Appendix EHealth Care and Related Benefits
The appropriate contract provisions and/or employee benefits will be updated as relevant to incorporate the following:
- There shall be up to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) and unlimited chiropractic services.
- Bargaining unit employees enrolled in a CPS medical insurance will have access to free vaccines at any vaccination provider in Chicago that accepts CPS medical insurance for a range of basic vaccines through the PPO plan and can obtain reimbursements for vaccine costs at pharmacies with the HMO plan.
- Guarantee that all offered health plans include access to bariatric surgery and the LMCC will continue to explore ways to offer weight loss drugs, at lower costs, to a greater number of members in the covered population.
- Eliminate co-pay for physical therapy through Athletico in the PPO, on all plans for other PT offerings, after the member satisfies their deductible.
- The Employee Assistance Program shall provide up to five free on demand therapeutic support for stress/anxiety, financial coaching, wellness and community resources if members require the support before, during or after the school day.
- All employees are eligible to enroll in optional pet insurance coverage.
- The BOARD shall continue to explore opportunities to secure lower cost prescriptions to the maximum extent allowed by the Food and Drug Administration for units of state and local government. Additionally, the Board and Union shall send a letter to the district’s Pharmacy Benefit Manager to ensure that the full extent of pharmacy rebates are passed onto the district’s health plans.
- Under the PPO/HDHP plan for employees, home births are covered. Under the HMO plan for employees, home births are covered if the medical group provides a referral for a home birth, and the midwife performing the home birth is affiliated with the HMO.
- CPS shall provide all PPO preventative and diagnostic dental insurance to cover 100% of the cost of said coverage and increase the annual maximum coverage from $1500 to $2000 and add orthodontic care, at 50% coinsurance coverage, up to $2,000 lifetime maximum.
- The STD plan will be updated to eliminate the 10 sick day exhaustion rule, to allow employees immediate access to their short-term disability benefits without the requirement to deplete their 10 sick days first.
MEDICAL BENEFIT
HEALTH CARE PLAN DESIGN EFFECTIVE
Plan Design. The Board and Union agree to provide a healthcare plan to qualifying employees that includes an HMO, a PPO and PPO with HSA.
Show only checked plans
| HMO | Traditional PPO | PPO with HSA | ||||
|---|---|---|---|---|---|---|
| HSA Contribution (Single/Family) | N/A | N/A | N/A | Single: $600/Family: $2,000 | ||
| In-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | ||
| Annual Deductible | Individual | No Deductible | $600 | $1,200 | $2,000 | $4,000 |
| Individual + 1 | No Deductible | $1,800 | $3,600 | $4,000 | $8,000 | |
| Family | No Deductible | $1,800 | $3,600 | $4,000 | $8,000 | |
| Out-of-Pocket Maximum | Individual | $1,500 | $2,700 | $5,400 | $4,000 | $8,000 |
| Individual + 1 | $3,000 | $5,200 | $10,800 | $8,000 | $16,000 | |
| Family | $3,000 | $5,200 | $10,800 | $8,000 | $16,000 | |
| Doctor’s Visit | General office visits | 100% covered $30 Regular copay $45 Specialist copay $30 Urgent copay |
80% covered $25 Regular copay $40 Specialist copay $25 Urgent copay |
50% covered $25 Regular copay $40 Specialist copay $25 Urgent copay |
80% covered after deductible | 50% covered after deductible | Wellness/preventive care | 100% covered (no copay) | 100% covered (no copay) | 100% covered (no copay, no deductible) |
| Telemedicine (Virtual Visits) | 100% covered $30 Regular copay $45 Specialist copay $30 Urgent copay |
$25 copay | Not covered | 80% covered after deductible | Not covered | |
| Inpatient hospital services | Hospital (semi-private) room and board | $275 copay per admission, then 100% covered | $100 deductible per admission, then 80% covered after deductible | $100 deductible per admission, then 50% covered after deductible | 80% covered after deductible | 50% covered after deductible |
| Doctor’s visits (including specialists), x-rays, drugs, surgeon fees and anesthesiologists | 100% covered (no copay) |
Included in in-patient hospitalization | Included in in-patient hospitalization | |||
| Outpatient hospital care (includes surgery) | $225 copay per visit, then 100% covered | 80% covered after deductible | 50% covered after deductible | 80% covered after deductible | 50% covered after deductible | |
| Maternity | Prenatal/postnatal | $30 copay | 100% after $40 copay | 50% covered after deductible | 80% covered after deductible | 50% covered after deductible |
| Hospital coverage (mother and newborn) | $275 copay, then 100% covered | 80% covered after deductible | 50% covered after deductible | 80% covered after deductible | 50% covered after deductible | |
| Covered emergency care | Emergency care (if deemed an emergency) | $200 copay per visit for in and out-of-network providers, then 100% covered | $200 copay, then 100% covered | 80% covered after deductible | ||
| Ambulance | 100% covered. Ground Transportation only | 100% covered after deductible | 100% covered after deductible | |||
| Behavioral/ Mental Health (unlimited visits) | Inpatient | $275 copay then 100% covered | 80% covered after deductible | 50% covered after deductible | 100% covered after deductible | 80% covered after deductible |
| Outpatient | $20 copay then 100% covered | $25 copay, then 100% covered | $25 copay, then 80% covered | 100% covered after deductible | 80% covered after deductible | |
| Therapy | Physical, occupational and speech therapy for restoration of function approved by doctor | 100% covered for the number of visits which, if approved by a doctor, up to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) | $30 copay, then 100% covered after deductible, up to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) | 80% covered after deductible, up to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) | $30 copay, then 100% covered after deductible Limited to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) | 80% covered after deductible Limited to 60 visits per specialty (physical therapy, occupational therapy, speech therapy) |
| Chiropractic care | 100% covered after $45 copay per visit. Unlimited visits for chiropractic therapy. | $30 copay, then 100% covered after deductible. Unlimited visits for chiropractic therapy | 80% covered after deductible. Unlimited visits for chiropractic therapy | $30 copay, then 100% covered after deductible. Unlimited visits for chiropractic therapy. | $30 copay, then 80% covered after deductible. Unlimited visits for chiropractic therapy | |
| Care in skilled nursing facility (up to 120 days/year if medically necessary) | 100% covered 60 calendar day limit |
80% covered after deductible | 50% covered after deductible | 80% covered after deductible | 50% covered after deductible | |
| Prosthetic devices and medical equipment | 100% covered | 80% covered after deductible | 50% covered after deductible | 80% covered after deductible | 50% covered after deductible | |
| Pharmacy | 80% covered after deductible | 50% covered after deductible | ||||
INSURANCE BENEFITS - OTHER
Pre-authorization. Pre-authorization required, failure can result in 50% additional co-insurance charge up to $1,000 per individual per event per hospital stay, plus the coinsurance that is applicable to the service. Benefits for medically unnecessary procedures are subject to further reduction or denial in accordance with plan policy. The BOARD will continue to provide information about pre-authorization to its employees in the Benefits Handbook. The BOARD agrees that employees should be provided with additional information materials upon which to base health care decisions and will design a specific communication piece such as a section of the annual open enrollment materials, or other communication.
Chronic Care/Disease Management Program. The parties agree to continue to maintain a chronic care/disease management program. The program shall provide individualized/customized treatment plans, education support, monitoring via nurse care coordinators, communications to employees through the internet and mail, and targeted phone calls to engage employees in preventive actions.
Enhanced Vision Plan. The BOARD shall continue to offer an employee-paid vision plan providing contacts/lenses once every calendar year and frames once every calendar year. Employee premiums are as follows:
- Employee: as determined by insurer, or if self-insured as determined by vendor.
- Employee + 1: as determined by insurer, or if self-insured as determined by vendor.
- Family: as determined by insurer, or if self-insured as determined by vendor.
Frames once every calendar year. Any available frame at provider location: $0 copay, $150 allowance, 20% off balance over $150. Contact lenses once every calendar year. The BOARD will continue to provide information about co-pays and allowances to its employees in the Benefits Handbook.
Pharmaceutical Benefit. Employees enrolled in a medical plan will only have access to generic drugs. Brand name drugs will only be covered if approved by Pharmacy vendor through an appeal process or the employee’s doctor completes the prior authorization process. Employees enrolled in the HMO or Traditional PPO plan will have to pay a $75 prescription drug deductible per calendar year per household. Employees enrolled in the PPO with HSA plan must pay the medical deductible before prescription coinsurance applies.
Covered prescriptions purchased at a non-participating pharmacy will be reimbursed at 60% of the generic drug cost. The plan will also only pay 60% of the generic drug cost if a brand-name drug is issued when a generic drug is available.
Benefits Eligibility for New Hires. A newly hired employee will continue to be eligible for health care benefits beginning on the first day of the month following their date of hire.
Employee Assistance Program. An Employee Assistance Program shall continue to be maintained as part of the health care program.
Employee Wellness Program.
Benefit Information
- The BOARD currently provides a guide, providing an overview of its health care plans to new employees and re-hired employees and during the annual Open Enrollment period, and the BOARD will continue to do so. The guide will be available online to allow employees to view current plan information electronically.
- The BOARD benefit plans provide a toll-free hotline and an online site for members to access with questions regarding their health care plan. The hours of operation for each health care plan are 8:00 a.m. to 6:00 p.m. Additionally, the BOARD has a Benefits Customer Service team which answers calls during business hours.
- As a result of the PeopleSoft conversion, the BOARD relies on a unique identification number (“UID”) for all employees. The BOARD will work with each of its vendors to ensure that employees are routinely identified by these UIDs as opposed to the employees’ Social Security numbers.
Anti-Fungal Drugs.
Griseofulvin is covered by the Board. All other anti-fungal drugs have the option of going through medical necessity review and may be covered after review with the exception of Penlac which is excluded from the plan and Grifulvin V and Gris-Peg which are no longer available on the market.
| Drug Name | Covered |
|---|---|
| Grifulvin V | N/A |
| Gris-Peg | No |
| Griseofulvin | Yes |
| Lamisil | No |
| Sporanox | No |
| Penlac | No |
Dental Benefit
Employees and eligible family members will have the choice of PPO or Managed Care. PPO Dental Plan - Member selects an in-network or an out-of-network provider. Managed Care - Member selects a dentist in the provider network.
| Services | PPO In-Network | PPO Out-of-Network* | Managed Care |
|---|---|---|---|
| Preventive | 100% of PPO rate | 100% of PPO rate | 100% |
| Basic | 80% of PPO rate | 80% of PPO rate | 75-85% |
| Major | 50% of PPO rate | 50% of PPO rate | 65-70% |
| Individual Maximum | |||
| Benefits Limit | $2,000 annually | None | |
| *Deductible | None | $100 annually | None |
| Orthodontics | 50% coinsurance to lifetime maximum of $2,000 for adults & dependents up to age 26. | 50% coinsurance to lifetime maximum of $2,000 for adults & dependents up to age 26. | 50% coinsurance to lifetime maximum of $2,000 for adults & dependents up to age 26. |
Employee Contributions
PPO
- Employee: $0
- Employee plus one: 100% contributory at rates determined by plan provider
- Employee plus family: 100% contributory at rates determined by plan provider
Managed Care
- Employee: $0
- Employee plus one: $0
- Employee plus family: $0
Flexible Spending Accounts (“FSAs”)
The BOARD will offer its employees two types of voluntary 100% contributory, flexible spending accounts:
Medical Reimbursement Account – to be used for FSA eligible expenses not covered by the employee’s medical or dental plan, such as co-pays, deductibles and coinsurance. The maximum annual amount is based on IRS guidelines.
Dependent Care Account – to be used for dependent care expenses. The maximum annual amount is based on IRS guidelines.
Life and Personal Accident Insurance
Employees are covered by Basic Life coverage. A voluntary Optional Life and matching Accidental Death and Dismemberment insurance is available for employees and eligible family members.
- Basic Life: $25,000
- Optional Dependent Life: $50,000 spouse
- Optional Dependent Accidental Death and Dismemberment: $50,000 spouse
Employee Contributions
- Basic Life: $0
- Optional Dependent Life: 100% contributory at rates determined by plan provider
- Optional Accidental Death and Dismemberment: 100% contributory at rates determined by plan provider
Savings and Retirement Program
The BOARD will contribute, at retirement, a percentage of the value of an employee’s unused retained sick day bank to the employee’s 403(b) account, within legal limits, based on retirement benefit eligibility requirements. The “retained sick day bank” shall be as defined in Article 37-4 above and subject to the terms of that article. The percentage shall be as set forth in Article 37-4 above. If no account exists, one will be established with one of the authorized vendors, based on agreed-upon criteria.
A contribution will be made for all employees, with sick pay balances, meeting the pension benefit eligibility requirements.
No exceptions.
Contributions made on behalf of the employee will not be subject to state or Medicare tax, as allowed by law.