Updated August 2014

Insurance Services Benefits Presentation

Office Hours: Monday-Friday 7:45-4:45

Edison Building:615 7th St SW

Contact our office at any time with questions:

Phone: 507-328-4280Fax: 507-328-4213Email:insurance@rochester.k12.mn.us

Insurance Services

If forms are completed and returned within 30 days (of hire date) your insurance effective date will be your first day of employment

Health and Dental Application (Cost Shift and Birthday Rule apply for family health and/or dental coverage.)

Madison Nat’l Life Application Life Insurance/AD&D & LTD Supplemental LTD (Start date determined by acceptance)

Cost share of premiums is determined by your employment contract

To decline coverage for any of the above, fill out Employee Information and sign waiver

Return completed forms to Insurance Services by dropping off at the Maintenance Service Building, Door 2 or send in inter-office mail

Forms to Return within 30 days

Madison National LifeLife Insurance

Cost = 11¢ per $1,000 of coverage

Coverage amount is determined by your employment contract

Coverage over $50,000 will be subject to income tax

Example: $40,000 = 40 units x .11 = $4.40 per month premium (for your cost per month refer to your contract)

There is a 30 day open enrollment period for new employees for Life & Long Term Disability. This is the one time you can sign up for basic life & LTD with no additional health questions. If you wish to apply for any coverage at a later date you will be required to complete an additional form and coverage is at the discretion of Madison National Life.

Basic Long Term Disability Cost = 34 ¢ per $100 of your salary Pays 66 2/3% of your salary, after a 90 calendar day elimination period

(How long you have to be disabled before the plan will pay a benefit)

Example: $3000/mo. Salary ÷ $100 = 30 units x .34 = $10.20 per month premium (your monthly cost determined by your contract)

Supplemental Disability Employee pays 100% of cost Cost = 21 ¢ per $100 plus the cost of basic LTD Same as Long Term Disability, but pays 85% of your salary, after a 90

calendar day elimination period (How long you have to be disabled before the plan will pay you)

Example: $3000/mo. Salary ÷ $100 = 30 units x .21 = $6.30 per month premium (plus the portion of the Basic LTD you have to pay)

If you wish to apply for any coverage at a later date you will be required to complete an additional form and coverage is at the discretion of Madison National Life.

Madison National LifeLTD & Supplemental

LTD

In lieu of short term disability, the District offers Hospital Days◦ Up to 20 days per calendar year (Refer to

your employment contract for approved usage)

You may elect to sign up with Aflac for Short Term Disability and have your Aflac premiums payroll deducted

Doug Schwingler is the Aflac Agent. 507-289-0400

Aflac has an open enrollment period in November for coverage to change/begin the following year.

Hospital Days & Short Term Disability

Rochester Public Schools is self-insured and self administered, meaning the premiums paid are actually paying the claims.

There are two health plans available◦ Copay Plan◦ High Deductible Health Plan

There is no primary care facility.◦ In network providers are encouraged for cost containment◦ Mayo & OMC are in network providers◦ PHCS is our out of state network◦ When you choose a non participating provider, you pay any

charges billed to you that exceed the allowed amount (Including ER visits)

Insurance benefits run by calendar year.◦ Out of pocket expenses, deductibles, etc.◦ Deductible amounts incurred in the last 3 months of the calendar

year carry over into the new plan year (Does not apply if switching between plans) (Does not apply to investigational deductible)

Health Plan

Health Plans CO-PAY PLAN HDHP Deductible & Out-of-Pocket

Deductible

$500 per person ($400 until 12/31) $1,500 per family ($1,200 until 12/31)

$1,500 per person $3,000 per family

Out-of-Pocket Maximum

Lifetime Maximum

$2,500 per person $5,000 per family Unlimited

$3,500 per person (RX OOP included) $7,000 per family Unlimited

Services Office Visits for I llness/ Injury Preventive Care (routine care, cancer screenings, immunizations) Routine Physicals, Hearing & Vision Exams Well Child Care Mental Health/ Substance Abuse Services I nvestigative & Experimental Services Hospital Emergency Room Emergency Ambulance Emergency Ambulance

$30 copay, then 80% 100% 100% 100% $30 copay, then 80% $1,000 copay per calendar year, then 80% $50 copay, 80% after deductible 80% after deductible

80% after deductible 100% 100% 100% 80% after deductible $1,000 copay per calendar year, then 80% 80% after deductible 80% after deductible

Prescription Drugs (RX) Generic Formulary Formulary Brand Name Non-Formulary Brand Name Specialty Pharmacy RX Out-of-Pocket Maximum (OOP)

$12 copay $30 copay $55 copay $60 copay $1,500 per person $3,000 per family

$12 copay $30 copay $55 copay $60 copay $1,500 per person $3,000 per family Maternity Care

Prenatal Services Delivery For Prenatal Support Program Call 1-866-938-9743

100% 80% after deductible $50 Gift Card

100% 80% after deductible $50 Gift Card

For employees who elect to participate in the high deductible health plan, the District will make an annual lump-sum contribution (shown on your January paycheck) to an HRA for the employee.

Single coverage -- $750 Family coverage -- $1500

Must be enrolled in the HDHP as of January 1 of each calendar year in order to receive contribution from the District.

Contributions for new hires are not prorated. 1st contribution will be Jan 1st of the following year.

If the employee separates employment or switches plans before the end of their first HRA contribution year, their remaining HRA balance will be forfeited.

Health Reimbursement Agreement – HRA

(VEBA)

Fitness Club Membership Discount - $20 per month per person (two people age 18 and over if family coverage) covered by the RPS health plan who work out at least12 times per month.

$50 Prenatal Gift Card if enrolled in the Prenatal Support Program.

Flu Shots in September are FREE for all active and retired RPS employees who are still on the District’s health insurance plan. Family members are covered (age 10 years+) if employee has family coverage as primary through the RPS health plan.

EAP plan pays for one session per year with an EAP counselor. The Center for Effective Living, 288-5675.

Various activities throughout the school year to encourage work/life balance. See the wellness page or contact your site Wellness coordinator for more information.

Wellness

Individual deductible - $25 per calendar year

Family deductible - $75 per calendar year

Ortho coverage: $50 lifetime deductible –pays 50% of eligible expenses

◦Over 18 - $1000 - 3 years waiting period

◦Under 18 - $1500 - 1 year waiting period

Dental Insurance Coverage

80% coverage after deductible for basic services

• 2 cleanings per calendar year• Fillings• Extractions• Fluoride (1 time per calendar year)• Sealants (1 per tooth, per lifetime)

50% coverage after deductible for Major Services• Root Canals• Crowns• Perio• Implants (1time per 5 year period)

Up to $1200 per calendar year maximum per person

Dental Insurance Coverage

Health & Dental Insurance Premiums

Medical Teachers

Copay Plan Employee Cost Per Month

Copay Plan District Cost Per Month

HDHP Employee Cost Per Month

HDHP

District Cost Per Month

Employee $0 $756.00 $0 $629.00

Family $235.54 $1,286.46 $0 $1,266.00

Medical All Other Staff

Copay Plan Employee Cost Per Month

Copay Plan District Cost Per Month

HDHP Employee cost Per Month

HDHP

District Cost Per Month

Employee $39.00 $717.00 $0 $629.00

Family $296.80 $1,225.20 $40.80 $1,225.20

DentalEmployee Cost Per Month

District Cost Per Month

Employee $0 $34.00

Family $0 $84.00

Cost Shift and/or Birthday Rule apply

Cost Shift

Cost Shift (cont.)Adding dependents to RPS coverage: Is spouse’s birth month first in the calendar year? Yes No (there is no cost shift) Does employer (former employer for retiree) offer dependent/family coverage? Yes No (there is no cost shift) Does employer (former employer for retiree) pay any portion of the dependent/family insurance premium? Yes No (there is no cost shift)

Does the employer reimburse premiums for spouse to obtain RPS insurance? Yes No (there is no cost shift) Cost shift applies Cost shift for Health Co-Pay Plan = $766/mo. Cost shift for Health High Deductible Health Plan (HDHP) = $637/mo. Cost shift for Dental = $50

Dual Coverage is allowed.◦ RPS will be YOUR primary insurance as your active

employer◦ Birthday rule is followed for coordination of benefits &

cost shifting Dependent’s primary insurance responsibility is

determined using the birthday rule. Which ever parent’s birthday comes first in the calendar year, is primary on the children.

If you choose to decline spouse’s insurance coverage for either your spouse or your dependents against cost shifting rules, cost shift will apply

Example: Parent 1 (RPS employee) DOB is July 1st

Parent 2 (Employed elsewhere with employer contribution to insurance costs) DOB Feb 1st

Parent 2 is primary for themselves and any applicable dependents. If you choose to take Rochester Public Schools as your primary insurance for spouse/dependents, cost shift would apply.

Coordination of Benefits

All District employees are eligible to participate

You can have pre-tax dollars deducted from your paycheck to reimburse yourself for eligible health care and/or dependent daycare expenses incurred during the plan year

You can set aside up to $2496 for healthcare expenses and $4992 for dependent daycare expenses each year

If dollars are not spent they are lost Submit claim form with receipts or Explanation of

Benefits to Insurance Services and expenses will be reimbursed via ACH on the second and fourth Monday of the month (claim submission cut off is the Tuesday before)

Forms are on the District website (www.rochester.k12.mn.us)

Flexible Spending Accounts

Dependent Care Flexible Spending Reimbursement

Expenses incurred to place your dependent into care while you are working:

Dependent is defined as:

A dependent child under age 13Someone who is physically or mentally incapable of self-care who is dependent upon you for their care (spouse, elderly parent, etc.)

Eligible dependent care provider is defined as:Other than dependents parents who is over the age of 18, not a dependent of the parents and provides either a Tax ID number or Social Security number.

Annual Open Enrollment Usually two weeks near the end of October/

beginning of November for January 1 coverage.

You may enroll into the Flexible Spending Plan. Re-enrollment into the Plan is necessary each year.

If you are eligible and initially decline coverage, you may enroll in Health and/or Dental coverage.

If you are enrolled in Health and/or Dental coverage you may make changes to your initial selections.

If you are eligible and initially decline coverage, per your employment contract you will automatically be enrolled in the HDHP (single coverage) if you do not decline coverage during annual open enrollment.

Special Enrollment/Disenrollme

nt Rights No changes can be made to your health

and/or dental coverage outside initial/open enrollment selections, unless you have a qualifying life event (QLE) occur.

Possible events are:◦ Birth, adoption◦ Marriage◦ Divorce◦ Loss/gain of eligibility for and/ or coverage◦ Loss/change of employment

*please see handout for more QLEs*

HIPAA Privacy – requires written authorization to release information.

Security- All emails from our office are encrypted using ZixMail.

Notes

All premiums and flexible spending account contributions are deducted from your paycheck.

Premiums are paid one month in

advance of coverage month.

There may be a extra premium(s) taken out of your first paycheck in order to cover the first month of coverage, which depends on the date your paperwork is completed and received in Insurance Services.

Payroll Deductions