EMPLOYEE BENEFIT HEALTH PLAN - Frequently Asked Questions

1. Who is eligible to enroll? All active, full-time employees who work at least 20 hours per week may enroll in the plan.

2. What happens if I am part-time, then I go to full time? If you are working less than 20 hours per week, and then your contract is changed to full-time, you may enroll immediately in the health plan.

3. When Should I enroll? You must enroll within 31 days of meeting the eligibility requirement. Therefore, if you are hired as a full time employee, you should sign up immediately for the health insurance. If you change from part time to full time, you should enroll immediately in the health plan.

4. What happens if I do not enroll when I am first eligible? The plan allows an employee to enroll at different times as governed by federal law:
a. Special Enrollment - Other Coverage: If you do not enroll in the plan because you had other insurance at the time (for instance, you were covered by your spouse's plan), and the other coverage has terminated due to a "qualifying event," you may enroll in this Plan, as long as the enrollment is received within 31 days of the termination of the other coverage. Refer to your Plan Document for "qualifying events." In order to be eligible for this Special Enrollment, you must have originally waived enrollment in the Plan, and told the Personnel/Human Resources office that you were rejecting coverage because you were insured elsewhere.
b. Special Enrollment - Dependent Acquisition: If you acquire new dependents, through marriage, birth, or adoption, you may enroll such new dependents (and yourself, if you have never enrolled), as long as the enrollment is received within 31 days of the date of the marriage, birth or adoption. However, you cannot enroll the dependents you had prior to acquiring the new dependent. For instance, if you are single with one child, but you never enrolled either yourself or the child, and then marry and your new spouse has a child, you may request a Special Enrollment, within 31 days of the marriage, and enroll yourself, your new spouse, and your new stepchild. The child you had pri9or to the marriage cannot be enrolled, except as a Late Enrollee.
c. Late Enrollment: If you do not enroll yourself and your dependents when you are first eligible for coverage under this Plan, either by reason of being a full-time employee or by the two special enrollment provisions above, you and your dependents are then considered Late Enrollees. Late Enrollees may apply for coverage only during Open Enrollment. Late Enrollees are subject to 18 months pre-existing conditions.
d. Open Enrollment: Once a year, the Plan will hold an Open Enrollment. The Employer will announce when Open Enrollment is to be held. Those eligible employees and dependents who have never enrolled in the Plan are eligible to enroll during Open Enrollment.

5. When will my coverage become effective? Provided the employee completes the enrollment forms as required, coverage is effective as follows.
a. For a new, full-time employee who enrolls in the Plan when first eligible, the effective date of coverage is the first day of the month coincident with or following the Employee's date of hire.
b. For a part-time employee, who goes to full-time, the effective date of coverage is the date the Employee becomes full-time, providing the Waiting Period has been satisfied. For instance, if your are hired on July 1st as a part-time employee, and on July 3rd your hours are changed to full-time, your coverage will be effective the first of the month following your date of hire, September 1st. If you are hired on July 1st as a part-time employee and on September 3rd your hours are changed to full-time, you may enroll immediately and your coverage can be effective September 3rd.
c. For those enrolling by Special Enrollment, Other Coverage: Coverage is effective the first day of the month following the Employer's receipt of your completed enrollment form, provided you are requesting enrollment within 31 days of losing the other coverage.
d. For those enrolling by Special Enrollment, Dependent Acquisition: Coverage is effective:
1. If marriage is the reason, coverage is effective the first day of the month following the employer's receipt of the completed enrollment form, provided you are requesting enrollment within 31 days of the date of your marriage. 2. If a newborn or newly adopted child is the reason, coverage is effective the date of birth, or the date the child was placed for adoption with you. e. Late Enrollment/Open Enrollment: Coverage is effective the first day of the month of December, coverage will be effective January 1st.

6. When will my employee coverage end? Coverage ends either on the last day of the month, or the date of specified event occurs, as follows:
a. Coverage will end on the last day of the month when you terminate employment, reduce your hours to less then full-time, are laid-off, you request cancellation of coverage, or fail to make the required payment of premiums.
b. Coverage will end on the day the following events occur: the employer terminates the Plan: you join the Armed Forces; or you fail to return from a Leave of Absence.

7. When will my dependent coverage end? Coverage ends either on the last day of the the month, or the date of specified event occurs, as follows:
a. Dependent coverage will end on the last day of the month when you terminate employment, request cancellation of coverage, or fail to pay premiums.
b. Dependent coverage will end on the last day when: the dependent ceases to meet the eligibility requirements of the Plan, or ceases to be a full-time student (if over the age of 19).
c. Dependent coverage will end on the day the following events occur, the dependent reaches the maximum age of the Plan (24); the dependent becomes a member of the Armed Forces. There are special provision made for dependent children who are disabled prior to reaching the maximum age limit.

8. Does my employer provide continuing coverage under COBRA? Yes, Yuma Union High School District abides by all Federal Laws regarding the extension of Insurance coverage as mandated by the Consolidated Omnibus Reconciliation Act of 1986, as amended.

9. How do I obtain coverage under COBRA? When you lose coverage due to a qualifying event, you and/or your dependents will be notified by the Plan Administrator regarding your rights under COBRA, how long your extension period is, and what the premium will be. You will be required to enroll for COBRA and begin paying premiums for the coverage within a specified time limit, which will be explained in your COBRA literature.

10.What is a "Pre-existing Condition" and how will it affect my coverage this Plan? A Pre-existing Condition is a condition for which medical advice, diagnosis, care or treatment, including the use of prescription drugs was recommended by or received from a Physician or health care practitioner during the six months immediately preceding your enrollment under this Plan. Such conditions are excluded from benefits under this plan for either 12 months, if you enroll when first eligible or under special enrollment provisions, or for 18 months, if you are a Late Enrollee. The 12 and 18 month period of exclusion may be reduced for periods when you were previously covered by other eligible health insurance. You may be required to verify your prior health coverage, by submitting a Certificate of Insurance to the Yuma Union High School or it's claims processor. You should ask your former employer's Human Resource Officer to provide your certificate of prior creditable coverage. Federal Law requires that the employer or the health insurance company provide this Certificate. If you have problems obtaining your certificate, please see the Personnel office of the Yuma Union High School District for assistance.



EMPLOYEE BENEFIT FLEX PLAN

1. What is a Flex Plan? There are two parts to a Flex Plan. The "Flexible Spending Account" is a way for you to set aside pre-tax dollars, to pay for certain eligible medical, dental, and vision expenses that are not covered by your health plan. The federal government determines what are eligible expenses. When you enroll for coverage, you will be given information regarding eligible expenses. The "Child Care Account" is a way to set aside pre-tax dollars to pay for certain child care expenses. Again, the federal government determines what are eligible child care expenses. If you use this account, you cannot claim the same expenses on your Federal Income Tax Form. Check with your financial advisor to determine which is more appropriate for you.

2. When can I enroll in the Flex Plan? You may enroll in the Flex Plan when you become a new employee or during the Plan's Annual Open Enrollment (also called the Election period), if you fail to enroll when first eligible.

3. How do I determine what amounts to put into the medical account? You should estimate your eligible medical expenses, based on your own personal historical expenditures, and have that amount payroll deducted. One way to "guesstimate" your medical expenses is to examine the Employee Health Plan. Your are allowed to set aside amount for Deductibles, Co-payments, and your Coinsurance Expense Limits. You may set aside money for eyeglasses, contact lenses and other qualified medical Expenses either not covered or limited by the Plan.

4. How do I determine what amount to put into the child care account? You should estimate your eligible child day care expenses for the coming year, and base your payroll deductions on your anticipated child care expenses. Usually it is easier to determine this amount than anticipated medical expenses, since you know the amount you will be charged for your child's day care.

5. How do I get reimbursed for my eligible medical expenses or my child day care expenses? You must file a claim for your expenses, much in the same way you file a claim for your health insurance. You will need to complete the right forms, which you can obtain from the Personnel Office, and attach receipts for your expenses to the forms. The forms are sent to Eldorado Claims Services, Inc., in Phoenix. You must submit your claim forms no later than 30 days after the end of the Plan year. If you fail to submit a claim within the 30 day period immediately following the end of the Plan year, those medical expense claims will not be considered for reimbursement.

6. What happens to my money if there is any left over at the end of the year? It is very important to correctly estimate your expenses, as any money left over in your account will not be returned to you. This is a "use it or lose it" account! Amounts not claimed will be forfeited.

7. What if I want to change my payroll deductions mid-year? The federal government has set down guidelines regarding when your can change your deductions. There must be a "qualifying event" in order to change your deductions. Such events are defined a s a change in family status, such as marriage, divorce, death, birth or adoption, or if there is a significant change to your health insurance coverage attributable to your spouse's employment. For instance, if you were covered under your spouse's health plan, and you lose coverage due to your spouse's termination of employment, you should request a Special Enrollment/Other Coverage under the health Plan, and also enroll in the Flex Plan at the same time. However, if your employment with the Yuma Union High School District is terminated mid-year, your participation in this Flex Plan will terminate immediately, and only those expenses incurred prior to your termination will be eligible for reimbursement.

8. When can I change or stop my payroll deductions? During Open Enrollment each year you may change your salary deductions for both medical expenses and child care expenses. If you were in the Plan during the previous year and do not complete a new enrollment form, your deductions will continue in the same manner as elected in the prior year. In the same manner, if you want to discontinue the plan, during Open Enrollment you must indicate your desire to withdraw from the Flex Plan, or Deductions will continue in the same manner as elected in the prior year.

9. What are the maximum amounts I can have deducted? You may set aside up to $5,000 for eligible medical expenses and up to $5,000 for child care expenses ($2,500 if you are married and file a separate return).