6-Benefit Enrollment Guide, 2025-26 Standard.pdf

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Estimates are illustrative given data limitation, may not be cumulative and are subject to change based on carrier underwriting. © 2025 USI Insurance

Services. All rights reserved.

CONFIDENTIAL AND PROPRIETARY: This document and the information contained herein is confidential and proprietary information of USI Insurance

Services, LLC ("USI"). Recipient agrees not to copy, reproduce or distribute this document, in whole or in part, without the prior written consent of USI.

Estimates are illustrative given data limitation, may not be cumulative and are subject to change based on carrier underwriting.

© 2025 USI Insurance Services. All rights reserved.

Benefit Enrollment Guide Standard Benefits – Active Employees

Plan Year November 1, 2025 – October 31, 2026

Table of Contents

Page

Benefit Company Contact Info 2

Benefits for You and Your Family 4

Online Enrollment 6

Medical Benefits Overview 9-11

Prescriptions 13

Vision Insurance 16-17

Flexible Savings Account (FSA) 19-20

Supplemental Life Insurance 22

Diabetes, Hypertension and Insulin Savings 24

Employee Assistance Program (EAP) 26-27

Wellness and Incentives 29-30

Flu Vaccination Schedule 32

Sick Leave Award 34

FML and COBRA 36

Newborns Act Disclosure 37

Wellness Notice 38-39

Medicare Part D 44-45

Health Insurance through Marketplace 50-52

RSD Office Staff 54

Page

A Message to Our Employees 3

Did you Know? and Need Help? 5

Medical Plans 7-8

Emergency Room Vs Urgent Care 12

Dental Insurance 14-15

Health Savings Account (HSA) 18

Life & AD&D Insurance 21

Income Protection (LTD) 23

Omada Diabetes Prevention Program 25

Virtual Care 28

Flu Vaccination Clinics 31

Biometric Screenings & Health Fair 33

Salary Deductions 35

Women’s Cancer Rights Act 37

Notice of Special Enrollment 37

Disclosure of Medical Information 40-43

Children’s Health Information 46-49

Glossary 53

Premiums for Medical, Dental & Vision…Back Cover

Contacts

Additional information regarding benefit plans can be found on One Rockwood Benefits pages. Please contact

Benefits to complete any changes to your benefits that are not related to your initial or annual enrollment.

Carrier Customer Service

BENEFITS PLAN

CARRIER

PHONE NUMBER

WEBSITE

Medical

1-800-CIGNA24

(1-800-244-6224)

Pre-Enrollment Hotline 1-800-401-4041 www.mycigna.com

Pharmacy

1-844-494-1052 www.express-scripts.com

Dental

1-800-335-8266 www.deltadentalmo.com

Vision

1-866-939-3633 www.eyemed.com

Life and AD&D Voluntary Life and AD&D

Customer Service:

1-866-294-7987

To file a claim:

1-888-563-1124

Email:

GBDCustomerService@ thehartford.com

Member Portal to file a claim:

www.thehartford.com/employee-benefits/claims

Long Term Disability (LTD)

Customer Service:

1-866-294-7987

To file a claim:

1-888-277-4767

Email:

GBDCustomerService@ thehartford.com

Member Portal to file a claim:

www.thehartford.com/employee-benefits/claims

Employee Assistance Program (EAP)

1-800-356-0845 www.MyPASEAP.com

Flexible Spending Account

1-800-727-0182 Option 1 www.FSA.help\login mailto:Claims@lfg.com http://www.thehartford.com/employee-benefits/claims http://www.thehartford.com/employee-benefits/claims mailto:Claims@lfg.com http://www.thehartford.com/employee-benefits/claims http://www.thehartford.com/employee-benefits/claims

A Message to Our Employees

Your Benefits Open Enrollment Period Is August 26, 2025 – September 10, 2025 The Rockwood School District is committed to providing a comprehensive benefits package to its employees even as healthcare costs continue to rise due to an increase in the frequency and severity of healthcare claims. This increase in healthcare costs is a scenario occurring across the market.

Rockwood is committed to supporting our employees in this current healthcare climate the best we can.

Open Enrollment at a Glance August 26, 2025 to September 10, 2025 is the open enrollment window. All changes must be made by 4:30 p.m., September 10, 2025.

Adding Dependents If you are adding a spouse or dependent(s) to your medical, dental or vision for the first time, please send a copy of their birth certificate(s) for your dependent(s) and/or marriage certificate for your spouse to the Benefits Office by October 10, 2025.

Flexible Spending Accounts (FSA) Administration for FSA Healthcare and Dependent

Care is administered through Tri-Star Systems.

Employees must ALWAYS reenroll in a Flexible

Spending Account (FSA) every year. Flex accounts do NOT roll over. Enrollment must be made by 4:30 p.m. September 10, 2025.

Debit cards are valid for 5 years. Each new year, the new funds are loaded onto the same card. The only time new cards are issued is if the current card is close to expiring or if new cards are requested by the employee.

Programs to Improve Your Health Rockwood offers many programs to support your physical and mental wellbeing, participation in some can even earn you incentive awards. For more information, turn to pages 24-33.

Earn Gift Cards!!

Rockwood wants employees to stay healthy and offers a $100 gift card for those who complete their annual preventative exam. See pages 29-30 for more information.

HSA Update Employees who elect the Tan Plan will receive a $1,587.84 district contribution to their HSA in early

November. If you changed your contribution amount during the 2024-25 plan year, that is the annual amount that will be spread out over 24 paychecks starting January 1, 2026.

Premiums & Benefits There is an increase to medical premiums. Dental and vision premiums are staying the same. See the rate chart on the back cover for more details.

Smart90 To fill maintenance medications and receive the discount, you have the option of filling through home delivery from Express Scripts Pharmacy or at a participating retail pharmacy, but it must be a 90-day supply. If you fill a 30-day supply more than 2 times, you will be responsible for 100% of the cost of the medication. When filling a 90-day supply you receive copay savings. For more information, turn to page 13.

Cigna and Express-Scripts Mobile Apps

Cigna and Express-Scripts no longer mail out a physical copy of your insurance card. You can download the mobile app on your phone to access a digital card. Then you always have your card with you. You also have the option to request a physical ID card. You can call Cigna at 1-800-244-6224 and Express-Scripts at 1-844-494-1052 for an ID card.

Message, Continued

Benefits for You & Your Family

Rockwood School District (RSD) is pleased to announce our 2025 benefits program, which is designed to help you stay healthy, feel secure, and maintain a work/life balance. Offering a competitive benefits package is just one way we strive to provide our employees with a rewarding workplace. Please read the information provided in this guide carefully. For full details about our plans, please refer to the summary plan descriptions on One Rockwood or on Alight. Listed below are the

Rockwood School District benefits available during open enrollment:

Medical

Dental Vision Life and AD&D (can only designate and/or update beneficiary) Supplemental Life and AD&D Health Savings Account (HSA) If on tan plan FSA Plan

Who is Eligible?

Full-Time employees working at least 35 Hours per Week and 187 days or more and their eligible dependents may participate in the Rockwood

School District Standard Benefit Program.

Generally, for the Rockwood School District benefits program, dependents are defined as:

Dependent “child” up to age 26. (Child means the employee’s natural child or adopted child and any other child as defined in the certificate of coverage) Your lawful spouse (Please note, spouse cannot have an offer of coverage through their employer.)

Do I Need to Log in During Open Enrollment?

Open enrollment will be conducted August 26, 2025 – September 10, 2025.

You do not need to log in if you want your benefits to remain the same. The ONLY exception is if you have an FSA (Flexible Spending Account) and you want it to continue. If you don’t log in and elect an amount for your FSA, it will revert to $0.

New Plan Year Changes Any medical, dental and vision changes for the

2025-26 plan year will start with your first October paycheck. Any Life or FSA changes for the 2025-26 plan year will start with your first November paycheck. Any HSA changes for the 2025-26 plan year will start with your first January 2026 paycheck.

Changing Coverage During the Year You can change your coverage during the year when you experience a qualified change in status, such as marriage, divorce, birth, adoption, placement for adoption, or loss of coverage. The change must be reported to the Human Resources Department within 30 days of the event. The change must be consistent with the event.

For example, if your dependent child no longer meets eligibility requirements, you can drop coverage only for that dependent.

If you do not contact RSD within 30 days of a qualifying event, you will have to wait until the next Annual Open Enrollment period to make benefit changes unless you have another qualifying event. Visit the Benefits page on One

Rockwood and click on “Benefits Election and

Changes” for information on making your change request.

Did you Know?

• Rockwood School District’s medical, prescription and dental plans are self -insured. Rockwood School District is fully-insured on its vision, basic life, long term disability and EAP. When a plan is self -insured, the employer pays all the costs of health care, plus administrative fees. When a plan is fully-insured, the insurance company pays for the healthcare costs and the employer pays premiums to the insurance company.

• RSD’s annual insurance fund is over $30,000,000.

• RSD pays 100% of employee insurance premiums for the Standard Plan. This includes medical, dental, vision, basic life, long term disability, and EAP (Employee Assistance Program).

• RSD pays 50% of the premium for medical, dental, and vision for employees who elect to have their children, spouse, or both on their plans.

• RSD has an Insurance Committee whose main charge is to make recommendations to the Board of Education, for their final decision, on funding, plan design, impact of any vendor changes, district’s contribution increases, and the rate of the percent of dependent coverage.

• If you have an FSA (Flexible Spending Account), you will need to re-enroll and elect your new contribution amount for the 2025-2026 plan year. Your previous year’s election WILL NOT carry forward.

Need Help?

Phone or email Call or email RSD Benefit Staff during regular business hours between 8:00 a.m. – 4:30 p.m. Contact information may be found on page 54.

24/7 Contact the Cigna Pre-Enrollment Helpline at 1-800-401-4041. Representatives can help explain our medical plans and answer your medical plan questions.

By Make an appointment for a one-on-one phone consultation with one of our appointment RSD Benefit Staff. Call 636-733-2043 to schedule your appointment.

Webinars Visit One Rockwood’s Benefit page and click on Benefits and Plan S-Standard Plan for helpful videos to understand your benefits.

Online Enrollment

Alight Worklife is our online enrollment tool. The site is accessible at worklife.alight.com/rockwoodschools and can be accessed 24 hours a day, 7 days a week.

When you log in, your username is your 10-digit employee ID preceded by RSD. Your password is your birth date without dashes. Once you log in, you will be prompted to change your password.

Example: Username: RSD0000123456

Password: 01031973 (January 3, 1973) Click on the Benefit to update

• Make sure you have the correct plan and coverage selected.

• Make sure the correct people are assigned to each benefit.

HSA (Health Savings Account)

• If you have the TAN PLAN and want to put your own money into your HSA, enter an amount here. Unlike an FSA, you can change your amount any time.

• Any HSA change made during Open Enrollment is effective January 1, 2026.

FSA (Flexible Spending Account)

• Healthcare FSA and Dependent Care FSA must be re-elected each year.

Life Insurance

• Click on the life benefit to update your beneficiary.

• Click “continue.”

• You will then be able to assign a beneficiary or add a beneficiary.

• If you elect spouse or child life, you are the beneficiary, but you will need to assign the family members to the benefit.

You will know you are done when you can print a confirmation page. Be sure to review for accuracy.

http://worklife.alight.com/rockwoodschools

The health plan pays

100%

Medical Plans

Provider Network: Cigna mycigna.com or 1-800-CIGNA24 (1-800-244-6224)

For help deciding which plan to enroll in, call Cigna’s Pre-Enrollment Hotline 1-800-401-4041.

Pharmacy Administration: Express Scripts express-scripts.com or 1-844-494-1052

There are two medical plans to choose from:

1. Deluxe Green Plan

How your Deluxe Green Plan works

What’s covered: Medical care, other health services. In-network preventive care services are covered at no additional cost to you.

You pay with personal funds.

2. High Deductible Tan Plan How your Tan Plan works

How your account is funded: Your What’s covered: In-network preventive contribution and money from your employer. care services are covered at no additional cost to you.

You pay with your

HSA

account This HSA account or __________ goes with you other when you leave personal the health plan, funds. change jobs or retire.

Once you reach your out-of-pocket maximum….

You pay a set % and/or set fee.

The health plan pays the rest.

Once you reach your deductible…

The health plan pays 100%

TIP

Look over your family’s previous medical expenses to determine which plan will be best for you.

Once you reach your deductible…

Once you reach your out-of-pocket maximum…

You pay a set %.

The health plan pays the rest.

http://www.mycigna.com/ http://www.express-scripts.com/

Monthly Premiums

Green Medical Employee Cost District Cost Total Cost Employee Only $ 0.00 $ 722.90 $ 722.90 Employee & Spouse $ 412.94 $ 1,135.84 $ 1,548.78

Employee & Child(ren) $ 311.98 $ 1,034.88 $ 1,346.86 Employee & Family $ 725.00 $ 1,447.90 $ 2,172.90

Tan* Medical Employee Only $0.00 $ 590.58 $ 590.58

Employee & Spouse $ 247.76 $ 1,003.52 $ 1,251.28 Employee & Child(ren) $ 187.20 $ 902.56 $ 1,089.76 Employee & Family $ 435.06 $ 1,315.58 $ 1,750.64

*Employees who elect the Tan Plan will receive a yearly contribution to their HSA for 2025-26 = $1,587.84.

Employees who enroll in the tan plan mid plan year will receive the yearly HSA prorated based on the months enrolled at $132.32 per month.

Premiums are paid a month in advance.

For spouses who both work for the district, please contact Brenda Tinsley, Coordinator of Benefits and ask about the Dual Spouse Plan.

When you enroll in either the Green or Tan Plan, you will use your Cigna ID card for medical visits and your Express Scripts card at your pharmacy. Both Cigna and Express Scripts do not automatically mail out physical copies of your cards anymore unless you request them. You can download their mobile apps to your phone and your digital ID cards will be on their apps. You can also log into their websites or call them to request a physical card. Refer to page 2 for that information.

Impacted wisdom teeth are covered under our medical plan through Cigna.

For the Tan Plan, the deductible must be met before the prescription copay is applied.

Choosing the right medical plan is an important decision for you and your family. Take the time to review your family’s past medical expenses and what expenses you are likely to incur during the upcoming plan year. Use this information to determine what kind of coverage is best for you and your family.

RSD offers you a choice between two medical plans: The Deluxe Green Plan and the High Deductible Tan Plan.

Neither of these plans requires choosing a primary care physician or the need to obtain referrals for specialized care. Both plans provide 100% coverage for well care when using in-network providers. Both plans utilize the same network of physicians.

Medical Benefits Overview

CIGNA

Green Plan (Note: The Individual Deductible is embedded in the Family Deductible. See Page 53 for definition of embedded.)

CIGNA

Tan Plan (HSA) (Note: The Individual Deductible is not embedded in the Family Deductible.)

Benefit Coverage In-Network Benefits (Open Access Plus

Network)

Out-of-Network Benefits (see page 11 for more information)

In-Network Benefits (Open Access

Plus Network)

Out-of-Network Benefits (see page 11 for more nformation)

Annual Deductible

Individual $1,000 $2,000 $3,000 $6,000

Family $2,000 $4,000 $6,000 $12,000

Coinsurance 20% 40% 10% 40%

Maximum Out-of-Pocket (includes deductible)

Individual $4,000 $8,000 $4,000 $8,000

Family $8,000 $16,000 $8,000 $16,000

Physician Office Visit

Primary Care $30 copay 40% After Deductible 10% After Deductible 40% After Deductible

Specialty Care $50 copay 40% After Deductible

10% After Deductible

40% After Deductible

Virtual Care (Cigna Telehealth) See Page 28 for Cost Not Covered

See Page 28 for Cost

Not Covered

Preventive Care

Adult Annual Exam 100% 40% After Deductible 100%

Well-Child Care 100% 40% After Deductible 100%

Maternity Care

Prenatal and Postnatal Visit

Initial visit – PCP Copay All subsequent visits and Physicians Delivery Charge – Deductible then 20%

40% After Deductible 10% After Deductible 40% After Deductible

Diagnostic Services

X-ray and Lab Tests 20% After Deductible 40% After Deductible 10% After Deductible 40% After Deductible

Complex Radiology 20% After Deductible 40% After Deductible 10% After Deductible 40% After Deductible

Urgent Care Facility $50 copay $50 copay 10% After Deductible 10% After Deductible

Emergency Room Facility Charges

$250 copay; waived if admitted

$250 copay; waived if admitted

10% After Deductible 10% After Deductible

Inpatient Facility Charges $250 per admission copay; then 20% 40% After Deductible 10% After Deductible 40% After Deductible

Outpatient Facility and Surgical Charges

$150 per facility visit copay; then 20%

40% After Deductible 10% After Deductible 40% After Deductible

Therapy

Occupational Therapy $30 per visit copay 40% After Deductible 10% After Deductible 40% After Deductible

Physical Therapy $30 per visit copay 40% After Deductible 10% After Deductible 40% After Deductible

CIGNA

Green Plan (Note: The Individual Deductible is embedded in the Family Deductible. See Page 53 for definition of embedded.)

CIGNA

Tan Plan (HSA) (Note: The Individual Deductible is not embedded in the Family Deductible.)

Benefit Coverage In-Network Benefits (Open Access Plus

Network)

Out-of-Network Benefits (see page 11 for more information)

In-Network Benefits (Open Access

Plus Network)

Out-of-Network Benefits (see page 11 for more nformation)

Speech Therapy $30 per visit copay 40% After Deductible 10% After Deductible 40% After Deductible

Mental Health

Inpatient $250 copay per admission; then 20% 40% After Deductible 10% After Deductible 40% After Deductible

Outpatient – Physician Office $30 copay 40% After Deductible 10% After Deductible 40% After Deductible

Outpatient – All Other Services 20% After Deductible 40% After Deductible 10% After Deductible 40% After Deductible

Substance Abuse

Inpatient $250 copay per admission; then 20%

Outpatient – Physician Office $30 copay 40% After Deductible

Outpatient – All Other Services 20% After Deductible 40% After Deductible 10% After Deductible 40% After Deductible

Other Services

Chiropractic – Unlimited days First 26 visits per year without referral, additional visits if medically necessary.

$30 PCP / $50 Spec 40% After Deductible 10% After Deductible 40% After Deductible

Retail Pharmacy (30 Day Supply)*

Generic $10 copay Not covered $10 After Deductible Not covered

Preferred $35 copay Not covered $35 After Deductible Not covered

Non-Preferred $60 copay Not covered $60 After Deductible Not covered

Preferred Specialty 10% with $100 Max Not covered 10% AD with $100 Max Not covered

Mail Order or Retail Pharmacy (90 Day Supply)

Generic $20 copay Not covered $20 After Deductible Not covered

Preferred $70 copay Not covered $70 After Deductible Not covered

Non-Preferred $120 copay Not covered $120 After Deductible Not covered

Preferred Specialty [1-30 day supply]

10% with $100 Max for Retail Supply

Not covered 10% AD with $100 Max for Retail Supply Not covered

Preferred Specialty [31-60 day supply]

10% with $200 Max for Retail Supply

Not covered 10% AD with $200 Max for Retail Supply Not covered

Preferred Specialty [61-90 day supply]

10% with $300 Max for Home Delivery Supply

Not Covered 10% AD with $300 Max for Home Delivery Not Covered

*After two 30-day supply of maintenance medications are filled, the third 30-day supply cost will be 100% the member’s responsibility. It is less expensive to fill maintenance medications by using the Smart90 program (see page 13 for information).

Note: Medical and Hospital care and costs for the infant child of a Dependent, unless the infant child is otherwise eligible, are not covered under this plan. Contact Cigna at 1-800-244-6224 for more information.

For a detailed plan document, visit worklife.alight.com/rockwoodschools Pre-certification for outpatient services will be required. Examples are (but not limited to): outpatient surgery, infusions, high-tech radiology, home health care/home infusions therapy, dialysis, durable medical equipment, prosthetic appliances, biofeedback, speech therapy, cosmetic or reconstructive procedures, infertility treatment, radiation therapy, sleep management, and transplants. Covered expenses incurred by an out-of-network provider will be reduced by 50% for charges if pre-certification is not received prior to date the testing or procedure is performed. If you have questions, please call Cigna Customer

Support at: 1-800-CIGNA24.

Staying In-Network

If you choose to see an out-of-network provider or pharmacy, you will still be able to use insurance;

however, your costs will be substantially higher, and your deductible and out-of-pocket maximums will be higher. If you choose to see an out-of-network provider, the amount will could be higher than an in-network provider because the out-of-pocket provider probably won’t give you the discounted rate that Cigna has negotiated like with the in-network provider.

Your medical network is made of:

• Virtual care

• Convenience care (quick) clinics

• Physicians

• Facilities (urgent care, emergency room)

• Nurse practitioners

• Specialist

• Pharmacies

• Labs

When you see an in-network provider, you will:

• Have lower health care costs for medical services and prescription drugs.

• Not have to handle obtaining any necessary pre-authorization. Your in-network provider will handle it before a procedure (such as surgery or imaging) on your behalf.

• Not have to worry about paying for balance-billed charges and charges above the usual, reasonable, and customary fees. There is a negotiated rate with an in-network provider but not with an out-of-network provider.

• Not have to fill out forms to send to the insurance carrier in order to receive reimbursement; your in-network provider will handle this on your behalf.

How to find an in-network provider:

• Visit Cigna website at www.mycigna.com

✓ If you haven’t registered before, you will need to register. Once you are logged in, click on Find Care & Costs. You will then be able to look up a doctor by type or name.

• Call 1-800-CIGNA24 (1-800-244-6224)

• Check the myCigna mobile app

How to price medications:

• Visit Express-Scripts website at www.express-scripts.com

• If you haven’t registered before, you will need to register. Once you are logged in:

✓ To price medications, hover over prescriptions and then click on Price a Medication. Type in the medication you are wanting to price and the dose, if you have it, and enter your zip code.

You will see different in-network locations to purchase it and how much it costs at each location.

✓ To find an in-network pharmacy, hover over prescriptions and then click on Find a Pharmacy and enter your zip code.

TIP

When possible, choose virtual care or urgent care facilities over the emergency room to save time and money.

Emergency Room Urgent Care

Emergency Room vs. Urgent Care

Please note that every health plan is different.

You should check your plan documents to determine which tips apply to your plan.

More Expensive Options Less Expensive Options Out-of-network doctors and pharmacies Vs In-network doctors and pharmacies Brand name medications Vs Generic medications

Emergency room, average cost $1,523 (for non-emergencies)

Vs Urgent Care, average cost $131 Convenience clinic, average cost $80 (for non-emergencies)

Hospital lab, average cost $48 Vs Quest or Lab Corp, average cost $9 Hospital radiology CT, average cost $1,198 Vs Independent radiology center CT, average cost $591

Hospital radiology MRI, average cost $1,676 Vs Independent radiology center MRI, average cost $706 Outpatient surgery in a hospital, average cost $2,821 Vs Outpatient surgery in a surgery center, average cost $1,438

Tips for Saving on Your

Health Plan Year Round

More than 10 percent of all emergency room visits could have been better addressed in an urgent care facility or a doctor’s office. Your health plan with Rockwood School District covers both emergency room and urgent care visits. If you’re suddenly faced with symptoms of an illness or injury, how can you determine which facility is most appropriate for your condition?

The emergency room (ER) is equipped to handle life-threatening injuries and illnesses and other serious medical conditions. Patients are generally seen according to the seriousness of their conditions in relation to other patients.

Urgent care centers also offer after-hour care.

Unlike emergency rooms, they are not equipped to handle life-threatening situations. Rather, they are designed to address conditions where delaying treatment could cause serious problems or discomfort.

Go to the nearest ER if you experience any of the following:

• Compound fractures

• Shortness of breath

• Broken bones

• Poisoning

• Seizures

• Chest pain or difficulty breathing

• Uncontrollable bleeding

These conditions can be treated in an urgent care center:

• Cuts that require stitches

• Diagnostic tests (x-rays, labs)

• Ear infections

• Fever or the flu

• Sprains or strains

• Vomiting, diarrhea or dehydration

• Urinary tract infections

Cost with CIGNA Medical OAP (Green Plan): $250 copay; waived if admitted

Cost with CIGNA Medical OAP HSA (Tan Plan):

10% After Deductible is met

Cost with CIGNA Medical OAP (Green Plan): $50 copay

Cost with CIGNA Medical OAP HSA (Tan Plan):

10% After Deductible is met

Choosing the appropriate place of care not only ensures prompt and adequate medical attention, it also helps reduce unnecessary medical expenses. Although urgent care centers are usually more cost-effective, they are not a substitute for emergency care.

Prescription Medication Coverage

Our medical plans include prescription drug coverage through Express Scripts. The cost of each prescription is determined by the tier it falls under. The three tiers are Generic, Preferred, and Non-Preferred. You can find in-network pharmacies and a list of covered prescriptions at express-scripts.com or 1-844-494-1052. Whenever possible, generics provide the most economical way to fill your prescriptions. See page 11 for more details on how to price a medication.

Smart90 Program: To fill maintenance medications and receive the discount, you have the option of filling through home delivery from Express Scripts Pharmacy or at a participating retail pharmacy but it must be a

90-day supply. When filling a 90-day supply you receive copay savings, please refer to the below table. You will be allowed to fill a 30-day supply of your maintenance medication two times; after that, you will be responsible for

100% cost of the medication.

You can access your ID card on the mobile app. If you still want a physical copy of your ID card, you can call

Express-Scripts to get a card.

Generic Drugs

To get more out of your health care plan, choose generic drugs when possible. Generic drugs are the chemical equivalent of their more expensive brand name drug counterparts. Even if your doctor prescribes a brand name drug, you can always ask for the generic equivalent.

Preferred Drugs

Preferred brand drugs are prescriptions that your pharmacy benefit plan has selected as the most effective and cost efficient to treat certain conditions or illnesses. These brand name drugs are often more expensive than their generic counterpart.

Non-Preferred Drugs

Non-preferred brand drugs treat conditions or illnesses that can also be treated by a preferred brand or generic prescription. These drugs typically have a higher copayment.

Pharmacy Benefits 30-Day Supply* 90-Day Supply Retail 90-Day Supply Home Delivery Generic Copay $10 $20 $20 Preferred Copay $35 $70 $70 Non-Preferred Copay $60 $120 $120 Specialty Medications

1-30 day supply 31-60 day supply 61-90 day supply 10% with $100 max 10% with $200 max 10% with $300 max

For the Green Plan, the deductible does not apply

For the Tan Plan, the deductible must be met before the copay is applied.

This means when you are on the Tan Plan you pay full cost for your prescriptions until you reach your deductible. While on the Green Plan, you will pay copays from day one.

*You can fill 2 30-day supply of maintenance medications and after the second fill, you will pay 100% of the cost. It is less expensive to fill maintenance medications by using the Smart90 program (filling a 90-day supply).

TIP

Use the Express Scripts mobile app to price a medication while talking to your doctor.

Dental Insurance

Dental Network and Administration: Delta Dental 1-800-335-8266 or DeltaDentalMO.com

If your dentist recommends services other than a preventive cleaning, ensure you ask for and receive a pre-treatment estimate before the work is performed. This will avoid any misunderstanding of Delta Dental benefit payment amounts.

Delta Dental has a unique two-tiered system of participating providers: Delta Dental PPO and Delta Dental Premier.

These networks are critical in the delivery of quality care while maximizing cost savings for you and Rockwood School District.

• Delta Dental’s PPO Network offers access to over 113,000 dentists in over 380,000 locations.

• Delta Dental’s Premier Network offers access to over 150,000 dentists in over 440,000 locations.

Make sure you understand that if you choose an out-of-network dentist, they don’t have to charge you the negotiated amount that Delta Dental has negotiated for us with the in-network dentists. So even though the benefit summary on the following page says 100% covered, that is 100% of the negotiated rate for an in-network dentist.

Dental PPO Dentists

• Delta Dental Contracted

Provider

• Deepest Discounted Fees

• No Balance Billing

• No Claim Forms

• Direct Dentist Reimbursement

Delta Dental Premier Dentists

• Delta Dental Contracted

Provider

• Discounted Fees

• No Balance Billing

• No Claim Forms

• Direct Dentist Reimbursement

Non-Participating Dentists

• Not Under Contract with

Delta Dental

• No Discounted Fees

• Balance Billing is Possible

• Some Dentists May Not File Claims

• Patient Reimburses Dentist

Dental Employee Cost District Cost Total Cost

Employee Only $0 $38.26 $38.26

Employee + Spouse $18.58 $56.84 $75.42

Employee + Child(ren) $22.56 $60.82 $83.38

Employee + Family $41.18 $79.44 $120.62

TIP

Wisdom teeth are covered under our dental if they are not impacted. Wisdom teeth are covered under our medical plan if they are impacted.

You will receive $2,000 maximum for in-network

Orthodontia services provided by a PPO provider.

http://www.deltadentalmo.com/

Dental Benefits Summary

Rockwood School District

Group # 9127

Delta Dental PPOSM Network

Delta Dental Premier® Network

Out-of-Network

Based on applicable PPO Maximum Plan

Allowance - No balance billing

Based on applicable Premier Maximum

Plan Allowance - No balance billing

Based on applicable Maximum Plan

Allowance for Out-of- Network dentist - Balance billing is possible

Preventive Services

100% 100% 100%

• Oral examinations (evaluations)

• Bitewing and periapical x-rays

• Full-mouth x-rays

• Prophylaxis (cleaning, scaling, and polishing including periodontal maintenance visits)

• Topical fluoride application for children under age 19

• Sealants for children under age 19

• Brush biopsy

Basic Services

90% 80% 80%

• Space maintainers for children under age 16

• Emergency palliative treatment

• Fillings

• Periodontics

• Endodontics

• Oral surgery including simple and surgical extractions.

Extractions of bony impacted wisdom teeth are not cov-ered under dental but covered under the medical plan.

• General anesthesia

Major Services

90% 80% 80%

• Bridges and dentures

• Crowns, jackets, labial veneers, inlays and onlay

• Implants and bone grafts

Orthodontia 80% up to $2,000

50% up to $1,500

50% up to $1,500

• For dependent children under age 19

Calendar Year Deductible (Applied to Basic, Major and Orthodontic Services)

$50 individual 2X family

$50 individual 2X family

$50 individual 2X family

Annual Maximum (Applied to Preventive, Basic and Major) i )

$1,000 $1,000 $1,000

Dependent Age Limit: 26 Added Features Included MAXAdvantage: Charges for exams, cleanings, x-rays, and fluoride treatments do not apply towards your annual maximum.

Healthy Smiles, Healthy Lives: Two additional cleanings are covered per benefit period for patients who are pregnant, diabetic, have a suppressed immune system, or have a history of periodontal therapy. To be eligible for the additional benefits, you must submit a completed Self-Report form which can be obtained at www.deltadentalmo.com under the Member section, or by contacting customer service.

This is intended to be a summary only. If a discrepancy occurs the Summary Plan Document will govern. Please refer to your Summary Plan Description (SPD) for a more complete listing of services including plan limitations and exclusions.

http://www.deltadentalmo.com/

Vision Insurance

Vision Insurance Carrier: EyeMed

1-866-939-3633 or eyemed.com

Eyesight is critical to your overall health. Did you know that a regular eye exam can detect high cholesterol or even a brain tumor? Employees can enroll in employee only, employee + one dependent, or employee + two or more dependents.

When you schedule your appointment, verify your provider is in the EyeMed’s Advantage Network. Providers can be found at eyemed.com, on the mobile app or by calling customer service at the above phone number.

Many employees find ID cards useful, however ID cards are not needed to obtain services from an in -network provider.

To use your EyeMed vision insurance:

1. Present your ID card, or

2. Use the EyeMed mobile app ID card, or

3. Simply let your provider know the name and date of birth of the person with the appointment along with the Group # (1017708) for the provider to access coverage.

Vision Employee Cost District Cost Total Cost

Employee Only $0 $4.78 $4.78

Employee + 1 $1.86 $6.66 $8.52

Employee + 2 or more $3.98 $8.78 $12.76

If you are on the green plan, your medical plan will cover one annual eye exam at 100%. Make sure your provider codes your eye exam as preventive.

http://www.eyemed.com/ http://www.eyemed.com/

Vision Benefits Summary

Health Savings Account

HSA

A health savings account allows you to set aside money on a pre-tax basis to pay for qualified expenses, such as doctor visits, prescriptions, braces, or even Lasik eye surgery, with tax -free dollars.

There is no use it or lose it rule with HSAs. Any remaining balance at the end of the year will roll over into the next year. HSAs are also portable.

This means that if you were to change jobs or health plans, the money in your account stays with you.

One of the best parts of the HSA is its triple-tax advantage: tax-free deductions when you contribute to your account, tax-free investment earnings, and tax-free withdrawals for qualified medical expenses.

When you enroll in the High Deductible Tan Plan, you will receive a card linked to your account to pay for qualified expenses. You may be penalized or taxed if you use your HSA funds to pay for ineligible expenses.

Qualified expenses include prescriptions, contact lens fitting, orthodontia, acupuncture, artificial teeth, eye glasses, or other expenses that apply towards your deductible. A full list of qualified expenses can be found on the IRS website (IRS Publication 502).

Eligibility

• You are enrolled in the High Deductible Tan Plan; and

• You are not covered under another medical plan such as Medicare**, Tricare or a spouse’s medical plan (not a HDHP) which provides similar coverage; and

• You cannot be claimed as a dependent on another person’s insurance policy or tax return

• You may use the money in your HSA to pay for qualified expenses for you, your spouse and dependents, even if they are not enrolled in your plan.

2026 IRS CALENDAR YEAR CONTRIBUTION LIMITS

Individual Family Age 55+ Catch Up RSD Contribution

Early November

$4,400* $8,750* $1,000 $1,587.84

*This includes the District contribution. Make sure to subtract the District contribution before determining your annual contribution. … **Check with your Tax advisor on when to stop contributing to your HSA prior to enrolling in Medicare.

Keep all receipts from HSA expenses and associated documentation to prove

HSA funds were used for qualified medical expenses.

Flexible Spending Accounts

FSA

Administration: Tri-Star Systems

FSA.help\login or 1-800-727-0182, Option 1

A Flexible Spending Account, or FSA, is an account set-up by your employer that allows you to pay for medical and dependent care expenses on a pre -tax basis.

Pre-tax means before federal, state, and social security taxes are deducted from your paycheck. Refer to the IRS website for a full list of qualified and unqualified expenses.

Remember, health care and dependent care FSA plans are “use it or lose it”. This means that you forfeit any money remaining in the account at the end of the plan year.

If you leave Rockwood mid-year, for the Health Care FSA, you can incur expenses through the end of your benefit termination month and will have 30 days after to submit claims. For the Dependent Care FSA, you can incur expenses through the end of the plan year and you have 30 days afterwards to be reimbursed.

Health Care FSA (Green Plan)

• Access to the entire amount of money you elect for the plan year on the first day of the plan.

• You will receive a debit card that can be used at your doctor’s office or pharmacy for qualified expenses.

Limited Purpose FSA (Tan Plan)

• For dental and vision expenses only.

• Available if you have an HSA.

• Receive a debit card that can be used for dental and vision expenses only and will likely require substantiation.

Dependent Care FSA (Green Plan or Tan Plan)

• Use pre-tax income for dependent care for children under the age of 13 who are being cared for while you and your spouse are working or seeking employment.

• Eligible dependents could also include a spouse or other IRS dependent who is mentally or physically disabled and incapable of self-care.

• Qualified expenses include daycare and at-home care services. Ineligible expenses include tuition for kindergarten or private schools, sport camps, or overnight camps.

• For your Dependent Care FSA, funds become available as they are deducted from your paycheck and posted to your account.

• You can reimburse yourself from your account for services received by filing a claim with Tri-Star Systems. This means you do not receive a debit card for expenses. You will pay for the claim and then request a reimbursement on their portal or by completing a reimbursement form.

Budget wisely. FSA accounts have a “use it or lose it” rule. Any money left over in the account at the end of the plan year grace period must be forfeited.

http://www.fsa.help/login

Flexible Spending Accounts

2025 IRS Contribution Limits

2025 Maximum IRS Contribution Limits

Health Care FSA $3,300

Limited Purpose FSA $3,300

Dependent Care FSA $5,000 (per household)

According to IRS guidelines, Tri-Star is required to verify that all purchases made with your new blue debit card you received from Tri-Star are eligible expenses. If you receive a Request for Documentation letter from Tri-Star, you must provide documentation for the transactions listed in the letter. The following are a few common scenarios when substantiation may be required:

• You used your card at a merchant without an inventory information approval system (IIAS).

• The amount of the expense does not match your copay.

• The merchant description from the card swipe does not clarify the type of expense. This generally occurs with dental or hospital expenses.

Important Note: Use It or Lose It Claims for all Flexible Spending Accounts must be incurred during the eligible period of coverage AND submitted in a timely manner. IRS regulations require that any unclaimed dollars remaining in your account are forfeited after the end of the plan year grace period.

The grace period is as follows:

• January 15, 2027 is the last day to incur expenses

• January 29, 2027 is the last day to file claims

After November 1, you can’t use your debit card to pay for previous year expenses. For expenses that need to be paid out of the 2025-26 plan year, but after November 1, you will need to pay for the expense and file a reimbursement form to Tri-Star or request the reimbursement on their website.

Eligibility

• Do not need to participate in medical, dental, or vision plans sponsored by RSD.

FSAs are different from HSAs

HSA FSA

Health Savings Account Flexible Spending Account

Tax Deferred Payroll Deductions Tax Deferred Payroll Deductions

Higher IRS Limits IRS limit $3,300 Medical FSA

$5,000 Dependent Care FSA

You have funds year after year Use it or lose it IRS provision

Must be in Tan Plan to enroll in an HSA

Medical FSA:

Either Green or Tan plan can have a Medical FSA, however, dollars elected on the Tan plan will be for Limited Purpose

(dental and vision only)

Dependent FSA:

Either Green or Tan plan can have a Dependent Care FSA

Rockwood District Contribution: $1,587.84 No District Contribution

January 1 – December 31 November 1 – October 31

Life and Accidental Death & Dismemberment Insurance

Life Insurance Carrier: The Hartford 1-888-563-1124 or email at GBFCustomerService@thehartford.com for claims related questions.

If the unthinkable happens, you want to know your family is covered. RSD provides full -time employees with life and accidental death and dismemberment (AD&D) insurance through The Hartford and pays the full cost of this benefit. You also have the option to purchase supplemental life insurance through The Hartford.

Basic Life Insurance

Life insurance provides you with the peace of mind knowing that if you are no longer able to financially provide for your family due to death, they will receive some financial benefit.

Accidental Death & Dismemberment

If you pass away as the direct result of an accident, your beneficiary will receive both the life and AD&D portion of the benefit.

If you suffer a covered accidental injury such as loss of speech and hearing, quadriplegia, paraplegia, loss of limb, or thumb and index finger, you would be the beneficiary of a benefit (based on the type of loss).

Supplemental Life Insurance

For this Open Enrollment, you can elect in increments of $10,000 up to $30,000 without having to complete EOI (evidence of insurability) as long as you don’t go over the guaranteed amount ($300,000 for employees and $250,000 for spouses). If you go over $30,000 or increasing it causes you to go over the guaranteed amount, you will be required to complete EOI for approval.

Per check amount for Each $10,000 of Supplemental Life and AD&D Insurance Coverage

Benefit

EE Only Supplemental Life

EE Only Supplemental Life with AD&D

Supplemental Life with Family AD&D

Spouse Supplemental Life

Child Supplemental Life ($10,000 Limit)

Rate

$1.06

$1.13

$1.185

$1.06

$0.50

Make sure your beneficiary is clearly identified on all survivor benefit insurance documents.

You can update at:

worklife.alight.com/rockwoodschools mailto:GBFCustomerService@thehartford.com

Supplemental Life Insurance

Employee Only Supplemental Life with no AD&D ($1.06 per $10,000 elected per paycheck)

• With this benefit, if you die, your basic life beneficiary will receive this life insurance amount in addition to your basic life insurance amount.

• Employees who first become eligible for standard benefits can elect up to $300,000 without completing EOI. They can increase it by $30,000 during Open Enrollment without completing Evidence of Insurability (EOI) up to the Guarantee Issue amount of $300,000. If you elect more than $30,000 at one time, or an amount over $300,00, EOI is needed. Coverage can never exceed the Guarantee Issue amount of $500,000.

Employee Only Supplemental Life with AD&D ($1.13 per $10,000 elected per paycheck)

• AD&D stands for Accidental Death & Dismemberment. With this benefit, if you die from natural causes, your beneficiary will receive this amount along with your basic life insurance amount. If you die as a result of a qualifying accident, your beneficiary will receive this amount doubled in addition to your basic life insurance amount. In addition, if you suffer a qualifying loss or dismemberment (example eyesight, speech, hearing or a limb), the associated percentage of the AD&D benefit will be paid to you. Please see the life certificate for the schedule of coverage on worklife.alight.com/rockwoodschools.

• Employees can elect the same amount as Employee Only with no AD&D.

Employee Only Supplemental Life with Family AD&D ($1.185 per $10,000 elected per paycheck)

• This benefit is similar to the previous benefit except that your named immediate family members are covered for an accidental death or dismemberment only. Each family member is given a percentage that will be paid upon their death. Refer to the SPD on worklife.alight.com/rockwoodschools.

• Employees can elect the same amount as Employee Only with no AD&D.

• Your spouse coverage ends when the spouse turns age 70. Dependent coverage ends when the dependent turns 26.

Spouse Life Insurance ($1.06 per $10,000 elected per paycheck)

• This is life insurance for your spouse. If you elect this benefit, you would receive the life insurance amount if your spouse dies. The spouse voluntary life benefit may be purchased in 1, 2 or 3 increments of $10,000 ($30,000 total) without completing EOI up to the Guarantee Issue amount of $50,000. If you elect more than $30,000 at one time or go over the $50,000, EOI is needed. Coverage can never exceed the Guarantee Issue amount of $250,000.

• Employees can elect up to $250,000 when first eligible for Standard benefits and increase by $30,000 during Open Enrollment without complete EOI as long as the increase doesn’t go over $250,000.

• This coverage ends when the spouse turns age 70.

Child Life Insurance ($0.50 per paycheck)

• This is life insurance for your child. With this benefit, you will receive the life insurance amount if your child dies.

The only option is $10,000 and does not require EOI. Dependents will be covered until the end of the month they turn 26. Please notify us when your dependent reaches this age so we can update your coverage and your premium. Failure to do so could result in your overpayment.

Other Information Regarding Life Insurance

• You can only purchase voluntary life for your spouse/dependents if you purchase voluntary life for yourself in at least the same amount.

• If you make a change during Open Enrollment that requires Evidence of Insurability (EOI), The Hartford will email you a link. You will complete your EOI online and will get a real time answer. The Hartford then notifies Rockwood of the decision.

• If you leave employment, you can convert your basic and supplemental life insurance, provided you make the request for conversion within 30 days of leaving employment (or benefit eligibility).

• For some employee groups, the life insurance benefit has an age reduction at 65, 70, 75, and age 80. See your confirmation statement or contact the Benefits Office if you have questions.

• If both spouses work for the district, they cannot elect to cover each other and only 1 can cover their children.

Income Protection

Long Term Disability

Carrier: The Hartford (same carrier as we have for life insurance) thehartford.com/employee-benefits/claims or 1-888-277-4767

Rockwood School District provides Long Term Disability (LTD) protection at no cost to eligible employees. In the event you become unable to work due to a non-work-related illness or injury the benefit pays a portion of your salary. Benefit payments begin after 75 days of disability. See the Certificate of Coverage for benefit duration. Please see the summary plan description for complete plan details.

Even if you have enough sick leave to cover a long-term medical leave, we advise you to contact the Benefit Office and The Hartford to file a claim if you think you might miss work for three months or more.

Employees who need to file a claim can call 1-866-294-7987. The Hartford will walk employees through the process.

How to Submit a Claim Submitting a disability claim is as simple as 1-2-3:

What Happens Next A Hartford claims specialist will be in touch within 1-2 business days to develop an action plan and explain next steps.

Visit thehartford.com/employee-benefits/claims to submit a claim. You can also contact

Hartford at 888-277-4767.

Employees should have their physician’s contact information ready.

Answer some questions about the claim – the whole process takes just minutes!

http://www.metlife.com/mybenefits

Programs

Livongo Diabetes Program Key Features:

• For members diagnosed with type 1 or type 2 diabetes.

• More than a standard meter – The Livongo connected blood glucose meter uploads readings and provides real-time tips, making log books a thing of the past.

• Get as many test strips and lancets as you need shipped to your door, with no hidden costs.

• Coaches are Certified Diabetes Educators who can assist you with nutrition and lifestyle changes.

Livongo Hypertension Program Key Features:

• Easy remote monitoring via wireless-connected blood pressure cuff.

• Intuitive mobile experience to track progress and receive personalized,…