4-Scottsdale USD 2025-2026 Benefit Guide Revised.pdf

SCOTTSDALE UNIFIED SCHOOL DISTRICT NO. 48

2025–2026 BENEFITS

PLAN YEAR

The Kairos plan runs from July 1 to June 30 of each year. That means every July 1, deductibles and out-of-pocket maximums will reset.

WHAT’S NEW?

There are some exciting enhancements this year, called out in the appropriate section in the guide. Just look for anything labeled “new!”. There’s also more detail on the following page.

ABOUT THIS GUIDE

This interactive guide provides a summary of benefit options to help you make the right decisions for yourself and your family. If there is a conflict between this guide and the wording of plan documents, the plan documents will govern. A copy of the plan document is available upon request.

HOW TO USE

It’s simple to use; just follow these instructions.

Looking for something? To navigate through the eGuide, simply click through the pages using the arrows. Prefer to skip to a certain section? Just click on the Table of Contents or Pages icons to jump to the section you need.

You will also see a Search bar. When you’re looking for something, simply type the word in the search bar, and it will direct you to that section.

Clickable links. When you see an icon like the ones listed below, just click on it to get access to more information such as:

IMPORTANT!

Please note that the voiceover feature in this guide will only work if you use the electronic link provided. Also, not every page will offer a voiceover option. If you download the eGuide as a PDF, the voiceover will not work. To access your eGuide, please use this link:

Direct to websites, member portals, and documents

Watch a short, educational video

Listen to a voiceover about the information on the applicable page (click to start or stop the voiceover)

Send an email and get in contact with someone

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

GETTING STARTED

http://www.svc.kairoshealthaz.org/

WHAT’S NEW?

LISTEN UP!

THIS GUIDE PRESENTS BENEFIT OPTIONS

AND COSTS FOR THE PERIOD FROM JULY 1,

2025 THROUGH JUNE 30, 2026. IT ALSO

OUTLINES THE STEPS YOU NEED TO TAKE TO

SELECT AND ENROLL IN APPROPRIATE

BENEFITS FOR YOU AND YOUR DEPENDENTS.

PLEASE REVIEW THIS GUIDE CAREFULLY AND

CONTACT YOUR BENEFITS DEPARTMENT IF

YOU HAVE QUESTIONS.

NEW FOR 2025-2026

1. The in-network and out-of-network out-of-pocket maximums have increased on all plans except the $5,000

HDHP.

2. Your prescription copays have changed.

3. The Affordability Care Act (ACA) requires that plans begin charging for Teladoc services for those on a high-deductible health plan.

4. Introducing Aware: Employees and dependents (12 years and older) enrolled in a medical plan can access free virtual orthopedic care and physical therapy through Aware Health. Visit www.scottsdale.awarehealth.io for more information.

5. Our Centers of Excellence now covers services related to substance use therapy as of February 2025!

6. Total Dental Administrators has been acquired by EMI Health who offers our DHMO Prepaid Dental Plan. You may see TDA and EMI interchangeably going forward.

7. Nationwide Pet Insurance will introduce new, enhanced plans including customizable options to fit your pet needs.

More information about these changes can be found in this guide and will be discussed during the enrollment season.

http://www.scottsdale.awarehealth.io/

Contact our plan providers directly if you have questions or would like more detailed information about our plans. If you need further assistance regarding your benefits, contact your Benefits Department at 480.484.6104.

PLAN PROVIDER FOR QUESTIONS ABOUT… PHONE WEBSITE

UMR Medical eligibility and benefits; claims and appeals; precertification; ID cards

844.212.6811 UMR.com

MaxorPlus Prescription benefits 800.687.0707 MaxorPlus.com

Teladoc Virtual physician visits 800.835.2362 Teladoc.com

ComPsych Employee assistance program; counseling and work-life services

833.955.3386 GuidanceResources.com

HealthEquity Health savings account;

Flexible spending account

866.346.5800 HealthEquity.com

Delta Dental Delta Dental plan 602.938.3131 800.352.6132

DeltaDentalAZ.com

Total Dental Administrators an EMI Health Company

TDA DHMO dental plan 888.422.1995 TDAdental.com

VSP Vision benefits 800.877.7195 VSP.com

MetLife Basic and supplemental life and AD&D plans;

voluntary short-term disability; worksite benefits

877.638.7868 MetLife.com

MyBenefits.MetLife.com

MetLife Prepaid Legal Prepaid legal coverage 800.821.6400 LegalPlans.com

Aura Identity theft protection 855.443.7748 Aura.com

United Pet Care Pet insurance 602.266.5303 UnitedPetCare.com/Kairos

Nationwide Pet insurance 877.738.7874 PetInsurance.com

LIG Solutions Health insurance coverage solutions (Medicare, COBRA, individual)

844.214.0717 Partner.LIGSolutions.com

Kairos Plan administration and member services 888.331.0222 SVC.KairosHealthAZ.org

WHO SHOULD YOU CALL?

http://www.umr.com/ http://www.maxorplus.com/ http://www.teladoc.com/ http://www.guidanceresources.com/ http://www.healthequity.com/ http://www.deltadentalaz.com/ http://www.tdadental.com/ http://www.vsp.com/ http://www.mybenefits.metlife.com/ http://www.legalplans.com/ http://www.aura.com/ http://www.unitedpetcare.com/kairos http://www.petinsurance.com/kairoshealthaz http://www.partner.ligsolutions.com/kairos-scottsdale

WHO’S ELIGIBLE?

Full-time employees working at least 30 hours per week are eligible

Employees hired before 2009 working less than 30 hours per week may be eligible for benefits at a cost subsidy commensurate with their full-time equivalent

Employees in a job-share position are eligible for benefits if the position they share totals 30 or more hours per week, with employer-paid premiums to be prorated based on the percentage of the position each employee is assigned

Dependents of enrolled employees are eligible, including:

— lawfully married spouses

— dependent children up to age 26

— unmarried children who are mentally or physically handicapped and fully dependent on the enrolled employee for support and maintenance

NOTE: Duplicative coverage is prohibited, and no duplicative benefits will be paid. For example, a man who is married to a district employee and who is also a district employee himself may not enroll both as an employee and as a dependent spouse.

It is each employee's responsibility to make sure that they and their dependents do not have duplicative coverage.

WHEN COVERAGE BEGINS

o New hires: Insurance elections are effective the first day of the month.

Hire dates in the first half of the month result in a benefits effective date of the first of the month immediately following the hire date.

Hire dates in the second half of the month result in a benefits effective date of the first of the month following 30 days.

o Open enrollment: Insurance elections and changes are effective on July 1, 2025.

o Allowable mid-year changes: Insurance elections and coverage changes are effective on the first day of the month following the event date or date of birth for a newborn, if required enrollments have been completed and all required supporting documentation has been received by the Benefits Department.

o For life insurance requiring a statement of health (SOH) form: The effective date may be delayed according to SOH form completion, submission to the insurance carrier, and approval by the insurance carrier.

THE ELECTIONS MADE DURING THE ENROLLMENT PERIOD ARE EFFECTIVE FROM

July 1, 2025 to June 30, 2026

PLAN RULES

You can make changes or elect benefits once a year during open enrollment. Outside of open enrollment, the IRS says a "qualified life event" must occur.

Below are examples of qualified life events that may make a mid-year change possible:

o marriage, divorce, legal separation, or annulment;

o birth, adoption, placement for adoption, or legal guardianship of a child;

o death of a dependent;

o a change in your spouse’s employment, or involuntary loss of health coverage under another employer’s plan;

o loss of coverage due to the exhaustion of another employer’s COBRA benefits, provided you were paying premiums on a timely basis; and o change in your dependent’s eligibility status.

NOTE: This list is not inclusive of all mid-year or special enrollment changes. For more information, please contact your Benefits Department.

Changes must be made within 31 days of the change in status event. If you don't make changes within this timeframe, your next opportunity to make changes to your coverage will be during the next open enrollment period.

WHEN CAN I MAKE A CHANGE?

HAD A BABY?

If you recently had a baby, please note that newborns are not automatically added to your medical coverage. You must notify your employer within 31 days of the date of birth and pay the full premium amount for the month the child is added, if necessary.

If you do not take action within 31 days of the birth, you will have to wait until next open enrollment period to add your child to your benefits.

ELIGIBLE FOR MARKETPLACE COVERAGE?

If you lose medical coverage through the Marketplace mid-year, you may not then join the Kairos plan outside of your open enrollment period. You may, however, drop your Kairos medical coverage to join a Marketplace plan outside of your open enrollment period.

Voluntary termination from COBRA is also not considered a qualified life event.

LIG SOLUTIONS

Speaking of other coverage, LIG Solutions is here to help compare your health insurance options such as Medicare, COBRA, individual coverage, and more. Contact LIG Solutions at 844.214.0717 or visit www.partner.LIGSolutions.com/Kairos-Scottsdale.

Questions: 888.331.0222 or www.svc.kairoshealthaz.org http://www.partner.ligsolutions.com/Kairos-Scottsdale http://www.partner.ligsolutions.com/Kairos-Scottsdale http://www.partner.ligsolutions.com/Kairos-Scottsdale

TO ENROLL THROUGH THE EMPLOYEE ACCESS PORTAL

1. Log on to SUSD Homeroom/Employee Services/Employee Access.

2. Click on Enrollment under the My Benefits tab.

3. Read through the Welcome Screen instructions.

4. If you need to make changes to your address or phone number, you will do that on the Profile tab under My Information and not via the benefits enrollment portal.

5. To add/edit dependents, you will click on the Profile tab and then on the Dependent menu item.

6. You will move through the screens with the “Next” or “Previous” button on the bottom of the page; do not hit the “Back” button on your browser.

7. To elect benefits, click on the radio button to make your election. If you choose any dependents, make sure you scroll to the bottom to select the corresponding dependent.

8. You may opt out of any benefit by scrolling to the bottom of the screen and clicking the “Waive” radio button.

9. When you come to the end of the portal, make sure you hit “Submit” to complete your enrollment. You will receive a thumbs up when your enrollment is completed.

10. You can print your enrollment after you have submitted to keep a copy for your records. Go to: Employee Access My Tasks/Documents to print your enrollment.

NAME EMAIL TELEPHONE FAX

SUSD Benefits Department benefits@susd.org 480.484.6104 480.484.6268

BENEFITS OVERVIEW

All plan information and rates can be found by logging into SUSD Homeroom/Departments/Benefits/ Benefits Resources or on each benefit election page in the top right corner.

Employee Access is your online enrollment tool. The site is accessible via your SUSD Homeroom/Employee

Services/Employee Access.

ENROLLMENT INSTRUCTIONS

mailto:benefits@susd.org

STARTING WITH THE BASICS

We get it, insurance is complicated. It doesn’t have to be. Kairos strives to simplify this for you by providing educational information, short videos, and spending the time to walk you through it.

So, let’s start with the basics like what a deductible is and how it works. Check out this short video that explains the different terminology and how a plan works.

HOW A MEDICAL PLAN WORKS

Let’s walk through an example together using a $2,000 deductible with a $6,000 out-of-pocket maximum as an example.

Medical Benefits 101 Click the link or scan the code to watch this quick video

PREVENTION IS PRICELESS

There are services under a medical plan that are 100% paid for when visiting an in-network provider. These are called your preventive services, or wellness care.

Examples of preventive benefits include:

But what happens if I receive a bill from my provider for a qualified wellness screening?

This could mean that you had a diagnostic screening or it may have been coded incorrectly. Get in touch with Kairos and we can help you through it: 888.331.0222.

Annual wellness visit Prostate screenings Immunizations and flu shots Hearing exams Mammogram screenings

Colonoscopy screenings Cancer screenings Generic contraceptives Blood pressure tests

DEDUCTIBLE $2,000

You’re responsible for paying

100% of costs

YOU PAY

COINSURANCE 30%

After your deductible, you pay 30% of expenses & SUSD pays 70%

OUT-OF-POCKET $6,000

After your maximum, SUSD pays

100% of all expenses

BOTH PAY SUSD PAYS

Note: This is a general overview of how a medical plan works. Actual amounts may vary based on the plans offered by your employer. Always remember to stay in-network to maximize your benefits. Refer to the medical plan section for more details about plans offered to you.

UNDERSTANDING YOUR BENEFITS

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

UMR

UMR is the medical claims processor and uses the UnitedHealthcare (UHC) Choice Plus network. This is a PPO network, which is a group of health care providers who discount what they charge you for services.

By staying in-network, services will cost you less.

FIND A DOCTOR

If you want to find a doctor, there’s no need to log in! Instead, follow these simple steps:

Go to umr.com Select “Find a Provider” In the Provider Network search bar, type the network name:

UnitedHealthcare Choice Plus Click search, then view providers Type in your address or zip code

Now you’ll be able to search by provider name, locations, services, and more.

KAIROS

The Plan

Kairos manages and funds all of the health care plans and voluntary coverages. We also work closely with your employer to administer your benefits.

UMR

Claims Handling

UMR processes your medical claims. When you see your doctor, he or she submits the claim to UMR. For questions about your medical coverage, call Kairos or

UMR (not United).

UnitedHealthcare Medical Network

Kairos medical plans use the UnitedHealthcare network. If your doctor asks what medical network you have, you'll say, “United.”

Where does Kairos fit in?

MANAGE YOUR BENEFITS

Create your mobile-friendly account at umr.com to take full advantage of your medical benefits. You’ll need to have your ID card handy to register. From there, you can:

View/print/order ID cards View medical claims Monitor your deductible and out-of-pocket limits Shop for the best and most cost-effective care

Questions: 844.212.6811 or www.umr.com

MEDICAL BENEFITS

Not all doctors and facilities charge the same amount for services.

Individuals who compare costs before receiving care pay 36% less.

You shop for car insurance, so why not shop for your medical care?

When logged into the UMR portal, leverage their Cost Transparency Tool to get cost estimates for services.

http://www.umr.com/ http://www.umr.com/

MAXORPLUS

When you enroll in Kairos medical benefits, you automatically receive prescription drug coverage through MaxorPlus. This benefit allows you to fill prescriptions through any participating pharmacy listed in the MaxorPlus pharmacy network.

MANAGE YOUR BENEFITS

Your pharmacy coverage includes access to a member portal at members.maxorplus.com. At a glance, you can use the member portal to:

View your prior authorization activity Manage pharmacy refills View deductible and out-of-pocket limits

TIPS

• If you’re on a high deductible health plan (if offered by your employer), you must pay for the full cost of medications prior to meeting your deductible. The exception to this is if you take a medication on the Kairos Preventive List and Formulary. Keep this in mind when deciding which plan is right for you.

• Thanks to the ever-changing market, covered medications change often throughout the year. If you’re ever concerned about a medication being covered, contact Maxor at the number below or Kairos (888.331.0222).

• If you like convenience, sign up for mail order to have your 90-day medications delivered right to your doorstep. This might not be an option for everyone.

TAKE THE GENERIC

Generics have the same strength and active ingredients as the name brand version of your medications. The only difference is that they’re significantly cheaper. Talk to your prescriber to see if generics are right for you.

SIGN UP FOR MYMAXORLINK

The myMaxorLink discount program does the work for you. Once enrolled, you’ll automatically receive information on lower-cost prescriptions, reminders specific to your benefits, and other important health updates. Call 888.596.0723 to enroll or go to mymaxorlink.com/maxorplus.

TRY GOODRx GoodRx could be a good option for those expensive medications or medications not covered by insurance. Please note, however, that when using GoodRx, your insurance will not apply.

PHARMACY BENEFITS

SHOPPING FOR PRESCRIPTIONS

Depending on your medication type, dosage, and frequency, the dollars can add up quickly. But you have options for lowering your out-of-pocket costs. Try these simple steps to help you save a buck or two!

Sign up for home delivery Shop around for pharmacies and medications

Questions: 800.687.0707 or www.maxorplus.com http://www.members.maxorplus.com/ http://www.mymaxorlink.com/maxorplus http://www.mymaxorlink.com/maxorplus http://www.maxorplus.com/

SKIP THE ER & USE TELADOC

Teladoc allows those enrolled in the medical plan to use their phone or computer to conduct a live virtual visit with a board-certified medical professional—any day, anytime, anywhere.

COVERED SERVICES

• General medicine: Treat cold & flu, allergies, strep throat, and more

• Dermatology: Treat psoriasis, eczema, acne, and more (no phone call needed)

• Counseling: Support for anxiety, eating disorders, depression, and more

NEW: Starting July 1, 2025, Teladoc will now collect a fee for services for those on a high-deductible health plan until they meet their deductible. However, these fees can be significantly lower than if you were to go to Urgent Care or the Emergency Room.

Please note: Enrolled dependents ages 18+ must set up their own Teladoc account prior to receiving care.

WAIT! DID YOU REGISTER?

You must create an account through Teladoc before you can access your benefits. Click the link, scan the code, or call Teladoc at 800.835.2362.

NURSES ON YOUR SIDE

Navigating health care and insurance can be complicated and leave you feeling overwhelmed. That’s where we come in. Through the KairosPro Nurse Navigators program, our dedicated in-house nurses help guide you through the health care system, choose the best treatment, and keep your costs to a minimum.

With this program, you have a real person in your corner who not only has a clinical background but understands your insurance coverage and is there to provide support at no cost to you.

How can our nurses help you?

Finding in-network providers Assisting with appeals and prior authorizations Reviewing and monitoring claims Obtaining medical and prescription orders Monitoring high-cost medications and medical treatment Coordinating medical services, prescriptions, and durable medical equipment supplies

Monitoring inpatient admissions Helping with post-discharge needs Overseeing and collaborating with partner case management programs Arranging for redirection of care, if appropriate Researching and connecting members with community resources

Want to speak to a Nurse Navigator? Call 888.331.0222 or send an email to nurse@kairoshealthaz.org

(Please include the name of your employer and refrain from emailing sensitive and personal information.)

Bonus: Personalized mental health support for finding in-network mental health providers, lining up post-discharge resources, and more!

ADDED SUPPORT PAGE 11

mailto:nurse@kairoshealthaz.org

Our wellness programs—available through KairosPro Wellness—include a variety of options to help promote a healthier and happier you. Take advantage of these offerings at no cost (unless you see a cost listed).

CARE Programs Maternity care program: Whether you are considering having a baby or are already expecting, UMR Maternity CARE can explain how to reduce your risk of complications and prepare you to have a successful, full-term pregnancy and a healthy baby. For completion of the program, you’ll receive a $25 incentive!

Ongoing condition care program: For those who need help when managing chronic conditions like diabetes, COPD, asthma, hypertension, and more, this program is for you.

Complex condition care program: Get assistance with complex cases such as transplants, oncology, high-risk maternity, and neonatal care.

Active&Fit fitness program Starting at $28/month, you’ll get access to 18,000+ fitness centers with no long-term contracts. You’ll also get access to online workout videos, one-on-one life coaching, and options for enrolling your spouse.

Get more information or access to promo codes by visiting kairoshealthaz.org/AFD.

Online wellness center Our online wellness hub provides wellness activities to keep you on track for healthy eating, weight management, physical activity, and more.

To access, log in at umr.com, Health Center, and Wellness Activity Center.

Real Appeal A no-cost healthy lifestyle and weight loss program for employees and dependents 18+. Participants on the medical plan who qualify based on BMI or comorbidities can work directly with a health coach.

Sign up at enroll.realappeal.com.

Discount tool Through EmployeeNetwork.com, you can register to receive over 300 exclusive discounts. These include tickets to theme parks, concerts, sporting events, and more.

Use Company Code: Kairos Health when registering. (Yes, there should be a space between Kairos and Health)

WELLNESS PROGRAMS

KAIROS VITALITY VIBE

Vitality Vibe is your monthly newsletter dedicated to promoting healthy habits and recipes, wellness offerings, and other valuable benefit insights.

These are emailed out to you from your employer on a monthly basis. They are also posted on the Kairos website underneath Resources: www.svc.kairoshealthaz.org.

Vitality Vibe Newsletters Scan the code to access

Questions: 888.331.0222 or www.svc.kairoshealthaz.org https://www.svc.kairoshealthaz.org/NewsDescription/Index/54 http://www.umr.com/ http://www.enroll.realappeal.com/ http://www.employeenetwork.com/

COMPSYCH EAP

Everyone can use a little help sometimes. That’s where your EAP benefit comes in. Through the employee assistance program (EAP) with ComPsych, you can speak with a highly-trained and compassionate guidance consultant who can help you and your family 24/7.

FREE SHORT-TERM COUNSELING

Your benefit includes 6 one-on-one counseling sessions per family member, per issue, per year at no cost to you.

WORK-LIFE SOLUTIONS

Get the everyday help you need with work-life solutions. Call the number at the bottom of the page for assistance with topics including:

Stress and anxiety Relationship/marital conflicts Grief, loss, and life adjustments

Substance abuse Minor depression management

ONLINE RESOURCES

You have 24/7 access to vital information, tools, and support through the ComPsych website.

WHAT TO EXPECT

Finding child, pet, or elder care Housing searches Seeking financial assistance

Will preparation Sending a child off to school Planning a major project or event

• Product and service discounts

• Educational articles, podcasts, and videos

• On-demand trainings

• “Ask the Expert” personal responses to your questions

HOW TO ACCESS

1. Go to guidanceresources.com

2. Click Register

3. Enter Web ID: KAIROSEAP

4. Complete your registration

5. Gain access to endless resources

EMPLOYEE ASSISTANCE PROGRAM

Questions: 833.955.3386 or www.guidanceresources.com http://www.guidanceresources.com/ http://www.guidanceresources.com/

OPTIONS, OPTIONS, OPTIONS

Kairos offers an abundance of health care options for you to choose from. At times, this could feel overwhelming. Don’t let it be.

Save this guide to help you when deciding where to go.

Let’s break it down for you:

CENTERS OF EXCELLENCE

Do you have an upcoming non-emergent surgery planned? Find care with fewer headaches at our Centers of Excellence facilities, in partnership with Carrum Health. This benefit is available to those enrolled in a medical plan, ages 18 to 65.

COVERED PROCEDURES

• Joint replacement: Hip, knee, ankle, shoulder – total or partial replacement revisions

• Spine (neck and back): Fusion, decompression, laminectomy

• Heart (valve repair)

• Cancer care: Breast, thyroid

• NEW: Substance use therapy

BENEFITS

Most procedures covered from pre-op consult to post-op discharge Pay no or low cost for covered procedures Receive care from proven quality specialist throughout the country You and your plus one get main mode of transportation, lodging, and a food stipend covered

Ready to get started? Visit www.carrum.me/kairos or call 888.855.7806

TELADOC URGENT CARE PRIMARY CARE OR

SPECIALIST EMERGENCY ROOM

• Sore throat

• Mild cold and flu symptoms

• Skin conditions

• Short-term counseling

• Allergic reaction

• Cuts requiring stitches

• Minor burns

• Sprains or strains

• Suspected broken bones

• Check ups or physicals

• Wellness/preventive care

• Common illness

• Flu shots and other vaccines

• Health advice

• Medication refills

• Routine tests

• Broken bones

• Coughing/vomiting blood

• Chest pain

• Head or eye injury

• Poisoning or overdose

• Severe burns

• Signs of stroke

• Shortness of breath

To get in touch with Teladoc, visit www.teladochealth.com

To find in-network facilities, visit www.umr.com

To find in-network providers, visit www.umr.com

To find in-network facilities, visit www.umr.com

These examples are general guidelines, and it's important to use your judgment and consult with health care professionals when deciding where to seek care. If in doubt, especially in potentially life-threatening situations, it's always best to err on the side of caution and seek emergency care.

WHERE TO GO FOR CARE

Questions: 888.331.0222 or www.svc.kairoshealthaz.org http://www.carrum.me/kairos http://www.teladochealth.com/ http://www.umr.com/ http://www.umr.com/

1This plan has an embedded individual deductible and out-of-pocket maximum. This means that although a deductible and out-of-pocket maximum apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket maximum. The deductible must be met before the plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.

2The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.

3You pay one access fee per member, per day, per facility, plus in-network deductible and coinsurance. The fee is waived if you are admitted to the hospital as an inpatient.

4The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.

Please note: Information provided above may be subject to change at any point in time.

BENEFIT OVERVIEW IN-NETWORK4 OUT-OF-NETWORK4

DEDUCTIBLE1 $2,000/employee $4,000/employee +1 or more

$4,000/employee $8,000/employee +1 or more

OUT-OF-POCKET MAXIMUM2 $6,000/employee $12,000/employee +1 or more

$10,000/employee $20,000/employee +1 or more

OFFICE VISITS/TELEHEALTH $40 copay primary care physician $50 copay specialist Deductible, then 75%

TELADOC No deductible, $0 Not available

URGENT CARE $75 copay Deductible, then 75%

EMERGENCY ROOM3 $250 access fee, then 30% $250 access fee, then 30%

WELLNESS SERVICES

Mammograms Colonoscopies Immunizations Well visits (adult/child)

No deductible, $0

Deductible, then 75%

HOSPITAL SERVICES

Inpatient services Outpatient services Outpatient lab/x-ray

Deductible, then 30%

NON-HOSPITAL SERVICES

Labs/Pathology Radiology Infusion center Ambulatory surgical center

$25 copay $75 copay $250 copay $250 copay

CENTERS OF EXCELLENCE

Joint replacement Spine (neck and back) Heart (valve repair) Cancer care: Breast, thyroid Substance use therapy

No deductible, $0 Not available

PRESCRIPTIONS

You must meet your prescription deductible first: $100 employee/$200 family

RETAIL PRESCRIPTIONS

(30-day supply)

After deductible, you pay:

• Generic: $10

• Preferred: 20% up to $80 max

• Non-preferred: 20% up to $200 max

• Specialty: 50% up to $200 max

MAIL ORDER DRUGS

(90-day supply)

After deductible, you pay:

• Generic: $30

• Preferred: 20% up to $200 max

• Non-preferred: 20% up to $500 max

PPO PLAN PAGE 15

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

BENEFIT OVERVIEW IN-NETWORK4 OUT-OF-NETWORK4

DEDUCTIBLE1 $1,700/employee $3,400/employee +1 or more

$3,400/employee $6,800/employee +1 or more

OUT-OF-POCKET MAXIMUM2 $6,000/employee $12,000/employee +1 or more

$10,000/employee $20,000/employee +1 or more

OFFICE VISITS/TELEHEALTH Deductible, then 30% Deductible, then 75%

TELADOC Deductible, then $0 Not available

URGENT CARE Deductible, then 30% Deductible, then 75%

EMERGENCY ROOM Deductible, then 30% Deductible, then 30%

WELLNESS SERVICES

Mammograms Colonoscopies Immunizations Well visits (adult/child)

No deductible, $0

Deductible, then 75%

HOSPITAL SERVICES

Inpatient services Outpatient services Outpatient lab/x-ray

Deductible, then 30%

NON-HOSPITAL SERVICES

Labs/Pathology Radiology Infusion center Ambulatory surgical center

Deductible, then 30%

CENTERS OF EXCELLENCE

Joint replacement Spine (neck and back) Heart (valve repair) Cancer care: Breast, thyroid Substance use therapy

No deductible, $0 Not available

PRESCRIPTIONS

You must meet your annual medical deductible except for preventive medications3

RETAIL PRESCRIPTIONS

(30-day supply)

After deductible, you pay:

• Generic: $10

• Preferred: 20% up to $80 max

• Non-preferred: 20% up to $200 max

• Specialty: 50% up to $200 max

MAIL ORDER DRUGS

(90-day supply)

After deductible, you pay:

• Generic: $30

• Preferred: 20% up to $200 max

• Non-preferred: 20% up to $500 max

$1,700 HDHP PAGE 16

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

1This plan has a non-embedded deductible and out-of-pocket maximum. This means that families enrolling in the plan will need to meet the entire family deductible before the plan pays benefits for any member of the family (other than for preventive/wellness care). The deductible must be met before the HDHP plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.

2The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.

3The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive medications. For a detailed list of these medications, visit maxorplus.com.

4The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.

Please note: Information provided above may be subject to change at any point in time.

DEDUCTIBLE $3,000/employee $5,000/employee

OUT-OF-POCKET MAXIMUM2 $6,000/employee $10,000/employee

OFFICE VISITS/TELEHEALTH Deductible, then 30% Deductible, then 75%

TELADOC Deductible, then $0 Not available

URGENT CARE Deductible, then 30% Deductible, then 75%

EMERGENCY ROOM Deductible, then 30% Deductible, then 30%

WELLNESS SERVICES

Mammograms Colonoscopies Immunizations Well visits (adult/child)

No deductible, $0

Deductible, then 75%

HOSPITAL SERVICES

Inpatient services Outpatient services Outpatient lab/x-ray

Deductible, then 30%

NON-HOSPITAL SERVICES

Labs/Pathology Radiology Infusion center Ambulatory surgical center

Deductible, then 30%

CENTERS OF EXCELLENCE

Joint replacement Spine (neck and back) Heart (valve repair) Cancer care: Breast, thyroid Substance use therapy

No deductible, $0 Not available

PRESCRIPTIONS

You must meet your annual medical deductible except for preventive medications3

RETAIL PRESCRIPTIONS

(30-day supply)

After deductible, you pay:

• Generic: $10

• Preferred: 20% up to $80 max

• Non-preferred: 20% up to $200 max

• Specialty: 50% up to $200 max

MAIL ORDER DRUGS

(90-day supply)

After deductible, you pay:

• Generic: $30

• Preferred: 20% up to $200 max

• Non-preferred: 20% up to $500 max

$3,000 HDHP (Employee only coverage) PAGE 17

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

1This plan has a non-embedded deductible and out-of-pocket maximum. This means that families enrolling in the plan will need to meet the entire family deductible before the plan pays benefits for any member of the family (other than for preventive/wellness care). The deductible must be met before the HDHP plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.

2The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.

3The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive medications. For a detailed list of these medications, visit maxorplus.com.

4The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.

DEDUCTIBLE1 $3,300/employee $6,000/employee +1 or more

$5,000/employee $10,000/employee +1 or more

OUT-OF-POCKET MAXIMUM2 $6,000/employee $12,000/employee +1 or more

$10,000/employee $20,000/employee +1 or more

OFFICE VISITS/TELEHEALTH Deductible, then 30% Deductible, then 75%

TELADOC Deductible, then $0 Not available

URGENT CARE Deductible, then 30% Deductible, then 75%

EMERGENCY ROOM Deductible, then 30% Deductible, then 30%

WELLNESS SERVICES

Mammograms Colonoscopies Immunizations Well visits (adult/child)

No deductible, $0

Deductible, then 75%

HOSPITAL SERVICES

Inpatient services Outpatient services Outpatient lab/x-ray

Deductible, then 30%

NON-HOSPITAL SERVICES

Labs/Pathology Radiology Infusion center Ambulatory surgical center

Deductible, then 30%

CENTERS OF EXCELLENCE

Joint replacement Spine (neck and back) Heart (valve repair) Cancer care: Breast, thyroid Substance use therapy

No deductible, $0 Not available

PRESCRIPTIONS

You must meet your annual medical deductible except for preventive medications3

RETAIL PRESCRIPTIONS

(30-day supply)

After deductible, you pay:

• Generic: $10

• Preferred: 20% up to $80 max

• Non-preferred: 20% up to $200 max

• Specialty: 50% up to $200 max

MAIL ORDER DRUGS

(90-day supply)

After deductible, you pay:

• Generic: $30

• Preferred: 20% up to $200 max

• Non-preferred: 20% up to $500 max

$3,300 HDHP (Employee + 1 or more dependents) PAGE 18

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

1This plan has an embedded individual deductible and out-of-pocket maximum. This means that although a deductible and out-of-pocket maximum apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket maximum. The deductible must be met before the plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.

2The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.

3The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive medications. For a detailed list of these medications, visit maxorplus.com.

4The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.

DEDUCTIBLE1 $5,000/employee $10,000/employee +1 or more

$10,000/employee $20,000/employee +1 or more

OUT-OF-POCKET MAXIMUM2 $6,750/employee $13,500/employee +1 or more

$13,500/employee $27,000/employee +1 or more

OFFICE VISITS/TELEHEALTH Deductible, then 30% Deductible, then 75%

TELADOC Deductible, then $0 Not available

URGENT CARE Deductible, then 30% Deductible, then 75%

EMERGENCY ROOM Deductible, then 30% Deductible, then 30%

WELLNESS SERVICES

Mammograms Colonoscopies Immunizations Well visits (adult/child)

No deductible, $0

Deductible, then 75%

HOSPITAL SERVICES

Inpatient services Outpatient services Outpatient lab/x-ray

Deductible, then 30%

NON-HOSPITAL SERVICES

Labs/Pathology Radiology Infusion center Ambulatory surgical center

Deductible, then 30%

CENTERS OF EXCELLENCE

Joint replacement Spine (neck and back) Heart (valve repair) Cancer care: Breast, thyroid Substance use therapy

No deductible, $0 Not available

PRESCRIPTIONS

You must meet your annual medical deductible except for preventive medications3

RETAIL PRESCRIPTIONS

(30-day supply)

After deductible, you pay:

• Generic: $10

• Preferred: 20% up to $80 max

• Non-preferred: 20% up to $200 max

• Specialty: 50% up to $200 max

MAIL ORDER DRUGS

(90-day supply)

After deductible, you pay:

• Generic: $30

• Preferred: 20% up to $200 max

• Non-preferred: 20% up to $500 max

$5,000 HDHP PAGE 19

Questions: 888.331.0222 or www.svc.kairoshealthaz.org

1This plan has an embedded individual deductible and out-of-pocket maximum. This means that although a deductible and out-of-pocket maximum apply to the family as a whole, no individual will be responsible for more than his/her individual deductible before the plan pays benefits for that person, and no individual will be responsible for more than his/her individual out-of-pocket maximum. The deductible must be met before the plan pays benefits. All benefits are subject to the deductible, unless otherwise noted.

2The out-of-pocket maximum includes deductibles, copayments, and coinsurance for all medical and prescription plan benefits.

3The annual deductible must be met before the plan pays a prescription drug benefit, with the exception of certain preventive medications. For a detailed list of these medications, visit maxorplus.com.

4The in-network and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward one another.

PLAN FEATURES PPO PLAN $1,700 HDHP $3,000/**

$3,300 HDHP ** $5,000 HDHP

In-network Out-of-network In-network Out-of-network In-network Out-of-network In-network Out-of-network

ANNUAL DEDUCTIBLE

Individual $2,000 $4,000 $1,700 $3,400 $3,000 or $3,300 $5,000 $5,000 $10,000

Family $4,000 $8,000 $3,400 $6,800 $6,000 $10,000 $10,000 $20,000

OUT-OF-POCKET MAXIMUM (OOP)

Individual $6,000 $10,000 $6,000 $10,000 $6,000 $10,000 $6,750 $13,500

Family $12,000 $20,000 $12,000 $20,000 $12,000 $20,000 $13,500 $27,000

PREVENTIVE CARE

Wellness visits 0% 75% 0% 75% 0% 75% 0% 75%

Mammogram 0% 75% 0% 75% 0% 75% 0% 75%

DOCTOR AND SPECIALIST

Doctor visits $40 75% 30%* 75% 30%* 75% 30%* 75%*

Specialist visit $50 75% 30%* 75% 30%* 75% 30%* 75%*

URGENT AND EMERGENCY CARE

Urgent care visit $75 75% 30%* 75%* 30%* 75%* 30%* 75%*

Emergency room $250, then 30%

$250, then 30% 30%* 30%* 30%* 30%* 30%* 30%*

HOSPITAL CARE

Outpatient surgery

30%* 75%* 30%* 75%* 30%* 75%* 30%* 75%* Lab/X-ray

Hospital stay

Maternity stay

ADDITIONAL SERVICES

Embedded deductible & OOP max Yes Yes No No Yes Yes Yes Yes

Combined medical & Rx deductible No No Yes Yes Yes Yes Yes Yes

OOP max includes deductible Yes Yes Yes Yes Yes Yes Yes Yes

PRESCRIPTION

Retail (30-day)*

Generic Preferred Non-preferred Specialty

$10 20% up to $80

20% up to $200 50% up to $200

Mail-order (90-day)*

Generic Preferred Non-preferred

$30 20% up to $200 20% up to $500

*Deductible applies first

** $3,000 HDHP - Employee coverage only ** $3,300 HDHP - Employee + 1 or more

YOU'RE ELIGIBLE FOR AN HSA IF

You’re enrolled in a qualified high deductible health plan.

You’re not also covered by a spouse’s non-HDHP employer plan.

You aren’t enrolled in Medicare or another non-qualified health care plan.

You can’t be claimed as a dependent on someone else’s tax return.

If you enroll in a high deductible health plan (HDHP), you are eligible to open a health savings account with HealthEquity. An HSA is a personal savings account that lets you set aside pre-tax money from your paycheck to use on qualified medical expenses. Some examples of qualified expenses include deductibles and copays, doctor’s office visits, prescription drugs, vaccines, screenings, and more! For a complete list, visit healthequity.com/kairos/qme.

Once you receive your debit card from HealthEquity, you’ll be able to use your account. New cards are issued only to first-time enrollees (or if an existing card expires). Because it’s your personal account, please contact HealthEquity if you need a replacement debit card.

Please note: The district contribution will be pro-rated based on benefit eligibility date and/or termination date.

Grow and Save You can invest the funds, and your earnings grow tax-free. After age 65, you can use the HSA like a traditional retirement account and funds used for non-medical expenses will be taxed as income.

It’s Yours Forever The money in your HSA rolls over every year and is yours to keep, even if you leave your employer.

HOW MUCH CAN YOU CONTRIBUTE?

Triple Tax Benefit Contributions are tax deductible; the funds grow with no tax liability; and money used for health expenses is not taxed upon withdrawal.

HSA Advantages

Learn how to maximize your HSA

Click link or scan for a short video

TIER MAXIMUM AMOUNT

INDIVIDUAL $4,300

FAMILY $8,550

AGE 55+ Additional $1,000

You may contribute the maximum amount stated on a calendar year basis, or January 1 to December 31. This is a little different from the Kairos plan year, which runs from July to June. You are responsible for verifying eligibility and calculating your contributions (including any employer contributions) so that they don’t exceed the maximum annual amount.

HEALTH SAVINGS ACCOUNT (HSA)

Questions: 866.346.5800 or www.healthequity.com https://learn2.healthequity.com/kairos/qme http://www.healthequity.com/

HOW FLEXIBLE SPENDING ACCOUNTS WORK

• You decide how much you want to contribute on an annual basis into one or both of the FSAs.

• It’s a “use it or lose it” plan, meaning you must use the funds to pay for eligible expenses during the plan year, otherwise you will lose them.

• Your FSA contributions are deducted from your paychecks on a pre-tax basis, in equal amounts each pay period.

• Your election stays in effect for the entire plan year (July 1 through June 30). You may not increase, decrease, or cancel your contributions outside of the plan’s enrollment period, unless you have a qualified life status change (see page 5 for information about status changes).

• You use your FSA contributions to pay for eligible expenses under the Medical Expense Reimbursement Account or Dependent Care Account. The IRS clearly defines eligible expenses, and only those that comply with the Internal Revenue Code are eligible for reimbursement.

• You may not use the contributions you make to the Medical Expense Reimbursement Account to reimburse yourself for eligible expenses under the Dependent Care Account, or vice versa.

IF YOU ENROLL IN AN HDHP PLAN WITH A HEALTH SAVINGS ACCOUNT, YOU ARE NOT ELIGIBLE FOR A MEDICAL EXPENSE REIMBURSEMENT ACCOUNT. HOWEVER, YOU ARE STILL ELIGIBLE TO ENROLL

IN A DEPENDENT CARE ACCOUNT.

MEDICAL REIMBURSEMENT FSA DEPENDENT CARE FSA

WHAT ARE THEANNUAL

CONTRIBUTION LIMITS?

Up to $3,300 Up to $5,000 (tax filingstatus and participation in other plans may affect contribution limits)

WHAT CAN AN FSABE USED FOR?

Eligible medical, dental, and vision expenses that are not already covered or deducted on your income taxes

Eligible childcare expenses

HOW ARE REIMBURSEMENTS MADE? Claim form submitted via employee portal, fax, ormail

Claim form submitted via employee portal, fax, ormail

Set aside pre-tax dollars for eligible health care and dependent care expenses in a flexible spending account (FSA) administered by HealthEquity. These accounts are also referred to as consumer-driven accounts, or CDAs. You elect how much you want to contribute in equal installments throughout the year.

FLEXIBLE SPENDING ACCOUNT (FSA) PAGE 22

Questions: 866.346.5800 or www.healthequity.com http://www.healthequity.com/

The dental plans through Delta Dental allows you and your eligible dependents to visit any dentist or specialist without a referral. The plan also travels with you anywhere in the country. Delta Dental issues ID cards to new enrollees, so be on the lookout for yours if enrolling for the first time.

While both PPO and Premier dentists are in-network, you will save more money when using a PPO dentist. Out-of-pocket costs increase by going out-of-network.

THERE ARE 2 PLANS TO CHOOSE FROM

CORE PLAN PPO/Premier Dentist

ANNUAL MAXIMUM BENEFIT1 $1,000

ANNUAL DEDUCTIBLE (INDIVIDUAL/FAMILY)1 $50/$150

PREVENTIVE SERVICES (TWICE A YEAR)

• Exams

• Routine cleanings

• Fluoride: for children up to age 18

• Sealants: for children up to age 19

• X-rays

• Space maintainers: for children missing baby teeth up to age 14

100%

BASIC SERVICES

• Fillings

• Stainless steel crowns

• Emergency treatment

80%2

MAJOR SERVICES

• Endodontics: root canal treatment

• Periodontics: treatment of gum disease

• Prosthodontics: bridges, partial dentures, complete dentures

• Bridge and denture repair

• Implants

• Restorative: crowns and onlays

• Oral surgery: simple and surgical extractions

50%2

PREMIER PLAN PPO/Premier Dentist

ANNUAL MAXIMUM BENEFIT1 $2,000

ANNUAL DEDUCTIBLE (INDIVIDUAL/FAMILY)1 $50/$150

LIFETIME ORTHODONTIA MAXIMUM1 $1,500

PREVENTIVE SERVICES (TWICE A YEAR)

• Exams

• Routine cleanings

• Fluoride: for children up to age 18

• Sealants: for children up to age 19

• X-rays

• Space maintainers: for children missing baby teeth up to age 14

100%

BASIC SERVICES

• Fillings

• Stainless steel crowns

• Emergency treatment

• Endodontics: root canal treatment

• Periodontics: treatment of gum disease

• Oral surgery: simple and surgical extractions

90%2

MAJOR SERVICES

• Prosthodontics: bridges, partial dentures, complete dentures

• Bridge and denture repair

• Implants

• Restorative: crowns and onlays

60%2

ORTHODONTIC SERVICES (AGES 8+) 50%

1Combination of in-network and out-of-network.

2Deductibles apply to these services.

DELTA DENTAL PAGE 23

THIRD CLEANING BENEFIT

Delta Dental offers a third cleaning benefit for those with certain medical conditions that have oral health implications. Research shows that increased frequency of cleanings can greatly impact oral health and play an important role in managing conditions like diabetes, heart disease, pregnancy, cancer and more.

Qualified members must enroll for the enhanced preventive benefits to receive coverage for a third dental cleaning. Contact Delta Dental at 800.352.6132 to enroll.

Questions: 800.352.6132 or www.deltadentalaz.com http://www.deltadentalaz.com/

HOW DO I PICK MY PROVIDER?

STEP 1

While in the employee access portal, click the TDA link to navigate to the website.

STEP 2

Click on “find a provider” and select your DHMO dental plan network.

STEP 3

Make note of the provider code number listed to the right of the dental office. You’ll use this code number to identify your selection when enrolling for benefits or calling customer service. Once you have picked your provider, you must use the selected provider.

Contact TDA customer service atthe number below if you need to change your providermid-year.

Total Dental Administrators (TDA) an EMI Health Company provides comprehensive dental care on a predetermined fee schedule.

There are no deductibles, no claim forms, and no annual or lifetime benefit maximums. Services are covered in the State of Arizona only.

DHMO PLAN

OVERVIEW

IN-NETWORK COPAY

PREVENTIVE/DIAGNOSTIC

Initial exam Adult cleaning Office visits

$0 $0 $0

RESTORATIVE

Amalgam (one surface) Amalgam (two surfaces) Resin (one surface) Resin (two surfaces)

$13 $24 $29 $40

CROWN & BRIDGE

Crown porcelain Crown buildup

$495* $80

ENDODONTICS

Root canal therapy (anterior) Root canal therapy (molar)

$195 $399

ORAL SURGERY

Simple extraction Soft tissue impaction

$40 $90

PROSTHETICS

Complete denture Partial denture

$615* $550*

PERIODONTICS

Osseous surgery/quad $390

The above table is just an example of covered services. For a complete list, click the icon to refer to the schedule of benefits.

*Copay includes lab fee. Lab fees may vary; check with your provider for more details.

TDA/EMI PREPAID DENTAL PAGE 24

Questions: 888.422.1995 or www.tdadental.com http://www.tdadental.com/

Using your VSP Choice benefit is easy. Once enrolled, create an account at VSP.com where you can review your benefit information and find an eye doctor who’s right for you.

NO ID CARD NECESSARY. At your appointment, tell the office staff that you have VSP. They may ask for additional personal information to verify your coverage. From there, you’re good to go. You can also print out an ID card for reference through your online VSP account.

CHOICE PLAN

OVERVIEW

IN-NETWORK

COPAY FREQUENCY

WELL VISION EXAM $10 Every 12 months

ESSENTIAL MEDICAL EYE CARE

Retinal imaging for members with diabetes Additional exams to treat pink eye to sudden changes in vision

$20/exam As needed

PRESCRIPTION GLASSES $25 See Frames & Lenses

FRAMES

$200 featured frame brands allowance $180 frame allowance 20% savings on amount over your allowance $100 Walmart/Sam’s Club frame allowance

Included in prescription glasses copay

Every 12 months

LENSES

Single vision, lined bifocal, and lined trifocal lenses Impact-resistant lenses for children

Included in prescription glasses copay

Every 12 months

LENS ENHANCEMENTS

Standard progressive lenses UV protection Premium progressive lenses Custom progressive lenses

$0 $0 $95–$105 $150–$175

Every 12 months

CONTACTS (INSTEAD OF GLASSES)

$150 allowance; copay does not apply Contact lens exam (fitting and evaluation)

Up to $60 Every 12 months

MEMBER-EXCLUSIVE DISCOUNTS

Eyeconic: Save up to $220 on prescription glasses, sunglasses, and contacts with VSP’s online eyewear store. Browse the store here, eyeconic.com.

Member Extras: Want access to over $3,000 in savings? Visit vsp.com/offers for discounted offers on LASIK, contacts, hearing aids, and more!

VSP VISION

Questions: 800.877.7195 or www.vsp.com http://www.vsp.com/ https://www.eyeconic.com/ https://www.vsp.com/offers http://www.vsp.com/

BASIC LIFE/AD&D

The district provides eligible employees with basic term life and accidental death and dismemberment insurance coverage for each eligible employee who works a .75 or greater contract.