Enrollment Highlights 2014 At Open Enrollment:�� We are excited to introduce online enrollment for benefits using our online enrollment tool, Employee Self Service (ESS).�� In order to continue benefits coverage beginning January 1, 2014, all benefits-eligible employees MUST

enroll or re-enroll for their benefits with a Benefit Counselor. Open enrollment will be held October 1 - November 1, 2013.

�� You may choose how to enroll: — In person with a Benefit Counselor at your location during the work day—see your location manager to schedule

your onsite session, OR — Over the phone and online with a Benefit Counselor from the privacy of your home, using the new Co-Browsing

enrollment process. Visit www.iSelectSchedule.com and enter Enrollment Number 61436 to schedule your session with a Benefit Counselor.

For New Employees: � New employees must enroll during the first 30 days of employment. � If hired between July 1 and November 1, 2013, you will need to enroll twice. You will need to enroll for 2013 benefits

during your first month of employment, and then you must re-confirm your benefit elections and dependents for 2014 benefit coverage during the open enrollment period using Employee Self-Service (ESS).

� To enroll for Voluntary Benefits after November 1, 2013, new employees may call the Enrollment Call Center within 30 days of employment.

Call 1-888-9-ENROLL (1-888-936-7655)Monday through Friday, 9 am to 5 pm Eastern Time

Your 2014 Employee Benefits Enrollment Guide

About This BookletThis booklet has been designed to help you understand the Columbus City Schools Employee Benefits Program for the plan year January 1, 2014 through December 31, 2014. It outlines all of the available benefit plans, so you may choose the best possible combination of options for you and your family. Please read this booklet carefully, and if you have any questions not answered here, contact the Benefits Department at 614-365-6475.

Benefit Plan Carrier/ Administrator

Telephone Number

Web Site

Medical Options Medical Mutual® of Ohio 1-800-382-5729 www.medmutual.comPrescription Drugs Express Scripts 1-866-533-7005 www.express-scripts.comDental Option Delta Dental 1-800-282-0749 www.DeltaDentalOH.comVision Option Vision Service Plan (VSP) 1-800-877-7195 www.VSP.comBasic Term and Supplemental Life Insurance

Lincoln Financial 1-800-423-2765 www.lincoln4benefits.com

Flexible Spending Accounts (FSAs)

PayFlex 1-800-284-4885 www.healthhub.com

Employee Assistance Plan (EAP) People Resources 1-800-765-9124 www.WorkLifeTools.comUniversal Life Insurance Trustmark 1-800-918-8877 www.trustmark.comVoluntary Term Life Insurance American General 1-877-672-1648 www.agemployeebenefits.comShort Term Disability (STD) Option Trustmark 1-800-918-8877 www.trustmark.comCritical Illness Insurance Trustmark 1-800-918-8877 www.trustmark.comAccident Insurance Trustmark 1-800-918-8877 www.trustmark.comLegal Insurance LegalEASE 1-888-416-4313 http://vsc-legalease.comPet Insurance VPI Pet Insurance 1-877-PETSVPI www.eb.petinsurance.comVoluntary Benefits Enrollment Benefits Technologies 1-888-9-ENROLL www.iSelectSchedule.comCCS Benefits Department 1-614-365-6475 CCS Intranet

Medical Mutual’s My Health Plan – It’s All About You.

Medical Mutual and its Family of Companies gives you the helpful tools you need to understand and manage your healthcare coverage – and your health – through My Health Plan, the online member portal. Register for My Health Plan today on www.medmutual.com to gain access to valuable tools that allow you to:

�� Control and understand your expenses�� Improve your health�� Manage your plan

Learn more about My Health Plan on page 6 of this booklet.

Important Contacts

Table of Contents Page

A Message from the Superintendent 2

Benefits-at-a-Glance 2 What’s New in Benefits for 2014? 3 Benefit Costs 3 Who’s Eligible 3 How to Enroll, Change or Waive Coverage 4 When Coverage Begins 5 When Coverage Ends 5 Unpaid Leaves of Absence 5

Making Mid-Year Benefit Changes 5

Your Core Benefit Choices 6 Medical Benefit Options 6 Dental Benefits 7 Vision Benefits 8 Basic Term Life Insurance 9 Supplemental Life Insurance 9 Flexible Spending Accounts 10 Employee Assistance Plan 11

Your Voluntary Benefit Choices 12 Life Insurance Options 12 Voluntary Term Life Insurance 13 Short Term Disability (STD) Option 14 Critical Illness Insurance Option 14 Accident Insurance Option 15 Legal Insurance Option 16 Pet Insurance Option 16

Other Information 16

Please Note:This Benefits Guide highlights your benefits offered through the Columbus City Schools. Complete descriptions of the plans are contained in corresponding plan documents or insurance contracts. If there is any discrepancy between this benefits booklet and the wording of the corresponding plan document, the plan document or insurance documents will govern. This booklet does not constitute a contract to the extent permitted by law.

Note: This Guide includes the Medicare Part D Notice of Creditable Coverage

insert found in the back pocket.Your Summary of Benefits and Coverage (SBC) can be found on the

Columbus City Schools intranet (see page 3).

2

A Message from the SuperintendentThe Open Enrollment period for employee benefit programs will be held this from October 1, 2013 through November 1, 2013. This year we are introducing enrollment through an electronic online enrollment tool, Employee Self Service (ESS). To assist you with this new enrollment, all benefits-eligible employees will need to meet or schedule an appointment to Co-Browse with a Benefit Counselor to enroll or re-enroll in their benefits to continue coverage beginning January 1, 2014. This process is needed in order to confirm the information that we have in the new system and to provide you with training and support as we implement the new process.

We will be offering you two convenient ways to complete your enrollment:

1) You can meet with a Benefit Counselor in person at your location during the work day. OR 2) You can schedule a time to meet with a Benefit Counselor in a Co-Browsing session. The Co-Browsing session affords you the

opportunity to speak with the Benefit Counselor by phone as you log into the ESS portal to complete your enrollment. You and the counselor will be able to see the same screen at the same time. We will provide you with information about how to schedule a Co-Browsing session.

Your supervisor will let you know about times to schedule with a Benefits Counselor and you will find the information that you need to schedule a Co-Browsing session in this guide on Page 3.

This 2014 Benefits Enrollment Guide provides summary information about each benefit program provided by Columbus City Schools. Additionally, as part of the Patient Protection and Affordable Care Act (Health Care Reform), all employees are to have access to a Summary of Benefit Coverage (SBC). All this information is available on the Columbus City Schools Intranet (select Human Resources/Employee Benefits/Open Enrollment 2014). I encourage you to thoroughly review all benefits information and meet with a Benefit Counselor to help you make well-informed decisions about benefits for yourself and your family.

Thank you for your dedication to our students, parents and community.J. Daniel GoodSuperintendent/CEO

Benefits-at-a-Glance Whether you’re single or have a family, you’ll find benefit plan options designed to suit your unique needs. This guide will help you learn more about your choices, so you can make educated decisions when you enroll.

Core Benefits Your Choices Cost SharingMedical Options from

Medical Mutual of OhioYou and the employer share

Dental Delta Dental coverage You and the employer shareVision VSP coverage The employer pays for this program for

youBasic Term and Supplemental

Life InsuranceBasic only (Board-sponsored) or

Basic plus additional coverage (optional)The employer pays for Basic coverage; you

pay the cost of Supplemental coverage

Flexible Spending Accounts (FSAs)

Health Care FSADependent Care FSA

You set aside funds through payroll deduction and receive reimbursement

from your accountEmployee Assistance Plan

(EAP)Available to all employees and dependents The employer pays for this program for

youVoluntary Benefits Your Choices Cost Sharing

Universal Life Insurance (with Long Term Care Benefit)

Trustmark program offers whole life and long term care benefits

You pay the cost at group rates

Voluntary Term Life Insurance American General program offers term life insurance

You pay the cost at group rates

Short Term Disability Trustmark You pay the cost at group ratesAccident Insurance Trustmark You pay the cost at group rates

Critical Illness Insurance Trustmark You pay the cost at group ratesLegal Insurance For non-CEA members You pay the cost at group ratesPet Insurance Covers your pets You pay the cost at group rates

3

What’s New in Benefits For 2014?For 2014, there are several benefit provisions for you to know about as you consider your benefit enrollment.We are excited to announce that all employees will be enrolling online using Employee Self Service (ESS). Please make sure that you are able to log on to ESS PRIOR to the start of Open Enrollment.�� In order to continue benefits coverage beginning January

1, 2014, all benefits-eligible employees MUST enroll or re-enroll for their benefits with a Benefit Counselor .

�� During the Open Enrollment, you’ll be able to review your current Core and Voluntary Benefit selections, learn more about and enroll in Core Benefits and new Voluntary Benefits offered for 2014, and update your personal information—with our help.

�� We are offering an expanded schedule for enrollment and a new option:�— You may meet with a Benefit Counselor on-site at

your work location during working hours as in past years. See your location supervisor to schedule your meeting, OR�— Schedule a time for a new type of meeting with a

Benefit Counselor, called a co-browsing session. During the online call center meeting, the Benefit Counselor will guide you through enrolling using the new Employee Self Service (ESS) enrollment tool. All you need for this new option is a computer and a phone.�— Starting September 10, 2013, you may schedule

your call center enrollment meeting ahead of time. Visit www.iSelectSchedule.com to sign up. Enter your Enrollment Number 61436, and follow the instructions on screen.

�� As part of the Patient Protection and Affordable Care Act (Health Care Reform), all employees are required to have access to a Summary of Benefits and Coverage (SBC). This information can be found by accessing the following links on the CCS intranet:http://ccsoh.us/OpenEnrollment.aspxEmployees may also pick up a printed copy of this information in the Employee Benefits Department.

�� If you are enrolling for medical coverage for the first time or are changing your plan election, you will receive new medical plan ID cards shortly before the start of 2014.

�� When you speak with the Counselor, you will need to re-enter and update your dependent/beneficiary designation for all plans. You will need to provide beneficiary birthdate (MM/DD/YYYY) and Social Security number.

Who’s EligibleEmployee Eligibility

Columbus City Schools provides a benefits package for eligible employees, as shown on the chart below.

Eligible Employees Ineligible EmployeesFull-time teachers Temporary employeesFull-time hourly teachers Part-time hourly employeesHalf-time teachers working at least 50%

Summer school employees

Full-time administrators SubstitutesLatchkey teachers Employees working less

than 20 hours per weekSevere Learning Disability Tutors working a minimum of 15 hours per weekClassified supervisorsClassified employees working a minimum of 20 hours per week

Benefit CostsCore Benefit cost information can be found on the insert in the back pocket of this guide or on the CCS intranet. Voluntary Benefit cost information will be provided by a Benefit Counselor during Open Enrollment.

New employees hired after the Open Enrollment ends may visit www.iSelectSchedule.com and enter your Enrollment Number 61436 to learn about Voluntary Benefit costs and to enroll. You may also call 1-888-9-ENROLL to enroll by phone.

�� Several Voluntary Benefits will continue to be available. These include:�— Optional Life Insurance with Long Term Care

Benefits*�— Voluntary Term Life Insurance�— Short Term Disability Insurance�— Accident Insurance - NEW, see page 15�— Critical Illness Insurance - NEW, see page 14�— Legal Insurance (non-CEA members only)

�— Pet Insurance

�� During Open Enrollment, you may attend an Information Session about your Core Benefits, held at one of several facilities (see insert).

�� * The Long Term Care Plan through MetLife LTC is no longer available. If you are currently enrolled in this plan, you have two options: (1) to continue the plan through direct billing, or (2) enroll in the Trustmark Universal Life Plan with the long term care option. See page 13.

4

Photocopies of eligibility documents must be submitted at the time of enrollment, before coverage can begin. For details on these documents, please see the insert to this Guide or contact the Employee Benefits Department at 614-365-6475.

How to Enroll, Change or Waive Coverage �� At Open Enrollment:�— During the annual Open Enrollment, You MUST meet

with a Benefit Counselor to enroll or waive coverage. Coverage begins January 1, 2014.�— For 2014, you may choose either of two ways to

meet with a Benefit Counselor. Please see page 3 for information.

�� If you are adding any new dependents to your Core Benefits, you must provide the applicable verification documentation. Documents must be provided when you meet with the Benefit Counselor or must be given to the Benefits Department before the end of Open Enrollment, along with your benefits confirmation from ESS. See the insert in the back pocket of this guide for documentation requirements.

�� If you elect to waive health care coverage through Columbus City Schools, you will need to decline benefit coverage in ESS.

�� For New Hires After October 1, 2013:�— If you are a new employee, during your first 30 days

of employment, you will have an opportunity to enroll in your Core Benefits by completing the enrollment form and submitting it to the Benefits Department. You may also enroll in Voluntary Benefits during your first 30 days of employment by visiting www.iSelectSchedule.com and entering the Enrollment Number 61436 to schedule a Voluntary Benefit enrollment session.�— If you are hired between July 1 and November 1,

2013, you must enroll twice – first for 2013 and second for 2014 benefit coverage. You will need to enroll for the remainder of 2013, and re-confirm your benefit elections and dependents for coverage during 2014 using Employee Self-Service (ESS).

Dependent Eligibility

Eligible dependents include:

�� Your legal spouse or eligible same-sex domestic partner (CEA members/Administrators only). To enroll a spouse, you must provide a marriage certificate and your most recent Federal Income Tax Form 1040. To enroll a domestic partner, you must provide supporting documentation meeting the Columbus City Schools’ eligibility requirements for a domestic partner. Contact the Benefits Department at 614-365-6475 for more information.

�� Your children who are under 26 years of age (or 26 to 28 years, in some cases) – see NOTE below.

NOTE: Children up to age 26 will be eligible for health care and vision benefit coverage through their parent’s benefit plans. This age limit rule does not apply to dental coverage. Under these guidelines, a child can be married, but the child’s spouse and any of the child’s dependents would not be eligible for coverage.

Further, the guidelines DO NOT REQUIRE:

�� Child(ren) to live with parent(s)�� Child(ren) to be an IRS dependent�� Child(ren) to be a student

Dependent Eligibility Requirements UP TO AGE 26:�� Natural child, stepchild, adopted child or if legal guardian

for a child.

A dependent will be removed from coverage at the end of the month in which he or she reaches age 26.

State of Ohio Dependent Eligibility Requirements Ages 26 - 28:Parents have the option to continue to purchase health care coverage (medical only) for their children ages 26 - 28 under State of Ohio legislation as of July 1, 2010. The child must be:

�� Natural child, stepchild or adopted child;�� An Ohio resident or a full-time student in an accredited

public or private institution of higher education;�� Not employed by an employer that offers any health

benefit plan under which the child is eligible for coverage; and

�� Not eligible for coverage under Medicaid or Medicare. A dependent will be removed from coverage on his or her 28th birthday.

Documentation required to verify eligibility for dependents up to age 26:

�� Birth certificate �� Child Support Court Order�� Adoption/Guardianship Court Award

Documentation required to verify eligibility for dependents ages 26 - 28:�� Birth certificate�� Verification of Ohio residency (driver’s license, utility

bill, lease)�� Verification of full-time student status – transcript

and paid receipt (if not an Ohio resident) Please note when adding dependents ages 26 - 28 using the state of Ohio guidelines, employees will be responsible for the entire premium cost for this/these dependents. Costs can be found on the insert in the back pocket of this guide.

5

When Coverage BeginsIf you are a current employee and enroll during the annual Open Enrollment period, your new coverage selections will be effective January 1, 2014.

If you are a new hire, or have transferred into a benefits-eligible position, you will need to enroll for benefits coverage within 30 days of hire or your transfer date. Benefits will be effective on the first day of the month indicated on the Payroll and Deduction Schedule corresponding to your first earnings period. Contact the Benefits Department for specific dates. Coverage will typically become effective within 30 to 60 days, depending on your actual start date.

When Coverage EndsCore Benefits will terminate on the last day of the month indicated on the Payroll and Deduction Schedule corresponding to the last earnings period in which the employee works. Contact the Benefits Department for specific dates.

For dependents up to age 26, medical coverage ends at the end of the month in which they reach age 26. For a dependent up to age 28, medical coverage ends on the dependent’s 28th birthday.

Voluntary Benefits are portable and you can continue them when you leave your employment by paying premiums directly to the insurance company.

Worker’s Compensation Leave of AbsenceWhile on an approved Worker’s Compensation-related leave of absence, an employee choosing to continue benefits must self-pay for the benefits. The amount charged for Classified employees will be 10% of the total monthly cost of benefits. Certificated employees are responsible for 100% of the cost of continuing coverage (both employee and employer shares).

Voluntary Unpaid Leave If an employee is approved by the Board of Education for an unpaid leave of absence, it is the responsibility of the employee to pay 100% (Board and Employee share) of the cost should he/she choose to maintain benefit coverage. Coverage can continue up to two years.

Unpaid Leaves of AbsenceIf you choose to maintain benefits coverage while on an unpaid Leave of Absence, you are required to pay 100% of the total cost (both employee and employer shares) unless you are covered by FMLA. Your total cost of continuing your benefits coverage is paid directly to the Benefits Department. The Benefits Department will mail a written notice to you specifically outlining required payments to continue coverage for the employee and/or dependent(s).

FMLA (Family and Medical Leave Act of 1993)

The Human Resources Department will determine whether an employee is eligible for FMLA. Under the provisions of FMLA, Columbus City Schools is required to maintain an employee’s health benefits for a period not to exceed 12 weeks from the date of leave, under the same conditions as if the employee continued active employment. Upon approved FMLA leave, an employee will receive detailed documentation of his/her benefits continuation eligibility if the employee is in an unpaid status while on leave.

To continue Voluntary Benefits, the employee must contact the vendor and arrange to make payments directly to them.

Making Mid-Year Benefit ChangesQualifying events (Life or Job Status Changes) provide a 30-day eligibility period for current employees to add or drop dependents and make other eligible changes to coverage. Life status changes must be accompanied by the appropriate documentation (see chart below). Should a qualifying life event occur (Life or Job Status Change) in your family, you must inform the Benefits Department within 30 days and provide documentation as listed below.

Qualifying Event Required Documentation

Marriage Marriage certificateDivorce Divorce decreeLegal separation Court documentationThe birth of a child or children

Birth certificate(s)

Adoption or placement for adoption of a child

Adoption award letter

Your child becomes ineligible for coverage

Complete the proper form to terminate dependent coverage (available from the Benefits Department)

A court issues a Qualified Medical Child Support Order (QMCSO) requiring the plan to provide medical coverage for your dependent child

Copy of support order

Loss of coverage (due to a change in your spouse’s employment or your spouse’s eligibility for benefits)

Loss of coverage letter from prior insurance provider or prior employer (on their letterhead)

Dependent child gains coverage from an employer

Letter of creditable coverage from an employer

6

Medical Benefit OptionsColumbus City Schools offers you up to three different types of medical plans, administered by Medical Mutual of Ohio, from which to choose:�� Select Basic (offered to Classified employees and

Classified Supervisors only)�� Select�� Choice

All plans cover the same general types of services and pay benefits toward the cost of preventive care, as well as doctor visits, hospitalization, diagnostic tests, mental health and substance abuse treatment and prescription drugs.The medical plan options differ in that the Select Basic and Select Plans do not provide benefits for out-of-network providers. Choice covers both in-network and non-network providers. The plans also differ in both the portion of health care expenses that you pay out of your own pocket when you receive care and in the amount of your per pay contribution for coverage.

How The Medical Plans WorkSelect Basic (offered to Classified employees and Classified Supervisors only)

The plan offers lower employee contribution rates than the other options, but higher co-pays and a higher cost for prescription drugs. The plan includes an annual deductible and co-insurance for some services. Non-network services are not covered under this plan, except for approved emergency care.*Select The plan offers affordable employee contribution rates and co-pays for many services. Non-network services are not covered under this plan, except for approved emergency care. Co-insurance and deductible amounts vary depending on the employee’s classification.*Choice

The plan offers higher contribution rates than the other plans and co-pays for services. This plan option offers network coverage but also provides for non-network coverage. Co-insurance and deductible amounts vary depending on employee classification.**For details, see the medical benefit summary insert.

About Core BenefitsYour Core Benefits include medical, prescription drug, dental, vision care, life insurance, Flexible Spending Accounts and the Employee Assistance Plan (EAP). You and your employer share in the cost of these basic benefit programs. You can find more information about additional voluntary programs (for which you pay the cost) beginning on page 12. If you have questions about Core Benefits, contact the Benefits Department at 614-365-6475.

Your Prescription Drug BenefitsAll medical plans include a prescription drug benefit program administered by Express Scripts. You can find details on these benefits in the medical benefit summary inserted in the pocket of this guide.

Your Core Benefit Choices

My Health Plan — Your Personalized Web PortalAll you need to register is your Medical ID card! Visit the Medical Mutual website (www.medmutual.com) and click on Register Here under My Health Plan Login on the right side of the page. Using information from your ID card, complete the form fields and click Agree to the Terms and Conditions.Time, Money and Total Health-Saving Features In addition to ordering new ID cards, you have access to online customer service and 24/7 access to your benefit book, My Health Plan, and: �� Paperless Explanation of Benefits (EOBs) – A digital

archive of current and past EOBs keeps these important records organized and easily accessible. Along with the option to receive paperless EOBs, you can choose to opt out of receiving mailed copies.

�� Health Assessment – Complete this online questionnaire about your medical history and lifestyle to receive a complementary personalized report that includes recommendations you can use to improve your health.

�� Provider Search Tool – The Provider Search Tool helps you find in-network options by allowing you to search for doctors and medical facilities by name, specialty, gender and more. Using in-network providers ensures you receive the highest level of benefits available under your plan.

�� Treatment Cost Estimator – The Treatment Cost Estimator helps you make cost-effective choices by calculating approximate costs for certain procedures with in-network providers.

�� Disease & Maternity Management Programs – Medical Mutual offers the SuperWell® Disease and Maternity Management Program to help those with a chronic health condition or anyone who is currently pregnant. Specially trained Health Coaches provide education and support with an emphasis on increasing your knowledge of your disease or pregnancy. Participation is voluntary and there is no out-of-pocket cost to you. The SuperWell® Disease and Maternity Management Program is available to eligible members who are pregnant or diagnosed with one or more of the following conditions: Asthma, Chronic Obstructive Pulmonary Disease, Chronic Pain conditions, Congestive Heart Failure, Coronary Artery Disease, Depression, Diabetes and Pregnancy.

7

Your dental benefits cover you and your eligible enrolled dependents for a variety of services. NOTE: Dependent eligibility for the Dental Plan ends at age 23. The Health Care Reform legislation does not require extended dependent dental coverage over age 23.

Dental Provider Choice

With the Dental Plan, you may choose to receive care from any dentist, but you will receive the highest level of benefits when you use a dentist who participates in the Delta PPO network. You may also choose to see a Delta Premier provider and pay a bit more out of pocket.

Here’s how this works:

�� Delta PPO Network dentists have agreed to accept your plan benefit as payment in full for covered services, after you pay any applicable deductible and coinsurance amounts. When you use a PPO dentist, there are no claim forms to fill out. Your dentist will file a claim and the plan administrator will send payment directly to him or her.

�� Delta Premier Network dentists have agreed to accept the lesser of their submitted charge or the local Delta Dental approved maximum fee. This may mean that you pay a slightly larger share out of your own pocket, but it is likely that you will still save money over using a non-participating dentist.

If You Use a Non-participating Dentist

When you use a non-participating dentist, it is your responsibility to pay the dentist and then file a claim for reimbursement. You are responsible for paying the applicable deductible and coinsurance amounts as well as any charges that are over the plan’s allowed benefit (this is called balance billing).

Delta PPO/Premier Provider

Non-participating Provider*

Deductible NoneAnnual Calendar Year Maximum $1,500 per personLifetime Maximum for Orthodontic Treatment $1,000 per person/lifetime (child or adult)

Plan PaysPreventive and Diagnostic Services (2x per year check-up and cleaning; X-rays every 3 years)

100% 100%**

Minor Restorative Services (including fillings, root canals, periodontics and oral surgery)

80% 80%**

Major Restorative Services (such as crowns) 80% 80%**Prosthodontic Services (such as bridgework and dentures)

50% 50%**

Orthodontic Services (no age limit) 50% 50%**

* If you elect a non-participating provider, your share of costs may be slightly higher. ** Of Delta Dental’s maximum approved fees.

�� Wellness Programs – Take action to improve your health with access to programs like Weight Watchers®, fitness club discounts and our smoking-cessation program, SuperWell® QuitLine.

�� SuperWell® Health Resource Center – View videos that give you customized advice based on information you provide. The Resource Center also offers interactive tools and quizzes, a searchable health encyclopedia and a symptom checker.

�� SuperWell® Extras – Receive discounts on a variety of items including baby products, spas, hearing aids, drugstore items and health products.

�� CCS Wellness Initiative Programs – Healthy Bodies, Active Minds.

Your Medical Mutual Identification CardBe sure to carry your ID card with you and present it to any healthcare provider you visit. On your card, you will find:�� Coverage details, such as ID number, group number, group

name and type of coverage�� SuperMed Network coverage area and how to find care

when traveling�� The phone number to reach our Customer Service

department�� The amount owed at time of visit to a healthcare provider

(also known as the copay), if applicable

Dental BenefitsRegular, professional dental care is an important part of your family’s health care. To help you get that care, Columbus City Schools offers you a Dental Plan with a wide choice of providers. The dental benefit plan is administered by Delta Dental.

Your enrollment decision for the Dental Plan is separate from your medical plan enrollment. This means you may elect or decline coverage in the Dental Plan, whether or not you elect coverage under a medical plan.

8

Vision BenefitsIf you wish, you may also enroll for a separate vision care benefit for which the employer pays the full cost for you and your enrolled dependents.*

*Note that Latchkey Teachers are required to pay a portion of the cost for vision benefits.

Your Vision Plan covers you and your eligible enrolled dependents. NOTE: Dependent eligibility for the Vision Plan ends at age 26.

Your Vision Plan includes a full range of vision care services provided through a network of preferred vision providers, the Vision Service Provider (VSP) network. You may also receive care from any provider you wish, but your benefits are greater when you see a participating VSP provider.

To locate a participating provider, call VSP at 1-800-877-7195, or visit the VSP Web site at www.vsp.com. Once you choose a provider, call the provider directly to schedule your appointment.

If you choose a non-participating provider, you will have to file a claim for reimbursement.

Vision Plan BenefitsIn-Network Out-of-Network

Reimbursement(Plan Pays)

Covered ServicesRoutine eye exam (every 24 months)

$10 copay (applies to exam and eyewear materials)

$35 after $10 copay (applies to exam and eyewear materials)

Frames (every 24 months)

$105 allowance $35

Lenses (every 24 months) Single vision Covered in full (see above) $25 Lined Bifocal Covered in full after $10 copay

(see above)$40

Lined Trifocal Covered in full after $10 copay (see above)

$55

Contact lenses (every 24 months instead of eyeglass lenses and frames) Cosmetic $105 allowance $105

Medically necessary Covered in full after $10 copay (see above)*

$210 allowance**

** Medically necessary lenses are those required to correct serious vision conditions such as following cataract surgery. Most contact lenses worn in place of glasses do not fall into this category.

YOUR WELLNESS BENEFITS CCS Wellness Initiaive Programs - Healthy Bodies, Active MindsColumbus City Schools is committed to supporting the health and wellness of our employees. The Staff Wellness Committee has developed a program that is designed to cover a broad range of health topics and offers something for every employee.

In addition to the preventive health care coverage and wellness services provided under your medical plan, Columbus City Schools offers you access to a wide variety of additional wellness benefits and programs to help keep you healthy. Be sure to participate in the Health Fairs, Staff Wellness seminars, and our newest offering, free fitness classes that are offered at various locations every week.

9

Basic Term Life Insurance Planning for your family’s financial well-being can bring you peace of mind. Life Insurance can provide financial support to your beneficiaries in the event of your death. Your employer pays the full cost of your Basic Term Life Insurance coverage. You may purchase additional coverage to meet your needs. For more life insurance options in addition to the Supplemental Life Insurance described in the next column, please see the section of this guide on the Universal Life Insurance Plan (page 12) and the Voluntary Term Life Insurance Plan (page 13).

Your Coverage

You may choose from among the following options for Life Insurance coverage:

�� Basic Life Insurance – term life insurance paid for in full by your employer and based on your position

�� Supplemental Life Insurance – if eligible, you may elect to purchase additional term life insurance coverage for yourself in amounts based on your position

Basic Life Insurance Amounts

�� Full-time teachers and administrators receive $50,000 in Basic Life coverage

�� Half-time teachers receive $25,000 in Basic Life coverage

�� Full-time classified employees receive $50,000 in Basic Life coverage

�� Half-time classified employees receive $25,000 in Basic Life coverage

�� Eligible tutors receive $20,000 in Basic Life Insurance coverage

Please note that Latchkey teachers are not eligible for Basic Life coverage.

Supplemental Life InsuranceIf you are a teacher, administrator, or classified employee, you may purchase Supplemental Life Insurance equal to your Basic Life Insurance amount. Please note that tutors and latchkey teachers are not eligible to elect Supplemental Life Insurance.

Whether you are enrolling as a new employee or during Open Enrollment, no proof of good health is required.

You pay for your Supplemental Life Insurance coverage with post-tax dollars through convenient payroll deduction. Your premium is based on your coverage amount.

NEW PROCESS: Life Insurance Enrollment on ESSWe are phasing out enrolling for life insurance using the “yellow cards.” This means all eligible employees will need to re-enroll for Basic Life Insurance and enter their beneficiaries’ information. During Open Enrollment, you will be required to enter your beneficiaries’ birthdates (MM/DD/YYYY) and their Social Security numbers, along with the percentage (%) of insurance you wish to designate for that individual (for example, 100%).If you have elected Supplemental Life Insurance, or are enrolling for the first time, you will be required to enter your beneficiaries’ birthdates (MM/DD/YYYY) and their Social Security numbers, along with the percentage (%) of insurance you wish to designate for that individual.

10

Flexible Spending AccountsAs part of the wide range of choices the Columbus City Schools benefits program offers, you may also elect to set up a Flexible Spending Account to help save income taxes on predictable eligible health and/or dependent care expenses.

You may choose to set up either or both:

�� A Health Care Flexible Spending Account �� A Dependent Care Flexible Spending Account

How a Flexible Spending Account WorksHere’s how a Flexible Spending Account works:

�� For the Health Care Flexible Spending Account:Estimate how much you expect to spend on eligible health care expenses for the plan year (January 1, 2014 through December 31, 2014). Consider medical, dental, vision and hearing expenses not covered by the benefit plans, such as copays and deductibles, as well as other eligible expenses. The maximum contribution you may elect is $2,500 per plan year. The minimum contribution is $260 per plan year or $10 per pay.

�� Pay for eligible expenses by using the PayFlex Card you will receive after you enroll. You may use the card where MasterCard is accepted at physician and dental offices, hospitals, mail order pharmacy vendors, hearing and vision providers, as well as stores where the merchant has implemented an inventory information approval system (IIAS). You must retain all receipts for services utilizing the PayFlex Card to substantiate expenses, based on IRS guidelines. Expenses that cannot be substantiated could result in the PayFlex Card being suspended.`

�� For other eligible health care expenses not covered by your medical, dental, or vision plans where MasterCard is not accepted, pay out of your own pocket and submit a claim for reimbursement, with a copy of any necessary documents (receipts, explanation of benefits, etc.) to PayFlex at the address listed on the claim form available on the PayFlex site at www.healthhub.com. NOTE: Refer to Qualifying Expenses in the next column.

�� For the Dependent Care Flexible Spending Account:Estimate your eligible expenses for dependent day care while you work, or other dependent care expenses. The maximum you may elect is based on your tax filing status: $5,000 (if you are single or married and filing a joint return) or $2,500 (if you are married and filing a separate return).

�� Pay for eligible dependent care expenses out of your own pocket and submit a claim for reimbursement, with a copy of any necessary documents (receipts, etc.) to PayFlex at the address listed on the claim form, available at www.healthhub.com.

�� PayFlex processes reimbursements daily and your reimbursement will be sent according to your choice of direct deposit or check.

�� You must re-enroll in FSAs every year, as your enrollment cannot be carried over. You may make your elections:— During Open Enrollment;— Within 30 days of when you become eligible; or— Within 30 days of when you have a qualifying

event (Job or Life Status Change).

Qualifying Expenses

Health Care Flexible Spending Account

Any health care expenses qualifying under the Internal Revenue Code for income tax purposes also qualify for reimbursement through the Health Care Flexible Spending Account. If you use the account for these expenses, you cannot take an income tax deduction as well. Eligible expenses include, but are not limited to:

�� Deductibles, co-insurance and copays – for medical, dental, pharmacy and vision care;

�� Amounts you pay in excess of plan limitations for Usual, Customary and Reasonable (UCR) charges;

�� Amounts in excess of annual or lifetime benefit maximums; and

�� Expenses not covered or not fully covered by your plan.

NOTE: Over-the-counter medications without a prescription (except insulin) are not eligible for reimbursement through the Flexible Spending Account.

Dependent Care Flexible Spending Account

Any expenses qualifying for a Federal Child and Dependent Care Tax Credit for income tax purposes also qualify for reimbursement through the Dependent Care Flexible Spending Account.

If you use the account to reimburse yourself for eligible expenses, you cannot take the Federal Tax Credit for the same expenses. Eligible expenses include those services provided inside or outside your home while you work by anyone other than your spouse or your dependents to care for eligible dependent children (under age 13) or dependents who are physically or mentally unable to care for themselves for whom you contribute more than half of their support.

11

General Plan Rules

The Internal Revenue Service imposes the following rules and regulations on pre-tax Flexible Spending Accounts:

�� You lose any money left in your account at the end of the plan year, so decide carefully how much to contribute when you enroll each year. However, there is a 60-day grace period after the end of the plan year to submit eligible health care and dependent care expenses incurred during the plan year (January 1, 2014 through December 31, 2014).

�� You may be eligible for a Federal Child and Dependent Care Tax Credit and/or to deduct certain health care expenses on your tax return. Be sure to talk to a tax advisor to see whether the tax credits and deductions or the Flexible Spending Accounts are the best choice for you.

�� For the Health Care Flexible Spending Account, you can be reimbursed up to the full amount you elect to contribute for the plan year even if funds are not yet deposited into your account. However, you can only be reimbursed up to the amount deposited into your Dependent Care Flexible Spending Account at the time of your claim.

�� You cannot use money in your Health Care Flexible Spending Account to be reimbursed for dependent day care expenses and you cannot use money in your Dependent Care Flexible Spending Account to be reimbursed for health care expenses. You also cannot transfer money from one account to the other.

Employee Assistance PlanThe Employee Assistance Program (EAP) provides confidential, professional assistance and valuable resources to you and members of your family to help resolve any issue that interferes with your daily life. The EAP covers up to four (4) visits per issue per member.

In emergencies, a specialist can be reached by telephone 24 hours a day, seven days a week. The services have been prepaid by Columbus City Schools so there is no cost to you or your immediate family when you need help.

To arrange a confidential appointment with a specialist near you, call People Resources. Appointments can be scheduled during the day or evenings, Monday through Saturday. You can consult with a specialist in a face-to-face meeting or, if you prefer, a telephone appointment can be scheduled. A session is normally 50 minutes in length.

Frequently Asked EAP QuestionsHow can my EAP help me or my family member?

EAP specialists have professional training and expertise in a wide range of issues, including:

�� Relationship & family problems,�� Depression�� Alcohol & drug abuse�� Emotional & psychological concerns�� Financial & legal difficulties�� Daily living information�� Stress & much more

How do I or my family member use the EAP?

Just pick up the phone and call People Resources at 1-800-765-9124, available 24/7. A specialist will help you decide on your best course of action. You can also access information about the EAP by going online to www.WorkLifeTools.com.

Who will know about my problems?

This program is built on confidentiality. All discussions between employees and the EAP are kept private, unless you consent in writing to reveal your conversations, or as mandated by law.

Eligible Expenses

To learn more about which expenses are eligible under the Flexible Spending Accounts, you can find lists of eligible expenses in IRS Publications 502 and 503. Please visit the IRS Web site at www.irs.gov/publications.

Flexible Spending Accounts and ESSWhen entering your 2014 election amount for your Flexible Spending Account(s), you will need to enter the bi-weekly amount that you want taken out of your paycheck in the amount field in ESS. For example, if you want to elect a $1,000 annual amount for the Health Care FSA, you will need to enter $38.46 (for 26 pays) or $47.62 (for 21 pays). A link to a chart with these calculations will be available on the FSA page in ESS to assist you in entering the correct amount.

12

Life Insurance OptionsAs a benefits-eligible employee of Columbus City Schools, you may choose from two voluntary life insurance options:

�� Universal Life Insurance with Living Benefits�� Voluntary Term Life Insurance

Universal Life Insurance with Living BenefitsUniversal Life Insurance is permanent insurance that builds cash values. The Universal Life Insurance plan is made available through Trustmark Insurance Company. If you leave your employment, you may continue coverage through Trustmark Insurance Company.

Insurance for Yourself

You may purchase Universal Life Insurance for yourself in $5,000 increments, up to a maximum of $300,000. As a new employee, you may enroll for up to $14 per week. Later en-rollment will require proof of good health. At your death, the plan pays a benefit to your beneficiary. An Accidental Death Benefit doubles the death benefit if death occurs by accident prior to age 75.

Insurance for Your Dependents

You may also elect to buy insurance for your spouse or domestic partner (if applicable). For your spouse, you may choose the greater of $5,000 or an amount purchased with a premium of $4 per week. Premiums are based on your spouse’s age.

In addition, you may cover each eligible child for $5,000 or $10,000 through a Child Term Rider.

About Voluntary BenefitsVoluntary benefits are additional insurance products you can purchase at affordable rates. You also have the advantage of paying for these benefits through convenient after-tax payroll deductions.

As a new employee, you may purchase many of these coverages without a medical exam. Proof of good health will be required if an existing employee or dependent enrolls at any later time. Furthermore, since you purchase these plans individually, many can be continued should you terminate employment with the school system.

How to Enroll

During Open Enrollment, you can enroll for Voluntary Benefits when you meet with a Benefit Counselor who can answer your questions and provide you with rates for these insurance options. You can also enroll by visiting www.iSelectSchedule.com to schedule a co-browsing session with a Benefit Counselor. See Page 3 for instructions.

New employees will need to visit www.iSelectSchedule.com within 30 days of employment to schedule a Voluntary Benefit enrollment session.

EZ Value Plan Feature For Employees

The EZ Value Plan feature is a future guaranteed insurability option which automatically increases coverage annually on each of the first five or ten policy anniversaries. The amount of Death Benefit increase is equal to the amount of protection an additional $1.00 or $2.00 per week deduction will purchase. For more information about this feature, ask your Benefit Counselor.

Your Voluntary Benefit Choices

NOTE Regarding Voluntary Benefits:Proof of good health may be required

for enrollment.

13

Long Term Care Benefits

When you purchase the Universal Life Insurance, you will also have a Long Term Care Benefit to help you pay for medically necessary Long Term Care Services or confinement. To qualify, you must meet the plan’s requirements for assistance with Activities of Daily Living or suffer from a Cognitive Impairment.

Long Term Care Benefit is 4% of the death benefit per month for up to 25 months for Activities of Daily Living assistance provided by a:

�� Nursing Home

�� Assisted Living Facility

�� Adult Day Care

�� Home Health Care

There is a 90-day elimination (waiting) period before Long Term Care Benefits can be paid. A built-in rider automatically restores the death benefit that is reduced to pay for Long Term Care, so your family receives a full death benefit when they need it most. An optional rider extends the Long Term Care benefit up to an additional 25 months.

Living Benefits

Living Benefits allow to advance part of your death benefit to help you cover current financial needs for terminal illness, in addition to the long term care feature described above.

Plan Costs

You pay for your Universal Life Insurance coverage and any coverage you choose for your spouse or children through convenient post-tax payroll deduction.

Your premium is based on your age, the coverage amount you select and whether or not you smoke. For cost information, ask your Benefit Counselor when you enroll.

Plan UL205 is underwritten by Trustmark Insurance Company, Lake Forest, Illinois.

Voluntary Term Life InsuranceIf you wish to add to your life insurance coverage with term life insurance, you may elect the American General Group Voluntary Life Insurance Plan. Term life insurance is coverage that provides protection for a specified period of time and does not build cash values.

You may choose coverage in increments of $10,000, up to $300,000, but not to exceed five times your annual earnings. As a new employee, you may elect coverage of up to $150,000 with no health exam. Proof of good health will be required if you enroll at any later time.

You may also elect to cover your spouse in $5,000 increments, up to $50,000, but not to exceed 50% of your coverage. You may also elect to cover your children (ages 6 months to 19 years or 25 if full-time students) for $10,000 for each child.

You pay for your Voluntary Term Life Insurance coverage through convenient post-tax payroll deduction. Your premium is based on the ages of you and your spouse and the coverage amounts you select. Coverage for children is $ .249 per $1,000 of coverage per month. For more information, ask your Benefit Counselor when you enroll.

14

Short Term Disability (STD) Option Your ability to provide an income for your family is your most important asset. If you are sick or injured and can’t work, you need a way to replace lost income. If you wish, you may elect a voluntary Short Term Disability (STD) benefit plan. This plan is made available through Trustmark Insurance Company. This plan is designed to replace a portion of your income during disability due to illness or injuries lasting more than 14 days. During any absence of less than 14 days, you will be required to use any sick leave benefits you may have.

How the Plan Works

When you have a qualifying total disability*, you must first satisfy a 14-day elimination period before the plan will begin paying benefits. While using your sick leave (which is required even if you enroll for Short Term Disability), you may receive up to 60% of your earnings, to a maximum of $1,350 per week, in addition to your sick leave pay. Once your sick leave is exhausted, you will continue to receive up to 60% of your eligible earnings, up to $1,350 per week from the STD plan. As long as you qualify, benefits are payable for up to 26 weeks. Your premium is waived for you if you remain disabled for 90 consecutive days during the benefit period.

*A qualifying total disability means that, because of a non-work-related sickness or injury, you are unable to do the substantial and material duties of your regular job and you are not doing any work for pay or benefits. You must be under the care of a physician to receive benefits. Benefits are not payable for pre-existing conditions during the first 12 months of coverage for diagnoses three months prior to your effective date.

If you have questions about the Short Term Disability coverage, ask your Benefit Counselor when you enroll.

Plan Costs

You pay for the STD plan through convenient payroll deduction. For cost information, ask your Benefit Counselor when you enroll.

Plan STD-404 is underwritten by Trustmark Insurance Company, Lake Forest, Illinois.

Critical Illness insurance - NEWTrustmark Critical Illness insurance pays benefits upon the first diagnosis of a covered critical illness or condition. It provides a cash payment for expenses and treatments not covered by most medical plans, and it pays before most high-deductible health plan benefits begin. A health screening benefit identifies and reduces health risks, making it easier for you and your covered family members to stay healthy.

Covered Conditions

�� Invasive cancer �� Heart attack �� Stroke �� Renal (kidney) failure �� Blindness�� ALS (Lou Gehrig’s disease) �� Major organ transplant �� Paralysis of at least two limbs �� Coronary artery bypass surgery (25% benefit) �� Carcinoma in situ (25% benefit)

Plan Features

�� Portability – Take your coverage with you and pay the same premium even if you change jobs or retire.

�� Family Coverage – Apply for your spouse, children and dependent grandchildren. Your dependents are covered for 50% of your benefit amount.

�� Single Cash Benefit – Choose a benefit from $5,000 to $100,000.

�� Subsequent condition benefit with a recurring condition*--�� Pays a lump-sum cash payment when you are first

diagnosed with any and every covered condition included in your policy.

�� There are no limits to the number of payouts for each insured family member and no reduction in payouts for later-diagnosed conditions. (Coronary artery bypass and carcinoma in situ are limited to one payout for each condition, which will not reduce any subsequent benefits.)

�� Benefits are also payable for recurrence of the same covered condition previously paid under the contract.**No benefit is payable for recurrence of carcinoma in situ or coronary artery bypass. Separation periods between diagnoses may apply. Not available in all states. Please consult your policy/ group certificate for complete details.

�� Health Screening Benefit – Pays the cost of one screening test per calendar year ($100 maximum). Some of the many tests included:– Low Dose Mammography – Colonoscopy– Serum Cholesterol – Bone Density– Stress Test

15

�� Best Doctors® medical advice when you need it most.�� Receive one-on-one support in connecting you to the

medical information you may need for covered conditions.

Optional benefit

�� EZ Value automatic increases

Policy costs

The cost of coverage depends on the benefit amount you choose, your age and whether or not you use tobacco. When you meet with a Benefit Counselor, you’ll be provided with detailed cost information.

For More Information

Pre-existing Condition Limitation. Generally, no benefit will be paid for any condition caused by or resulting from a pre-existing condition, which begins in the first 12 months after the coverage effective date. A pre-existing condition is a sickness or injury for which medical care, diagnosis or advice was received or recommended, or the existence of symptoms which would have caused an ordinarily prudent person to seek medical care, treatment, diagnosis or advice during the 12 months immediately prior to coverage effective date. Please consult Plan CACI-82001 and other optional riders for your state for exact terms and provisions. Contact Trustmark if you have questions,

Accident Insurance Option - NEWYou do everything you can to keep your family safe, but accidents do happen. When they do, it’s good to know you have help to manage the medical costs associated with accidental injuries. Trustmark’s Accident insurance helps take care of medical bills, so you can take care of your family. Wellness benefits are payable every year and help offset the affordable premium you pay for coverage.

Plan Features

�� Benefits paid directly to you without any restrictions on how you can use them.

�� Benefits are paid to you regardless of any other coverage you have.

�� Guaranteed Issue – There are no medical questions you’ll have to answer, but your spouse or domestic partner must answer a disability question.

�� Level Premiums – Rates don’t increase because of age.�� Family Coverage – Apply for your spouse, children, and

dependent grandchildren.�� Portability – Take your coverage with you and pay the

same premium. It’s yours to keep even if you change jobs or retire.

Accident Insurance Provides 24-hour Coverage and provides benefits for:

�� Hospital Admission �� Hospital Confinement*�� Hospital Intensive Care Unit* �� Emergency Room Treatment�� Initial Care Benefits: Physician visit, ambulance,

emergency room treatment, hospital benefits, lodging, blood, surgery, emergency dental

�� Injury Benefits: Burn; concussion; dislocation; eye injury; fracture; herniated disc; laceration; loss of finger, toe, hand, foot, sight; tendon, ligament, rotator cuff injury; torn knee cartilage

�� Follow-up Care Benefits: Physical therapy, appliances, prosthetic device, artificial limb, skin graft, transportation

�� Accidental Death Benefit�� Catastrophic Accident Benefit�� Health Screening Benefit for health screening tests

($100 maximum), one per person per year. Please refer to Schedule of Benefits for benefit amounts and covered conditions for your state.

*Hospital Confinement and ICU Benefits cannot be paid at the same time. Benefit amount payable may vary by state. Benefits are payable only as the result of a covered accident. Benefits may vary by state and additional benefits may be available in some states. Most benefits are paid once per person per covered accident unless otherwise noted.

For More Information

Please consult Plan Form A-607 for exclusions that apply, and for exact terms and provisions. This provides a brief description of benefits and is not a contract. This is an Accident only policy/group certificate with limited benefits and does not pay benefits for diseases, sickness or for loss from sickness. This is not a Worker’s Compensation Policy nor a Medicare policy. Benefits are supplemental and not intended to cover all medical expenses. Contact Trustmark if you have questions.

16

Legal Insurance Option (non-CEA members only)The LegalGUARD Plan, through LegalEASE, offers a package of legal assistance benefits that can help you deal with a variety of legal situations. This service is available through a convenient post-tax payroll deduction.

The LegalGUARD Plan includes the following benefits:

�� Unlimited free consultations with Plan Attorneys in person, over the phone, or online;

�� Wide range of legal documents including deeds, leases, affidavits and others;

�� Members may have a free Simple Will and Power of Attorney prepared by a Plan Attorney each year;

�� A Simple Divorce is paid in full;�� Many other Family law issues are also covered such as

Child Support, Child Custody and Adoptions;�� Criminal Defense Matters; and�� Real Estate Matters and more.

Your LegalGUARD Plan also offers assistance with: �� Debt Management �� Financial Planning �� Budgeting �� Financial Counseling �� Identity Theft Prevention �� Identity Theft Recovery

To learn more about the LegalGUARD Plan through LegalEASE, ask your Benefit Counselor when you enroll, or visit their web site at http://vsc-legalease.com.

Pet Insurance OptionSimilar to health insurance for the people in your family, the Pet Insurance Plan helps you meet the cost of caring for your pets. The Pet Insurance Plan is available through VPI Pet Insurance.

You may choose from several levels of benefits that cover some of the cost of routine care as well as treatment for injuries and illnesses.

Your cost for coverage is based on your pet’s age and breed. You pay for the coverage through a convenient post-tax payroll deduction.

To learn more about Pet Insurance, ask your Benefit Counselor when you enroll or visit their web site at www.petinsurance.com.

Other InformationConsolidated Omnibus Budget Reconciliation Act (COBRA)COBRA, a federal law, allows insured employees and their dependents to continue health and dental coverage under several circumstances when it would normally be lost.

Below is the basis for COBRA continuation:

1. Loss of Employment (resignation/termination) – If an employee terminates employment, the employee and/or insured dependents may continue his/her health coverage for up to 18 months.

2. Reduction of Hours – If any employee’s hours of employment are reduced so that he/she is no longer entitled to benefits, he/she and/or insured dependents may continue health coverage for up to 18 months (includes unpaid leave of absence or personal leave).

3. Death of Employee – If an employee with dependent coverage should die, covered dependents may continue their health coverage for up to 36 months.

4. Loss of Dependent Eligibility – Health coverage may be continued for a child who was covered by dependent coverage and has reached the age limitation for normal coverage, for up to 36 months.

5. Divorce – If an employee and his/her spouse are divorced, and the spouse and/or other dependents were covered as dependents on the employee’s health insurance, the divorced spouse and/or dependents may continue his/her health coverage for up to 36 months.

6. Extension for Disabled Persons – If a person is totally disabled for social security purposes at the time that one of the reasons listed in (1) or (2) above occurs, that person is entitled to up to 29 months of continued health coverage.

Premiums for the above insurance are paid by the person using COBRA coverage. If one of the above events occurs, please contact Employee Benefits so that COBRA can be offered. Employees have 60 days from the qualifying event to complete and return the COBRA application or forfeit any rights to continuation of coverage.

Summary of Benefits and Coverage (SBC)As part of the Patient Protection and Affordable Care Act (Health Care Reform), all employees are to have access to a Summary of Benefits and Coverage (SBC). We are providing this information to you electronically by accessing the following links on the CCS intranet:

http://ccsoh.us/OpenEnrollment.aspx

Employees may also pick up a printed copy of this information in the Employee Benefits Department.

Other Information, ContinuedWomen’s Health and Cancer Rights Act of 1998 – Notice of Post-Mastectomy BenefitsThe Women’s Health and Cancer Rights Act of 1998, a federal law, was enacted on October 21, 1998. This law requires that a medical plan’s coverage of a necessary mastectomy also include the following post-mastectomy coverage for:

�� Reconstruction of the breast;�� Surgery of the other breast to achieve the appearance of

symmetry;�� Prostheses; and�� Treatment of physical complications during any stage of the

mastectomy, including lymphedemas. This coverage will be provided in consultation with the attending physician and the patient. Benefits will be subject to the same annual deductibles, copays and coinsurance as applicable to any other type of care.

The Newborns' and Mothers' Health Protection Act of 1996 (Newborn's Act)Group health plans generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Special Enrollment Rights under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides the following special enrollment rights:

�� If you do not enroll for medical coverage for yourself and your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself or your dependents in the medical plan, as long as you request enrollment within 31 days after your other coverage ends. You will need to provide proof that your other coverage has ended.

�� In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents as long as you request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

Effective April 1, 2009 special enrollment rights also may exist in the following circumstances:�� If you or your dependents experience a loss of eligibility

for Medicaid or a State Children’s Health Insurance Program (SCHIP) coverage and you request enrollment within 60 days after that coverage ends; or

�� If you or your dependents become eligible for a state premium assistance subsidy through Medicaid or a SCHIP program with respect to coverage under this plan and you request enrollment within 60 days after the determination of eligibility for such assistance.

Medicare Part D NotificationIf you or a dependent are eligible for Medicare due to age or disability, please review the inserted important notice regarding Medicare Part D Prescription Drug coverage. Please read the notice carefully and keep it with your important papers. If you have any questions, call the Benefits Department at 614-365-6475.

September 2013