Please note that by September 7, 2007 all employees must complete and submit the attached documents, even if you are electing to waive coverage.

Transcripción

1 July 9, 2007 To All s: Hopefully this letter finds you having a relaxing, happy, and healthy summer. As the school year approaches, it is time to provide you an update regarding health benefits for the upcoming year. Historically, LCISD through a self-funded plan has provided a benefits package with deductibles and employee premiums that are significantly lower than neighboring districts. To clarify self-funded means that the district s contributions of $1,000,000 yearly plus $286 per employee per month are combined with the premiums paid monthly by employees to become the basis of the health plan fund. That fund becomes the source of payment every time an employee or covered dependent files a medical, dental or pharmaceutical claim. Three factors have had substantial negative impact on the fiscal soundness of the health plan fund. They are growth in plan participation, increased medical costs and increased usage. Regrettably, the district must alter the current plan and premium structure so that the plan will remain viable. During the course of the school year, the Insurance Committee consisting of representatives from each campus and department, met many times to study the various issues. Some of the issues they reviewed were: 1. Comparison of LCISD s employee premiums to neighboring districts employee premiums 2. The impact of plan changes such as higher deductibles, increased co-pay for specialists and increased out-of-pocket maximum 3. The impact of increasing employee premiums 4. The impact of implementing a combination of plan and premium changes Ultimately, the Insurance Committee recommended a combination solution that involved increasing premiums and making adjustments to the current plan structure. The new plan was approved by the Board of Trustees on July 10, Copies of the plan structure and premium rates are attached. It is noteworthy that the premium for employee only coverage did not increase. Additionally, the Board of Trustees elected to increase the district s per employee per month contribution in order to share the premium burden. The purpose of this letter today is to provide you with the necessary information to analyze your personal situation in order to select the plan that best meets your needs. To assist you with this, there are several information sessions you may attend if you wish to do so. Please see the attached schedule for meeting dates and times. These meetings are to provide you with information so attendance is optional. Please note that by September 7, 2007 all employees must complete and submit the attached documents, even if you are electing to waive coverage. You may submit the paperwork in one of the following methods: 1. Mail the completed, signed documents to Benefits 2. Submit the paperwork in person in the Human Resources office at any time 3. Submit the paperwork on the day that the Benefits representatives are on your campus according to the attached schedule 4. Submit the paperwork to a Benefits representative at any site convenient to you according to the attached schedule The district will accept your paperwork as soon as it is completed; it is not necessary to adhere to the attached schedule or to wait until school starts. Should you have questions or need assistance, please contact Human Resources at

2 A todos los empleados del distrito: Ojalá que ustedes estén teniendo un verano relajado, contento, y sano. Como el año escolar se acera es tiempo de proveer a ustedes una actualización sobre los beneficios médicos para el año que viene. En el pasado, LCISD por un plan financiado de si mismo ha proveído un paquete de beneficios con deducibles y primas del empleado que son significativamente más bajos que distritos vecinos. Para clarificar, un plan financiado de si mismo significa que las contribuciones del distrito de $ cada año más $286 por empleado por mes están combinados anualmente con las primas pagadas cada mes por los empleados. Esta combinación se convierte en la base del fondo. Este fondo se convierte en la fuente del pago cada vez que un empleado o un dependiente cubierto archiva una demanda médica, dental o farmacéutica. Tres factores han tenido un impacto negativo substancial en la validez fiscal del fondo. Estos factores son crecimiento de la participación del plan, costes médicos y el uso. Desafortunadamente, el distrito debe cambiar el plan corriente y la estructura de la prima para que el plan siga viable. Durante el año escolar , el comité de seguro que consistía de representantes de cada escuela y departamento, se reunieron muchas veces para estudiar varias cuestiones. Algunas de las cuestiones que repasaron fueron: 1. Comparación de las primas de los empleados de LCISD a las primas de los empleados de los distritos vecinos 2. El impacto de los cambios del plan tal como deducibles más altos, aumento de co-paga para especialistas y aumento máximo de sus propios gastos (fuera-de-bolsillo) 3. El impacto de aumento de las primas de los empleados 4. El impacto de implementar la combinación de los cambios del plan y las primas. Al final, el comité de seguro recomendó una solución que aumentara las primas y hiciera ajustes del plan corriente. El plan nuevo fue aprobado por la mesa directiva el 10 de julio, Copias de la estructura del plan y las primas se unen. Es notable que la prima para la cobertura del "empleado solo" no aumentara. Adicionalmente, la mesa directiva eligió de aumentar la contribución del distrito por empleado por mes para compartir la carga de la prima. El propósito de esta carta es de proveer a usted la información necesaria para analizar su situación personal para seleccionar el mejor plan para sus propias necesidades. Para ayudarle, hay varias sesiones informativas en que usted puede asistir si usted quiere. Por favor, lea el horario unido por fechas y horas de las reuniones. Estas reuniones proveen la información, pero su asistencia es opcional. Por favor observe que antes del 7 de septiembre, 2007 todos los empleados deben cumplir y presentar los documentos unidos, aunque han elegido renunciar cobertura. Usted puede presentar el papeleo en uno de los métodos siguientes: 1. Envíe los documentos cumplidos y firmados al departamento de beneficios 2. Presente el papeleo en persona en la oficina de los Recursos Humanos 3. Presente el papeleo en el día que los representantes de los beneficios están en su escuela según el horario unido 4. Presente el papeleo a un representante de beneficios en un lugar que está conveniente según el horario unido El distrito aceptará su papeleo tan pronto como se cumpla; no es necesario seguir al horario unido o esperar hasta que la escuela comience. Si tiene preguntas o necesita ayuda, por favor llame al departamento de Recursos Humanos al

3 Question & Answer Sessions Date Location Time July 26, 2007 Board Room 5:00-6:30 P.M. August 2, 2007 Terry High Auditorium 6:00-7:30 P.M. August 8, 2007 Foster High Auditorium 4:00-5:30 P.M. August 15, 2007 Lamar High Auditorium 3:00-4:30 P.M. Enrollment Sessions July 16-27, 2007 M&O 7:30-4:00 Food George Jr. High 7:30-3:00 August 6-8, 2007 August 13-15, 2007 Transportation 7:30-4:00 August 24, 2007 Bowie 7:30-11:30 August 24, 2007 Huggins 7:30-11:30 August 24, 2007 Pink 7:30-11:30 August 24, 2007 Beasley 12:00-4:00 August 24, 2007 Briscoe 12:00-4:00 August 24, 2007 Seguin 12:00-4:00 August 30,2007 Frost 7:30-11:30 August 30,2007 Taylor Ray 7:30-11:30 August 30,2007 Lamar Jr. High 7:30-11:30 August 30,2007 Austin 12:00-4:00 August 30,2007 Travis & ALC 12:00-4:00 August 30,2007 Wessendorff 12:00-4:00 August 31, 2007 Smith 7:30-11:30 August 31, 2007 Navarro 7:30-11:30 August 31, 2007 Dickinson 7:30-11:30 August 31, 2007 Hutchinson 12:00-4:00 August 31, 2007 George 12:00-4:00 August 31, 2007 Campbell 12:00-4:00 September 4, 2007 Williams 7:30-11:30 September 4, 2007 Jackson 7:30-11:30 September 4, 2007 Velasquez 12:00-4:00 September 4, 2007 Meyer 12:00-4:00 Lamar High/Development Center 7:30-11:30 September 5, 2007 September 5, 2007 Foster High 7:30-11:30 September 5, 2007 Terry/Natatorium 7:30-11:30 September 5, 2007 Long Primary,1621,JDC 12:00-4:00 September 5, 2007 Administration 12:00-4:00

4 Instructions: Please complete the shaded sections Group Number Lamar Consolidated Independent School Medical/Dental Enrollment Form Date of Hire Effective Date A. Information Last Name First Name SS# DOB (MM/DD/YY) Address City State Zip Telephone Number Male Female B. Product Selection Job Title PPO Choice plus Plan (A) $1000 PPO Choice plus Plan (B) $500 Dental Network Dental PPO Only Child (ren) Spouse Family (1) Family (2) Only Child (ren) Spouse Family (1) Family (2) Only Child (ren) Spouse Family Only Child (ren) Spouse Family C. Family Information List family members taking medical, dental. Write name as it should appear on I. D Card. Full time student status information is required for all family members who exceed the eligible dependent age 19; or have completed High School Full Name of Dependent Social Security # Relationship M/F DOB ` D. /Dependent Waive (Decline) Medical Coverage I understand that if I and/or my dependents, if any, waive any coverage and desire to participate in the plan at a later date, I/we may be considered a late enrollee and must meet the requirements defined in the Enrollment and Effective date of Coverage in the section Certificate of Coverage. If I decline enrollment for myself or my dependents (including my spouse) because of other health coverage, I may in the future be able to enroll myself or my Dependents in this plan provided that I request enrollment within 31 days after other coverage ends. In addition, if a new dependent relationship forms as a result of marriage, birth, adoption, placement for adoption or party in suit of adoption, I may be able to enroll myself and my dependents, provided that I request enrollment within 31 days after such marriage, birth or adoption. I decline coverage for my (check all that apply): Self only Spouse Dependent Child (ren) Due to: Existence of other health coverage *** Other reason (explain below) Signature Date E.. Other Health Insurance Information (This section must be completed. Incomplete information may result in nonpayment of claims.) The day your coverage begins, will any family members, including those listed in Section C, be covered by other insurance or Medicare. No Yes (If yes, complete this section) Coverage Medical Ins. Medicare Insurance Company Name and Phone Number Policy Coverage Dates Policy Number Type Medicaid Continuation/COBRA to Name of Insured Insured Birthdates Name of family Member covered Policyholder s Employer Address Phone Number F. Signature (This form must be signed.) AUTHORIZATION TO OBTAIN OR RELEASE MEDICAL INFORMATION on behalf and anyone enrolled on or added to application ( Us ). I authorize any health care professional or entity to give to United Healthcare Insurance Company, their affiliates or any of their designees (individually or collectively You ) any and all record or information pertaining to demographic medical history, psychiatric or psychological care or examinations, and alcohol or drug abuse protected by 42 CFR. Part 2 or other applicable law (subject to any revocation rights there under) for any administrative purpose including underwriting, claims evaluation and for analytical or research purposes. Information concerning mental illness, sexually transmitted diseases or other serious communicable disease may be used by you in accordance with laws and regulations which apply to Us. United Health Care Insurance Company, may use and re-disclose any medical information. The information provided on this application is accurate and complete. I understand and agree that any intentional misrepresentation of a material fact, fraudulent or untrue statement made by Us on this application may invalidate my and /or my dependent s coverage. The authorization will remain valid for the purpose of the application, 12 months from the date authorization is given. The authorization will remain valid for the purpose of claims evaluation for the term of coverage of the policy. Signature Date

5 Plan A - $1000 Deductible Premium Changes contribution is $1,000,000 plus $ per employee per month Coverage EE Only $ $35.00 $ $ $35.00 $ $0.00 EE/Spouse $ $ $ $ $ $ $37.93 EE/Children $ $ $ $ $ $ $22.11 EE/Family 1 $ $ $ $ $ $ $48.49 EE/Family 2 $ $ $ $ $ $ $23.25 Amount of Increase to Plan B - $500 Deductible Coverage EE Only $ $50.77 $ $ $50.77 $ $0.00 EE/Spouse $ $ $ $ $ $ $52.96 EE/Children $ $ $ $ $ $ $33.18 EE/Family 1 $ $ $ $ $ $ $66.14 EE/Family 2 $ $ $ $ $ $ $40.01 Amount of Increase to

6 Plan Changes Plan A Plan B In Network Out of Network Annual Deductible Individual $500 $1,000 $1,000 $2,000 Annual Deductible Family $1,500 $3,000 $3,000 $6,000 Co-pay Primary Care $20 $20 50% after deduct 50% after deduct Co-pay Specialist $20 $30 50% after deduct 50% after deduct Out of Pocket Maximum Individual $2,000 $2,500 $7,000 $10,000 Out of Pocket Maximum Family $6,000 $7,500 $21,000 $30,000 Pharmacy Tier 1 $10 $10 Pharmacy Tier 2 $25 $25 Pharmacy Tier 3 $50 $50 Mail Order Prescription Tier 1 $25 $25 Mail Order Prescription Tier 2 $62.50 $62.50 Mail Order Prescription Tier 3 $125 $125 In Network Out of Network Annual Deductible Individual $250 $500 $500 $1,000 Annual Deductible Family $750 $1,500 $1,500 $3,000 Co-pay Primary Care $20 $20 50% after deduct 50% after deduct Co-pay Specialist $20 $30 50% after deduct 50% after deduct Out of Pocket Maximum Individual $1,500 $2,000 $7,000 $10,000 Out of Pocket Maximum Family $4,500 $6,000 $21,000 $30,000 Pharmacy Tier 1 $10 $15 Pharmacy Tier 2 $25 $30 Pharmacy Tier 3 $50 $60 Mail Order Prescription Tier 1 $25 $37.50 Mail Order Prescription Tier 2 $62.50 $75 Mail Order Prescription Tier 3 $125 $150

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