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Orchard FarmSchool District

OPEN ENROLLMENT

Three ways to complete enrollment:
Option 1		Option 2		Option 3
AFenroll ONLINE ENROLLMENT		Schedule a One-on-One Appointment		Review your benefit options ONLINE and SCHEDULE AN ONE-ON-ONE APPOINTMENT to meet with an American Fidelity representative to finalize your enrollment.
Available April 20-28, 2019		Appointments May 6-10, 2019
USER ID (Enter SSN without dashes)		The one-on-one in-person enrollment option provides an opportunity for employees to meet with an American Fidelity representative and enroll in the benefits that best meet your needs. American Fidelity representative will assist with the enrollment of all the district benefit plans as well as the supplemental plans offered by American Fidelity.
PIN (last 4 of SSN followed by the last 2 digits of your birth year) Ex: SSN xxx-xx-1234, Birth Year 1984. PIN would be 123484.
Step-by-step video guide for AFenroll: click here

AETNA HEALTH INSURANCE PLAN Plan Year July 1, 2019 – June 30, 2020
	Open Choice PPO Plan	High Deductible Health Plan (HDHP) with HSA
Employee (district paid)	$ 690.00	$ 562.00
Spouse (employee paid)	$ 790.00	$ 642.00
Child(ren) (employee paid)	$ 648.00	$ 528.00
Family (employee paid)	$1,354.00	$1,102.00
Rates are listed above on a per month basis.

Aetna Health	Open Choice PPO Plan In-Network	High Deductible Health Plan In-Network
Member Coinsurance	100%	100%
Preventive Care	100%; deductible waived	100%; deductible waived
Office Visit (non-Specialist)	$20 copay	100% after deductible
Specialist	$40 copay	100% after deductible
Urgent	$35 copay	100% after deductible
Emergency Room	$150 copay	100% after deductible
Deductible (individual/family)	$750 / $1,500	$2,700 / $5,400

AETNA DENTAL INSURANCE PLAN Plan Year July 1, 2019 – June 30, 2020
	Dental PPO	Dental DMO
Employee (district paid)	$41.38	$41.38
Spouse (employee paid)	$37.56	$37.56
Child(ren) (employee paid)	$44.02	$44.02
Family (employee paid)	$95.88	$95.88
Rates are listed above on a per month basis.

VISION BENEFITS OF AMERICA Plan Year July 1, 2019 – June 30, 2020
	Rates	Plan Summary
Employee (district paid)	$7.50	Routine Exam	Once every 12 months
Family (employee paid)	$10.92	Lenses	Once every 12 months
Rates are listed above on a per month basis.		Frames	Once every 24 months
		OR
		Contact Lenses	Once every 12 months

DEARBORN LIFE INSURANCE

Plan Year July 1, 2019 – June 30, 2020

See Schedule of Benefits Provided Below

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Aetna Dental	Dental PPO In-Network	Dental DMO In-Network
Office Visit Copay	n/a	$10
Preventive Services	100%	See DMO Benefit Summary Provided Below
Basic Services	80%
Major Services	50%
Annual Benefit Maximum	$2,000
Office Visit Copay	n/a
Deductible (individual/family)	$50 / $150
Deductible applies to basic & major services only

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