1. Insurance Services Benefits Presentation
Updated October 2013

2. Insurance Services
You may contact our office at any time with questions:
Phone:
Fax:
In Person: Maintenance Service Building
10 SE 9-1/2 St (MSB - Door 2)
Office Hours: Monday-Friday 7:45-4:15

3. Forms to Return within 30 days
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 Coverage
Life Insurance/AD&D
LTD
*If Life and LTD forms are signed after your first day of employment, then the effective date will be the date the form is signed*
To decline coverage for any of the above , fill out Employee Information and sign waiver
Return completed forms to Insurance Services at MSB directly – do not give them to your supervisor to send over

4. Life, Long Term Disability and Supplemental Disability Madison National Life
Cost share of Premiums is determined by your employment contract
There is a 30 day open enrollment period for new employees for Life & Long Term Disability
Supplemental Disability – employee can apply for
Coverage is not automatic
Must be enrolled in basic LTD
Additional Information will be requested
Coverage is at the discretion of Madison National Life
To decline coverage, sign waiver box
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

5. Madison National Life Life Insurance/Accidental Death & Dismemberment
Cost = 11¢ per $1,000 of coverage
Coverage amount is determined by your employment contract
Long Term Disability
Cost = 34 ¢ per $100 of your salary
Pays 66 2/3% of your salary, after a 90-day calendar day waiting period
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-day calendar day waiting period

6. General Health and/or Dental Plan Information
Rochester Public Schools is self-insured, meaning the premiums paid are actually paying the claims.
There is no primary care facility.
Appropriate care facilities for care are encouraged for cost containment
Insurance benefits run by calendar year.
Out of pocket expenses, deductibles, etc.
Health and Dental are separate plans.

8. Health and/or Dental Application
Reference employment contract from Human Resources and the Plan of Benefits. (For eligibility and employee portion of premium).
If you are enrolling in family coverage for Health and/or Dental, dependents age 19 and over require an additional form to be completed.
If you decline insurance coverage, you must sign and date the application form.
Cost Shift and Birthday Rule apply for family health and/or dental coverage.

10. Health 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
$110.70
$645.30
$62.90
$566.10
Family
$441.10
$1,080.90
$317.70
$948.30
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
Dental
Employee Cost Per Month
District Cost Per Month
Employee $0
$34.00
Family
$84.00
Updated 10/28/13

11. Health Reimbursement Agreement - HRA
For employees who elect to participate in the high deductible health plan, the District will make an annual contribution (in January) 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.
If the employee separates employment before the end of one year, their HRA balance will be forfeited.
*HRA eligibility is determined by your employment contract*

12. Dental Premiums
Single coverage – premium 100% paid by District per month(current rate is $34.00)
Family coverage – premium 100% paid by District per month (current rate for dependent coverage is $50.00, for a premium total of $84 per month)
Cost Shift and/or Birthday Rule apply

13. Dental Insurance Coverage
$1200 calendar year maximum per person
Individual deductible - $25 per calendar year
Family deductible - $75 per calendar year
Ortho coverage: $50 lifetime deductible –pays 50% of eligible expenses
Over 18 - $ years waiting period
Under 18 - $ year waiting period

15. Annual Open Enrollment
Usually the first two weeks in November for January 1 coverage.
You may enroll into the Flexible Spending Plan.
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.

16. Special Enrollment/Disenrollment 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
*please see handout for more QLEs*

17. Notes
HIPAA Privacy – requires written authorization to release information.
Security- All s from our office are encrypted using ZixMail.

18. Payroll Deductions
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.