Benefits Plan Overview

Pre-Tax Benefits

 Health Insurance: Anthem – The Local Choice

 Vision Insurance: Blue View Vision – The Local Choice

 Dental Insurance: Delta Dental of VA – The Local Choice

 Flexible Spending Accounts

• Medical Reimbursement FSA Maximum $2,750/year
• Limited Purpose FSA* Maximum $2,750/year
• Dependent Care Reimbursement Maximum $5,000/year

*Limited Purpose FSA funds can only be used for qualifying vision, dental and orthodontia expenses

You will need to re-sign for the Flexible Spending Accounts if you want them to continue next year.

IF YOU DO NOT RE-SIGN, YOUR CONTRIBUTION WILL STOP EFFECTIVE JUNE 30, 2021.

 Health Savings Accounts

• Employee Maximum $3,600/year
• Family Maximum $7,200/year

HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP)

 Cancer Benefits: Colonial Life

 Accident Benefits: Colonial Life

 Medical Bridge Benefits: Colonial Life

 Dental Insurance (Stand-Alone Policy): Delta

Post-Tax Benefits

 Disability Benefits: Colonial Life

 Critical Illness Benefits: Colonial Life

 Pre-Paid Legal Plan: Legal Resources

 Life Insurance

• Term Life Insurance: Colonial Life
• Whole Life Insurance: Colonial Life

Please note your insurance products will remain in effect unless you see a representative to change them.

ENROLLMENT PERIOD: MAY 3, 2021 – MAY 7, 2021

EFFECTIVE DATES: JULY 1, 2021 – JUNE 30, 2022

QUALIFICATIONS:

• You must be a contract employee working 30 hours or more per week.

IMPORTANT FACTS:

• The plan year for The Local Choice benefits (Anthem Health, Delta Dental & Blue View Vision), Health Savings Accounts, Flexible Spending Accounts, Delta Dental (stand-alone policy), Colonial Insurance products and Legal Resources Pre-Paid Legal plan lasts from July 1, 2021 through June 30, 2022.

• Deductions for The Local Choice benefits (Anthem Health, Delta Dental & Blue View Vision), Delta Dental (stand-alone policy) and Legal Resources Pre-Paid Legal plan will begin June 2021. Deductions for Health Savings Accounts, Flexible Spending Accounts and Colonial Insurance products will begin July 2021.

• Please visit www.piercegroupbenefits.com/kingandqueencountypublicschools to review plan summaries and other required health plan notices.

• If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when meeting with the Benefits Representative.

• If you will be receiving a new debit card, whether you are a new participant or to replace your expired card, please be aware that it may take up to 30 days following your plan effective date for your card to arrive. Your card will be delivered by mail in a plain white envelope. During this time you may use manual claim forms for eligible expenses. Please note that your debit card is good through the expiration date printed on the card.

• Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse’s employment, or the transition of spouse’s employment from full-time to part-time, or vice-versa.

• Once a family status change has occurred, an employee has 30 days to notify the Pierce Group Benefits Service Center at 1-800-387-5955 to request a change in elections.

• Flexible Spending Account expenses must be incurred during the Plan Year in order to be eligible for reimbursement.

• An employee has 90 days after the plan year ends to submit claims for spending account expenses that were incurred during the plan year. Please note that if employment terminates during the plan year, that employee’s plan year ends the day employment ends. The employee has 90 days after the termination date to submit claims.

• With Dependent Care Flexible Spending Accounts, the maximum reimbursement you can request is equal to the current account balance in your Dependent Care account. You cannot be reimbursed more than has actually been deducted from your pay.

• As a married couple, one spouse cannot be enrolled in an FSA at the same time the other is contributing to an HSA.

• The Health Screening Rider on the Colonial Medical Bridge plan has a 30-day waiting period for new enrollees. Coverage, therefore, will not begin until July 31, 2021.

• Additionally, some policies may include a pre-existing condition clause. Please read your policy carefully for full details.

• Please be aware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution.

• An employee taking a leave of absence, other than under the Family & Medical Leave Act, may not be eligible to re-enter the Flexible Benefits Program until the next plan year. Please contact your Benefit Administrator for more information.