In MA, you must have a health benefit plan in order to purchase this insurance. Please read your policy or cer ficate carefully for complete informa on. DI‐902 is

underwri en by Trustmark Insurance Company, Lake Forest, Illinois.

SHORT‐TERM DISABILITY INCOME INSURANCE

23

SHORT‐TERM DISABILITY INCOME INSURANCE SAMPLE RATES

Weekly Rates per $100 Monthly Indemnity

0/7 Elimina on Period 14/14 Elimina on Period

17‐49 $0.88 $0.66

50‐59 $1.10 $0.89

60‐67 $1.53 $1.26

Age

Sample weekly rates based on a 1‐year benefit period.

EXCLUSIONS*

Generally no benefits are paid for disability which results from your involvement in:

• Involvement in any period of armed conflict even if not declared;

• Riding in or driving any motor‐driven vehicle in a race, stunt show or speed test;

• Opera ng, learning to operate, serving as a crew member or jumping or falling from any aircra , including

those that are not motor‐driven, other than as a fare‐paying passenger;

• Par cipa ng in or a emp ng to par cipate in any illegal ac vity;

• Suicide, a empted suicide or inten onally self‐inflicted injury, whether you are sane or not;

• Addic on to use of alcohol or drugs;

• Having a psychiatric or psychological condi on including but not limited to affec ve disorders, neuroses,

anxiety, stress and adjustment reac ons. Alzheimer’s and other organic senile demen as are covered.

• Having a work‐related injury

*May vary by state mandates.


LONG TERM DISABILITY Employees with less than 5 years of service who are not covered under the NC TSERS disability program may choose from two long term disability plan benefit op ons:

• 60% of monthly earnings up to $8,000 per month, or

• 30% of monthly earnings up to $8,000 per month For employees with 5 or more qualifying years of service that are covered under the NC TSERS disability plan, you may elect:

• 30% of monthly earnings up to $8,000 per month; payable in addi on to what the State plan pays, and regardless of what other benefits for which you may qualify

24

Accident Insurance Offered by Voya Employee Benefits Every member of your family is suscep ble to an accident at any me, and the expenses associated with that accident may cause a financial burden. Accident Insurance is a limited benefit policy. This is not medical insurance and it does not sa sfy the requirement of minimum essen al coverage under the Affordable Care Act. It pays a specified dollar amount, on top of any health insurance benefits you currently receive, for a specific injuries resul ng from a covered accident. Benefits are paid directly to you and you can use the money as you see fit. You may receive a specified benefit amount for the following:

• Ini al care, including ambulance services, emergency room visits and the ini al doctors’ office visit

• Follow‐up care, including outpa ent services and medical appliances

• Injuries, including burns, disloca ons and fractures

• Catastrophic accidents, and

• Accidental death

Accident Insurance may be right for your family if:

• You have an ac ve family

• You are concerned about

unexpected injuries

• You and / or your family

members play sports

• A serious accident would

create a financial burden for

your family

Coverage Features Benefit to You

Eligibility Employees 18 years and older, Spouses ages 18‐74 and Child(ren) and Stepchild(ren) from birth through age 24. Age restric ons are waived for handicapped dependent children.

Coverage Op ons You can insure yourself, your spouse and your dependent children. Spouse and dependent children coverage are issued as riders. One rider covers all eligible dependent children.

Benefit Payments Accident Insurance pays you a specified amount, defined in the schedule of benefits, for certain services and condi ons resul ng from a covered accident.

Guaranteed Acceptance You don’t need to answer any medical ques ons to apply for coverage.

Pre‐Exis ng Condi ons Pre‐exis ng condi ons don’t apply to Accident Insurance. There is a 30‐day wai ng period on the Wellness Benefit Rider.

Portability Coverage is portable upon request, which means you may take the coverage with you if you leave employment or re re (subject to plan provision).

Level Premiums Rates do not increase as you age.

PLAN HIGHLIGHTS

Your Accident coverage also includes a Wellness Benefit Rider. This rider provides one annual benefit of $100 if you or your enrolled spouse have certain health screening tests, such as mammograms, PSA tests, chest x‐rays, and colonoscopies. The wellness benefit has a 30‐day wai ng period from the effec ve date of coverage. See your policy or a Benefit Counselor (a Licensed Insurance Producer) for a list of covered tests.

Type of Coverage Weekly Rate

Employee $3.41

Employee and Spouse $4.61

Employee and Child(ren) $5.77

Family $6.98

ACCIDENT INSURANCE RATES

25

Eligible CMS employees are automa cally enrolled in Basic Term Life Insurance paid for by CMS. CMS is increasing this benefit to $10,000. This benefit is payable to your beneficiary upon your death.

You may also apply for supplemental term life insurance through Unum to help provide you and your family with addi onal financial protec on at affordable group rates. You have the op on to purchase coverage for yourself, your spouse and your dependent children.

• Employee: Select an amount between $10,000 and $1,000,000, in increments of $10,000, not to exceed 5 mes your basic annual earnings.

• Spouse: Select an amount between $5,000 and $100,000, in increments of $5,000, not to exceed 50% of the employee’s supplemental coverage.

• Child(ren): Select an amount between $2,500 and $10,000, in increments of $2,500 for each child up to age 26 years old who are dependent on the employee for maintenance and support.

During Annual Enrollment 2016 CMS employees who are eligible to enroll in the Supplemental Term Life plan may do so without having to provide Evidence of Insurability, as long as the coverage does not exceed the lesser of 3x annual pay or $650,000. Eligible CMS employees may also enroll their spouse without having to provide Evidence of Insurability up to $50,000. Dependent coverage is con ngent upon employee coverage. Supplemental Term Life rates vary based on your age and the amount of coverage you choose. Employees must be ac vely at work for coverage to take effect. Dependents must not be totally disabled in order for coverage to take effect. This is an outline of coverage provided and does no include all of the terms, coverage, exclusions, limita ons and condi ons of the actual contract language.

Term Life Insurance

BASIC TERM LIFE INSURANCE— Increased Benefit!

SUPPLEMENTAL TERM LIFE INSURANCE

26

Premier Whole Life Insurance Offered by Voya Employee Benefits Protect your family from the loss of income that results from the unexpected death of a loved one. Whole Life Insurance is designed to provide a base of life insurance coverage for your life me. It offers you life insurance protec on, cash accumula on and cash value loan privileges—all in one policy. The premium you pay is based on the death benefit you select and the op onal riders you choose as well as your age and tobacco status. The insurance coverage premium amounts, and cash value are guaranteed as long as you meet the required premium payments. Because you care for your family and you want to leave your beneficiaries with financial security, the death benefit of your life insurance policy can provide money to help them meet financial obliga ons. These proceeds could be used by the beneficiary to help pay for child care, reduce bills or help with educa onal expenses, among other op ons.

OPTIONAL RIDERS

ACCIDENTAL DEATH BENEFIT RIDER*

This benefit provides an addi onal benefit equal to the

base policy face amount if the insured dies in a covered

accident. The maximum addi onal benefit available is

$150,000. The rider terminates on the policy anniversary

on which the insured is 65. Any employee or spouse up

through age 60 who is eligible for Whole Life Insurance is

eligible to apply for the Accidental Death Benefit Rider. NP‐

B‐ORD‐AB‐04.

WAIVER OF PREMIUM RIDER*

This rider allows the con nua on of your life insurance

policy by waiving the monthly premiums of the base policy

and any riders a er the insured has been totally disabled

for four consecu ve months. The waiver con nues

throughout the dura on of the disability. NP‐B‐ORD‐WOP‐93R.

ACCELERATED DEATH BENEFIT RIDER* (Only Available in

NC, IL, CA and TX)

To read more about the Accelerated Death Benefit Rider,

see rider brochure at h p://mycms.k12.nc.us and click on

2016 Annual Enrollment/Voluntary Benefits for more

details. WL2ADBR‐08‐NC.

CHILDREN’S TERM INSURANCE RIDER*

Insurance coverage is available in $1,000 increments, from

$2,000 to $10,000. On the first policy anniversary a er the

child’s 25th birthday—or expiry date, if earlier—he or she

can convert that insurance to an individual life policy for a

maximum of 5x the rider amount. Evidence of insurability is

not required. RL‐WL2‐CTR‐07.

*See full brochures at rider brochure at h p://my.cms.k12.nc.us and click on 2016 Benefits for more details.

Whole Life Insurance may be right for your family if you have recently:

• Increased your consumer

debt

• Purchased a new home or car

• Had any children or included

aging parents or other rela‐

ves in your financial respon‐

sibili es

• Evaluated the effect of

infla on on your current life

insurance coverage

27

Premier Whole Life Insurance


Eligibility All employees who are ac vely at work and spouses up to age 70 and child(ren) / grandchild(ren) ages 15 days through age 24 and unmarried.

Coverage Op ons You can apply for coverage for yourself, your spouse, your children and your grandchildren. You can cover your dependents even if you do not choose to apply for coverage yourself.

Benefit Amount* Employee: Guaranteed Issue—up to $25 per week, not to exceed $125,000 (ages 15‐65); Con ngent Issue—up to $50,000 maximum benefit (ages 66‐70). Spouse: Con ngent Issue— greater of $5/week or $5,000 (ages 15‐65); Above Con ngent Issue– Full underwri ng (ages 66‐70) Dependent Children: Con ngent Issue — $12,500, $15,000, $20,000 or $25,000 (15 days through 24 years). Note: Amounts above Guaranteed / Con ngent Issue Amounts are available with addi onal underwri ng.

Portability Coverage is portable, which means you may take the coverage with you as long as you make the required payments.

Level Premiums The premiums are guaranteed to be fixed for life of the policy as long as you make the required payments.

Guaranteed Cash Values Policy provides guaranteed cash values that are not based on variable interest rate. As long as premiums are paid, the policy’s cash value will grow over me based on a schedule provided with your policy.

Cash Value Loans Once cash values accumulates, the policy owner can borrow against it at the rate shown in the policy. Interest is payable in advance. The death benefit will be reduced by the amount of any outstanding loan and unpaid accrued interest.

Pre‐Exis ng Condi ons Pre‐exis ng condi ons don’t apply to Premier Whole Life Insurance.

Suicide Clause For suicide within 2 years from the policy's date of issue or increase in coverage, benefits are limited to a payment of all premiums paid without interest, less any policy loan and loan interest.

PLAN HIGHLIGHTS

PREMIER WHOLE LIFE INSURANCE SAMPLE RATES*

Age Weekly Rate for $25,000 of Coverage

30 $5.08

40 $8.25

50 $14.32

Sample weekly rates for employee only, non‐tobacco coverage, without any op onal riders:

*New rates for new polices effec ve 1/1/14. Rate increases are required to

sustain increased cash values. Rates for polices issued prior to 1/1/14 are not

affected.

This is a brief descrip on of coverage and is not a contract. Read your policy and riders carefully for exact terms and condi ons. This policy has exclusions and terms under

which the policy may be con nued in force or discon nued. Insurance is issued by ReliaStar Life Insurance Company, a member of Voya® family of companies. Voya

Employee Benefits is a division of the insurance company. Home and Administra ve Office: 20 Washington Avenue South, Minneapolis, MN 55041. Policy Form #: RL‐W2‐

POL‐07 (not available in all states). Policy form number, product availability and provisions may vary by state.

*Coverage amounts are based on age, tobacco status, and weekly premium. Amounts above Guaranteed / Con ngent Issue are available with addi onal underwri ng.

28

Permanent Life Insurance Permanent Life Insurance from Texas Life can be an ideal complement to your employer provided group term life insurance. Designed to be in force when you die, this universal life product is yours to keep, even when you change jobs or re re, as long as you pay the necessary premium. This permanent, portable coverage helps address your post‐re rement life insurance needs because it allows you to purchase a significant amount of life insurance at a reasonable cost during your working years, and thus, provides you with affordable coverage a er re rement.

PLAN FEATURES

EXPRESS ISSUE

Employees and spouses only have to answer three work and

health‐related ques ons to qualify for significant amounts of

coverage; children and grandchildren only have to answer

one health‐related ques on.1

HIGH DEATH BENEFIT

With one of the highest death benefits available at the

worksite2, PURELIFE gives your loved ones peace of mind

knowing there will be significant life insurance in place when

you die.

MINIMAL CASH VALUE

Designed to provide high death benefit, PURELIFE does not

compete with the cash accumula on in your employer‐

sponsored re rement plans.

LONG GUARANTEES3

Guaranteed death benefit to age 121 and level premium that

guarantees premium coverage for a significant period of me

(a er the guaranteed period, premiums may change).

REFUND OF PREMIUM

Unique in the marketplace, PURELIFE offers you a refund of

five years of premium should you surrender the policy if the

premium you pay when you buy the policy ever increases

(condi ons apply).

FAMILY COVERAGE

You may apply for coverage for yourself, your spouse, child

(ren) and grandchild(ren).

PURELIFE Permanent Life Insurance may be right for your family if...

• You want an ideal way to provide money for your family when they need it most.

• You want to help ensure that your family has money when you die.

1 Texas Life complies with all state laws regarding marriages, domes c and civil union partnerships, and legally recognized familial rela onships. 2 Voluntary and Universal Whole Life Products, Eastbridge Consul ng Group, October 2012

3 Guarantees are subject to product terms, exclusions and limita ons, and the insurer’s claims paying ability.

29

Permanent Life Insurance


Eligibility All ac vely at work employees ages 17‐70 may apply. Spouses ages 17‐60, children ages 15 days through 26 years, and grandchildren ages 15 days through age 18 are also eligible.

Coverage Op ons Employees may apply for coverage on their spouses, children, and grandchildren, regardless of whether or not the employee also applies.

Express Issue Benefit Amount

Employees ages 17‐49 are eligible to apply for up to $150,000 of coverage on an Express Issue basis; employees ages 50‐65 are eligible to apply for up to $75,000; and employees ages 66‐70 are able to apply for $10,000 under Express Issue underwri ng. Spouses may apply on an Express Issue basis as follows: issues ages 17‐49, $50,000; and issue ages 50‐60, $25,000. Children and grandchildren are eligible to apply for up to $25,000 of coverage and are required to answer only one health‐related ques on.

Rates Rates are based on age at issue and are the same for employees, spouses, children and grandchildren.1

Portability Coverage is guaranteed as long as required premiums are paid, even a er you re re or terminate employment. When employment ends, you can pay equivalent monthly premiums directly or by bank dra .

Accelerated Death Benefit Rider

Included in all policies at no addi onal charge, this rider pays 92% of the death benefit (in most states), minus a $150 processing fee ($100 in Florida), upon diagnosis of a terminal illness expected to result in death within 12 months. (In Illinois, the payout is 84% of the death benefit, minus the $150 processing fee, if the insured is expected to die within 24 months.) The policy terminates at the exercise of the rider.

Op onal Child Term Rider

$10,000 on all current and future children. The premium is the same ($5 per month) regardless of the number of children. Guaranteed Issue. Each child is covered un l he / she reaches age 25, at which me, the coverage terminates. Each child may convert the rider to an individual $30,000 policy at a ained‐age rates. May be a ached to either the employee’s or spouse’s policy. Rider terminates when last child reaches age 25.

PLAN HIGHLIGHTS

PURELIFE PERMANENT LIFE INSURANCE SAMPLE RATES

Age

Face Value2

$25,000 $50,000 $100,000

25 $1.97 $3.58 $6.81 59

35 $2.72 $5.08 $9.81 60

45 $5.54 $10.74 $21.12 72

Guaranteed Age3

Sample weekly rates shown are non‐tobacco with no addi onal benefits.

1 Policies not available for children and grandchildren in Washington. 2Insurance coverage is subject to evidence of insurability. Suicide and contestable clauses apply. 3 Age to which coverage is guaranteed at Table Premium. A er the Guaranteed Period, premiums may go down, stay the same or go up. PureLife is provided by Texas Life Insurance Company, 900 Washington, Waco, Texas, 76701. Like most life insurance policies, Texas Life policies contain certain exclusions, limita ons, excep ons, reduc ons of benefits, wai ng periods and terms for keeping them in force. See the PureLife brochure for details. Policy form PRFNG‐NI‐07 or ICC‐07‐PRFNG‐NI‐07. 15M216‐C 1090 (exp 0917)

30

Premium Assistance Under Medicaid & Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more informa on, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1‐877‐KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer‐sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have ques ons about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1‐866‐444‐EBSA (3272).

North Carolina South Carolina

Website: www.ncdhhs.gov/dma

Phone: 919‐855‐4100

Website: www.scdhhs.gov

Phone: (888) 549‐0820

Important Notices

31

Making Changes During the Plan Year Once you enroll during Annual Enrollment or during your new hire ini al eligibility period, you are required to maintain most of your benefit elec ons throughout the benefit year, unless you experience a Qualified Life Event, as defined by the IRS. These include:

• Marriage, death of a spouse, divorce, annulment or legal separa on

• A change in the number of dependent children; including birth, adop on, placement for adop on, becoming responsible for a stepchild who will reside in your home or death of a child

• Employment change by the employee, spouse or dependent child that results in a loss or gain of health coverage

• Child’s loss of eligibility due to age or marriage

• For Dependent Day Care FSA – enrollment into or removal from day care

If you experience a Qualified Life Event during January 1 ‐ December 31, 2016, you have 30 calendar days from the date you experience the event to change your benefit elec ons. The benefit changes you make must be consistent with your life event, and you must provide CMS with documenta on of the event (e.g., birth cer ficate, marriage cer ficate, COBRA or HIPAA le er showing loss of coverage) within the same 30 day window. If you do not make the change within 30 calendar days of the qualified life event or if you do not provide documenta on within that period, you must wait un l the next annual enrollment period to make an elec on change. To report a Qualified Life Event and to make your mid‐year benefit changes online, visit h p://my.cms.k12.nc.us

Other No ces To view the health plan legal no ces, visit the State Health Plan of North Carolina website at www.shpnc.org.

Charlo e‐Mecklenburg Schools reserves the right to amend, modify, suspend or terminate ‐ in whole or in part ‐ the plan at any me without approval, consent or acceptance of par cipants. This reserva on applies to all ac ve benefit plans including all medical and prescrip on drug plans, and includes the right to change contribu ons and available benefits. Charlo e‐Mecklenburg Schools will make reasonable efforts to maintain personal informa on, but it is en rely the responsibility of employees to maintain accurate and current personal informa on, including address, with the company. Failure to do so could result in loss of coverage.

It is the responsibility of employees and their covered dependents to no fy Charlo e‐Mecklenburg Schools of changes that may affect the eligibility of covered dependents, including but not limited to (1) the death of the covered employee, (2) divorce or legal separa on of the covered employee, (3) a covered dependent child ceasing to qualify as a “dependent child” under the terms of the plan, and (4) a covered member’s en tlement to Medicare. No ce of change must be made within 30 days of the change. Failure to no fy may result in loss of coverage.

Rate No ce and Escrow No ce for Less than 12 Month Employees

In order to provide con nuous medical coverage for less than 12‐month employees and their dependents during the summer months (June−August), CMS deducts addi onal amounts, called escrow payments, to cover the summer months' deduc ons. The total premiums for January are divided equally into nine monthly deduc ons beginning in February.

For employees who increase their coverage for January 1, addi onal escrow payments will be collected in one or more of your payroll checks in February.

Important Notices

32

PURCHASING POWER PURCHASING PROGRAM Through the Purchasing Power program you can buy various household items and other goods and pay for them via payroll deduc on. Things like computers, televisions, appliances and many more items are available. Visit www.cms.purchasingpower.com for more details.

HOME & AUTO INSURANCE DISCOUNT PROGRAM Four insurance companies partner with CMS to offer employees discounts on home and automobile insurance. The four vendors are:

For more informa on about what each carrier offers, you may contact them directly. Telephone numbers are listed on page 23 of this Guide.

LEGAL PLAN Finding an affordably‐priced lawyer to represent you when you have trouble with creditors, buy or sell a home, or even prepare a will can be a challenge. Hya Legal Plans is a legal service program that provides legal representa on for you, your spouse and dependents at a price that won’t break your budget.

This plan gives you a resource at your finger ps for important legal services such as:

• Court appearances

• Document review & prepara on

• Debt collec on defense

• Wills

• Family ma ers

• Real estate ma ers

• Liberty Mutual

• MetLife

• Na onwide

• Horace Mann

Employee Programs / Legal Plan

33

Coverage Carrier/Administrator Website Phone Number

Medical North Carolina State Health

Plan www.shpnc.org

Medical—888‐234‐2416 Rx—800‐336‐5933

Specified Disease and/or Hospital Indemnity

Unum www.unum.com/employees 800‐635‐5597

Dental Cigna www.mycigna.com 800‐244‐6224

Vision Superior Vision www.superiorvision.com 800‐507‐3800

Flexible Spending Accounts Flores & Associates www.flores247.com 800‐532‐3327

Short Term Disability Trustmark www.trustmarksolu ons.com 800‐918‐8877

Long Term Disability Unum www.unum.com 800‐633‐7479

Accident Insurance Voya h p://voya.com/products‐

services/employee‐benefits‐work 855‐730‐2902

Whole Life Voya h p://voya.com/products‐

services/employee‐benefits‐work 800‐537‐5024

Permanent Life Texas Life www.texaslife.com 800‐283‐9233, ext 6814

Term Life Unum www.unum.com 800‐445‐0402

Purchasing Program Purchasing Power www.cms.purchasingpower.com 866‐670‐3479

Legal Hya Legal members.legalplans.com 800‐821‐6400

Discount Home & Auto Insurance Programs

Met Life Liberty Mutual

Na onwide Horace Mann

800‐438‐6388 800‐835‐0894 704‐549‐4800 704‐532‐1111

Carrier Contacts

34

Notes

35

Notes

36

This document is an outline of the coverage proposed by the carrier(s), based on infor-ma on provided by your company. It does not include all of the terms, coverage, exclusions, limita ons, and condi ons of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.

The intent of this document is to provide you with general informa on regarding the status of, and/or poten al concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Ques ons regarding specific issues should be ad-dressed by your general counsel or an a orney who specializes in this prac ce area.

All printed materials, raffle prizes and giveaways have been provided

or donated by CMS benefit carriers.

2016

2016 CMS Benefit Guide CMS Benefit Guide.pdf · 5 What’s New for 2016? The State Health Plan has...

Documents

Transcript of 2016 CMS Benefit Guide CMS Benefit Guide.pdf · 5 What’s New for 2016? The State Health Plan has...