New Certified Employee Benefits Booklet ( )

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1 New Certified Employee Benefits Booklet ( ) Welcome to Idaho Falls School District #91. We are pleased to add your name to the members of our staff. We urge you to always keep in mind the importance of our work. What we do literally shapes the future. We believe every employee can have a positive impact on the life of a child. We believe our employees are our most important resource. There are two major groups of full-time employees. Certified employees are those requiring a teaching certificate for their job such as a teacher, a principal, a counselor, etc. The other group is classified employees and includes custodians, paraprofessionals, child nutrition workers, transportation workers, clerical workers, maintenance workers, and so on. There can be some differences between the groups, so certified employees should refer to the Negotiated Master Contract and Board Policy, and classified employees should refer to the Classified Employee Resource Booklet and the Classified Employee Benefit Booklet for additional information. These resources are available on the district website at under Employees Human Resources or under About Us Board of Trustees. This booklet contains information on the different benefits available to full-time employees. There are sections on insurance, the flex plan, PERSI and other retirement options, leave benefits, and other miscellaneous items of interest. This booklet is intended to serve as a guide to benefits. It is not intended to serve as a comprehensive compilation of all information related to benefits. In case of a conflict, the insurance contracts and Board Policy supersede any information contained in this booklet. Insurance The Board agrees to pay the premiums for individual health insurance, dental insurance, and term life insurance for those certified employees with at least a.75 FTE contract. The district s share of premiums will be prorated based on the certified employee s FTE with a maximum benefit of 100% of the individual premium. Employees will be responsible for their share of the individual premium in addition to the cost for any dependent coverage. The premium(s) will be deducted from the employee s paycheck each month. Employees will have the option to waive any or all coverage. As a full-time employee, you will pay the cost of any coverage you elect for your dependents. You may choose to cover them on medical, but not on dental or vice versa. If you choose not to add your dependents at this time and want to add them at a later date, they may have to wait until the next open enrollment period and meet late enrollee waiting periods for preexisting conditions for medical insurance or for major or orthodontic services for Delta Dental. You may make changes to your insurance plan during open enrollment from August 15 th to September 30 th. During open enrollment, you may add or delete dependents from your insurance without a qualifying event. (A qualifying event is a birth, death, marriage, divorce, loss of employment, etc.) You may change your insurance in the middle of the plan year within 30 days of a qualifying event. You may also change from one dental plan to the other during open enrollment. The effective date for changes made during open enrollment is October 1 st. 1

2 Medical Insurance Medical insurance is provided by Blue Cross of Idaho. There are two medical plan options for The first is a traditional PPO option which will cost $12.12 per month for certified employees with a 1.00 FTE contract. The second is the Dual Option Health Savings Account (H.S.A.) PPO Plan. The district will pay the full premium for certified employees with a 1.00 FTE contract. Please be aware that all medical and prescription costs go toward deductible first with the H.S.A. plan option with the exception of approved preventive services. Both plans are preferred provider plans (PPO). By going to healthcare providers who are part of the PPO network, you can save money on your out-of-pocket medical expenses. It is very important that you become an informed user of your medical benefits. Here is a brief overview of your coverage. For more specific information, see your Blue Cross members handbook, visit the Blue Cross website at or call their toll free number at How Much is Covered? With a PPO plan, you have two different kinds of providers, in-network providers (those who have contracted with Blue Cross to be a PPO provider) and out-of-network providers (those who have not contracted with Blue Cross). After you meet your deductible, Blue Cross pays 70% of major medical related to hospital room and board, physician/surgeon, ambulance, accident, diagnostic, x-ray, and lab tests if you go to an in-network (PPO) provider. If you go to an out-of-network provider, Blue Cross pays 50% of the usual and customary charges. If the out-of-network provider charges more than the Blue Cross usual and customary charges, you would be responsible for those excess charges in addition to your 50% share of the costs. Health Care Changes Effective September 1, 2011 Preventive services will be covered at 100% with no annual maximum (see attachment). Health Care Changes Effective September 1, 2012: Generic drugs for prescribed contraceptives will be covered at 100% Name brand drugs for prescribed contraceptives are covered and apply to Blue Cross co-pays or deductibles and co-insurance Certain contraceptive devices are covered at 100% Smoking cessation drugs are covered and apply to Blue Cross co-pays Breast feeding support and supplies are covered at 100% at in-network providers. There is no longer an annual or lifetime maximum. Expanded coverage for Women s Preventive Health Services. Please see Blue Cross Contract for full listing. Health Care Changes Effective September 1, 2014: Maternity is now covered for dependent children. Please keep in mind the birth child of dependent will not be covered under contract once birth has taken place. Pre-existing conditions will now be covered regardless of late enrollee status. FLEX accounts now have $500 carry-over provision. Prescription Costs: Traditional PPO Plan Option: If you visit a retail pharmacy, you will pay 50% of the cost of the prescription. This is the Blue Cross contractual rate which may be discounted from the retail cost. Mail order prescription service for maintenance prescriptions is available through CVS Caremark. The cost is $15 per month for a generic drug, $30 per month for a formulary drug and $45 per month for a non-formulary drug. You can order a three month supply by paying three co-pays ($45 for generic, $90 for formulary and 2

3 $135 for non-formulary). The order forms are available online on the District website or at the front desk in the Administration Office. H.S.A. Plan: After meeting the $3,000 deductible you pay 30% of the allowed amount until the Out-of-Pocket maximum has been reached and then the plan pays 100%. Plan and Premiums: Traditional PPO Plan Option: Deductibles, co-insurance and stop-loss follow a calendar year - from January through December. This plan has a $3,000 individual deductible with a $6,000 family aggregate. This means that a covered family member would need to meet the $3,000 individual deductible, and any combination of family members could combine to meet the $6,000 family aggregate. After you meet your deductible, Blue Cross pays 70% of the next $5,000 for in-network coverage and 50% of the next $6,000 for out-of-network coverage. These two co-payments accumulate separately. Your out-of-pocket maximum per person is $3,000 for your deductible plus $1,500 for your in-network co-payment and $3,000 for your out-of-network co-payment for a total of $7,500. In addition, you are also responsible for excess charges for out-of-network providers. After you reach your out-of-pocket maximum, Blue Cross will pay 100%. H.S.A. Plan: Deductibles, co-insurance and stop-loss follow a calendar year - from January through December. This plan has a $3,000 individual deductible with a $6,000 family aggregate. This means that a covered family member would need to meet the $3,000 individual deductible, and any combination of family members could combine to meet the $6,000 family aggregate. After you meet your deductible, Blue Cross pays 70% of the next $9,330 for in-network coverage and 50% of the next $5600 for out-of-network coverage. These two co-payments accumulate separately. In addition, you are also responsible for excess charges for out-of-network providers. After you reach your out-of-pocket maximum, Blue Cross will pay 100%. Please be aware that all medical and prescription expenses go towards deductible first with the exception of preventive services. Blue Cross Medical Insurance Premiums For.91 to 1.00 FTE Traditional PPO H S A Option Coverage Total Cost Employee Share Total Cost Employee Share Individual $ $12.12 $ $ Party $1, $ $1, $ Family $1, $ $1, $ Party No Spouse $ $ $ $ Family No Spouse $ $ $ For.81 to.90 FTE Traditional PPO H S A Option Coverage Total Cost Employee Share Total Cost Employee Share Individual $ $63.41 $ $ Party $1, $ $1, $ Family $1, $ $1, $ Party No Spouse $ $ $ $ Family No Spouse $ $ $ $

4 For.75 to.80 FTE Traditional PPO H S A Option Coverage Total Cost Employee Share Total Cost Employee Share Individual $ $ $ $ Party $1, $ $1, $ Family $1, $ $1, $ Party No Spouse $ $ $ $ Family No Spouse $ $ $ $ Less than.75 FTE: You will not be eligible for medical insurance through the district. Dental Insurance Premiums For.91 to 1.00 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $0.00 $39.05 $ Party $69.08 $36.13 $68.90 $29.85 Family $ $73.08 $ $72.00 For.81 to.90 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $3.30 $39.05 $ Party $69.08 $39.43 $68.90 $33.76 Family $ $76.38 $ $75.91 For.75 to.80 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $6.59 $39.05 $ Party $69.08 $42.72 $68.90 $37.66 Family $ $79.67 $ $79.81 Less than.75 FTE: You will not be eligible for medical insurance through the district. Special Medical Insurance Premium Considerations: If your spouse works for the district: If both husband and wife work full-time for the district and elect family coverage, the district subtracts two district shares from the total family cost to calculate the employee s cost. Here is a brief description of the Blue Cross of Idaho PPO medical insurance plan: Blue Cross Medical Insurance Plan Outlines There is also a service that allows you to talk to a Registered Nurse any time, day or night, to help you make informed decisions about your family s health. The Nurse Advice Line can be reached 24 hours a day, 7 days a week at

5 TRADITIONAL PPO PLAN OPTION Idaho Falls School District 91 Benefit Highlights- TRADITIONAL PPO PLAN OPTION Medical Benefits In-Network Out-of Network Individual & Family Aggregate Deductible $3,000 individual & $6,000 Family Aggregate Coinsurance 70% 50% Out-of-Pocket Excludes deductible. $1,500 $3,000 (Excludes drugs, dental services, charges in excess of the maximum allowance and non-covered services.) Immunizations 100% 100% Physician Office Visit Primary Care (See Dual Option Co-Pay) $30 co-payment 50% after deductible Physician Office Visit Specialist (See Dual Option Co-Pay) $60 co-payment 50% after deductible Maternity 70% after deductible 50% after deductible Physician Services (Hospital, surgery, anesthesia, etc.) 70% after deductible 50% after deductible Hospital Services (Inpatient, outpatient, diagnostic, etc.) 70% after deductible 50% after deductible Laboratory/x-ray ** 70% after deductible 50% after deductible Ambulance 70% after deductible 50% after deductible Inpatient Physical Rehabilitation 70% after deductible No benefits Idaho Falls School District 91 Benefit Highlights (continued) Medical Benefits In-Network Out-of Network Chiropractic Care (Up to $800 per insured per calendar year) 70 % after deductible 50% after deductible Mental Health Outpatient Psychotherapy Services Mental Health Psychiatric Services $30 co-pay 70 % after deductible 50% after deductible 50% after deductible Prescription Drugs Retail (30 day supply) Same as in-network PLUS amounts over allowance. Generic Brand Name 50% of the cost 50% of the cost Mail Order (30 day supply) Generic Formulary Non-formulary $15 co-pay $30 co-pay $45 co-pay Annual Benefit Limit Unlimited as of 9/1/2012 Dependent Care Coverage (Up to age 26, regardless of marital, financial or education status) Preventive Care Benefits (see included list of covered services) 100% 50% Contraceptives Generic prescription drugs Name Brand prescription drugs Certain contraceptive devices No benefits 100% Covered but co-pays apply 100% Breast Feeding Support and Supplies 100% Not covered Smoking Cessation Drugs Covered but co-insurance applies Out-of-Network Services include services from a provider not contracting with Blue Cross Preferred Blue PPO. You will be responsible for payment of the annual deductible and your designated percentage of the balance. If you choose a non-contracting or out-of-state provider, you may also be responsible for payment of any charges exceeding the Blue Cross pre-established maximum allowance. Many out-of-state providers are PPO providers. Call or visit the Blue Cross website at to find the PPO providers in your area. 5

6 TRADITIONAL PPO PLAN OPTION (continued) **For In-Network Services, Outpatient Diagnostic Covered Services (x-rays, lab tests, etc.) shall be paid at 100% of the Maximum Allowance up to $100 per insured per calendar year; thereafter services are subject to deductible and coinsurance. Out-of-Network Services are subject to deductible and coinsurance. The summary describes the general features of this program; it is not a contract. All provisions of the Group Master Policy apply to this program. Dual Option Co-Pay Listing for the Traditional PPO Plan Primary Care Providers Emergency Medicine Family Practice Family Practice Geriatric Medicine Family Practice Sports Medicine General Practice Geriatrics Gynecology Internal Medicine Manipulative Therapy (DO) Maternal and Fetal Medicine OB Gynecology Occupational Medicine Pediatrics Pediatric Emergency Medicine Preventative Medicine Public Health & Preventive Medicine Urgent Care Center Specialist Providers Allergy Anatomic Pathology Anesthesiology Cardiovascular Disease Child Psychiatry Dermatology Ear, Nose and Throat Gastroenterology Hematology Neonatology Nephrology Neurology Oncology Orthopedic Pathology Podiatry Psychiatry Pulmonary Radiology Urology *Please note that if you see a Primary Care Physician that also practices as specialist provider you will be charged the higher co-pay. Also, if you utilize an Urgent Care Facility that has a Specialist on call at the time of visit, the Specialist Co-pay will apply. 6

7 H S A PPO PLAN OPTION Idaho Falls School District 91 Benefit Highlights- Medical Benefits In-Network Out-of Network Individual & Family Aggregate Deductible $3,000 individual & $6,000 Family Aggregate Coinsurance 70% 50% Out-of-Pocket Excludes deductible. $2,800 $2,800 (Excludes dental services, charges in excess of the maximum allowance and non-covered services.) Preventative Immunizations 100% 100% Physician Office Visit Primary Care (See Dual Option Co-Pay) 70% after deductible 50% after deductible Physician Office Visit Specialist (See Dual Option Co-Pay) 70% after deductible 50% after deductible Maternity 70% after deductible 50% after deductible Physician Services (Hospital, surgery, anesthesia, etc.) 70% after deductible 50% after deductible Hospital Services (Inpatient, outpatient, diagnostic, etc.) 70% after deductible 50% after deductible Laboratory/x-ray 70% after deductible 50% after deductible Ambulance 70% after deductible 50% after deductible Inpatient Physical Rehabilitation 70% after deductible No benefits Idaho Falls School District 91 Benefit Highlights (continued) Medical Benefits In-Network Out-of Network Chiropractic Care (Up to $800 per insured per calendar year) 70 % after deductible 50% after deductible Mental Health Outpatient Psychotherapy Services Mental Health Psychiatric Services 70 % after deductible 70 % after deductible 50% after deductible 50% after deductible Prescription Drugs Retail (30 day supply) Generic Brand Name Mail Order (30 day supply) Generic Formulary 70% after the deductible Same as in-network PLUS amounts over allowance. No benefits Non-formulary Annual Benefit Limit Unlimited as of 9/1/2012 Dependent Care Coverage (Up to age 26, regardless of marital, financial or education status) Preventive Care Benefits (see included list of covered services) 100% 50% Contraceptives Generic prescription drugs Name Brand prescription drugs Certain contraceptive devices 100% Covered but co-pays apply 100% Breast Feeding Support and Supplies 100% Not covered Smoking Cessation Drugs Covered but co-pays apply The summary describes the general features of this program; it is not a contract. All provisions of the Group Master Policy apply to this program. 7

8 Dental Insurance There are two different dental plans Delta Dental and Willamette Dental. Delta Dental is a Preferred Provider (PPO) dental plan, and Willamette is a dental HMO. With Willamette, you must use the dentists at a Willamette Office. Delta Dental Delta Dental Benefits Summary (Group 2597) BENEFITS PPO Network Premier Premier Network/Non-Par Annual Maximum * $1,000 $1,000 Individual Deductible * $50 $50 Family Deductible * $150 $150 *The annual maximums and deductibles are determined each calendar year, from January 1st through December 31st. Preventive & Diagnostic Services Delta Dental Pays Delta Dental Pays (No Deductible Required for PPO Network) Routine and Emergency Exams 100% 70% All X-rays 100% 70% Teeth Cleaning 100% 70% Basic Services Delta Dental Pays Delta Dental Pays Fillings 70% 50% Periodontal Cleaning 70% 50% Root Canals 70% 50% Minor Oral Surgery 70% 50% Major Services Delta Dental Pays Delta Dental Pays Crown Buildup 40% 30% Crowns 40% 30% Bridges 40% 30% Dentures 40% 30% Implants 40% 30% Implants are a covered benefit per tooth with a maximum lifetime benefit of $900 (including crown) applied to the annual individual maximum benefit. Orthodontia Delta Dental Pays Delta Dental Pays Adult & Child Coverage 50% 50% Lifetime Maximum $1,000 $1,000 IMPORTANT - Late Enrollee Notice! Any employee and/or dependent(s) that did not enroll in the dental plan during their initial open enrollment will have a 24-month waiting period for major, implant and orthodontia services. Using a PPO or Premier Dentist Saves You Money With Delta Dental you can choose to visit any licensed dentist. When you visit a Delta Dental PPO network dentist, you will receive the highest level of benefits and the lowest out-of-pocket costs. If you choose to visit a Delta Dental Premier network dentist, you will pay a higher cost than a PPO dentist but still save money because Delta Dental innetwork dentists agree to lower fees and cannot charge you more than the contracted amount, also referred to as balance-billing. If you receive care from a non-participating dentist, benefits are provided but you are not protected from balance-billing and will be responsible for any charges above Delta Dental s allowed amount. When scheduling a dental visit, ask whether your dentist is a Delta Dental PPO or Premier dentist. 8

9 Delta Dental Benefits Summary (Group 2597), continued Find a Dentist Visit Delta Dental s website, and select Find a Dentist for the most up-to-date list of Delta Dental Premier or PPO dentists in Idaho or across the country. For a complete list of participating dentists in your area, just enter PPO or Premier plan, the city, or the dentist name or specialty. This is only a general summary of benefits and does not constitute a contract or guarantee of payment. Full terms and conditions are set forth in a contract between your employer and Delta Dental of Idaho, which is on file with your employer. There is a $1,000 annual maximum per member for Preventive, Basic, and Major Services. The maximum and deductible are figured over a calendar year and will reset on January 1 st. Willamette Dental Willamette Dental has a different way of providing dental services. Be sure to review the Willamette booklet included in your packet before enrolling. Willamette is an HMO Plan with no annual maximum. You must use the dentists in the Willamette Office. There are no deductibles or annual maximum. You will be charged a $20 office visit co-pay each time you go to the dentist. Willamette Dental Benefits Summary The following items are covered at 100% after paying the office visit co-pay: Routine and Emergency Exams All X-rays Teeth Cleaning Fluoride Treatment Sealants Head and Neck Cancer Screening Oral Hygiene Instruction Periodontal Charting Periodontal Evaluation Fillings Dental Lab Fees Routine Extraction Single Tooth Local Anesthesia (Novocain) The following items have additional co-pays: Permanent Crowns - $150 Complete Upper or Lower Denture - $250 Bridge - $150 per tooth Root Canal Therapy anterior - $50 Root Canal Therapy bicuspid - $75 Root Canal Therapy molar - $100 Osseous Surgery per quadrant - $100 Root Planing per quadrant - $50 Surgical Extraction - $50 Nitrous Oxide (per visit) - $20 Emergency Office Visit - $50 Missed Appointment & Cancellation Fee - $30 Out of Area Emergency Care Reimbursement up to $100 Orthodontic Treatment - for both children and adults with a $20 office visit co-pay for each visit. $150 Pre-Orthodontia Service* $2,200 Comprehensive Orthodontia *The $150 pre-orthodontia fee is credited toward the comprehensive orthodontia co-payment if patient accepts the treatment plan. 9

10 Dental Insurance Premiums For.91 to 1.00 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $0.00 $39.05 $ Party $69.08 $36.13 $68.90 $29.85 Family $ $73.08 $ $72.00 For.81 to.90 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $3.30 $39.05 $ Party $69.08 $39.43 $68.90 $33.76 Family $ $76.38 $ $75.91 For.75 to.80 FTE Delta Dental Willamette Dental Coverage Total Cost Employee Share Total Cost Employee Share Individual $32.95 $6.59 $39.05 $ Party $69.08 $42.72 $68.90 $37.66 Family $ $79.67 $ $79.81 Less than.75 FTE: You will not be eligible for dental insurance through the district. Special Considerations: If your spouse works for the district: If both husband and wife work full-time for the district and elect family coverage, the district subtracts two district shares from the total family cost to calculate the employee s cost. Life Insurance The district provides $50,000 of term life insurance coverage through LifeMap (formerly called Regence Life) for each full-time employee on a prorated basis up to age 70 with reduced benefits for active employees who are 70 or older. Prorated Life Insurance Table FTE From To District Employee Share $4.00 $ $4.50 $ $5.00 $0.00 Less than.75 FTE: You will not be eligible for life insurance through the district. 10

11 Life Insurance (continued) You may also purchase dependent life insurance from LifeMap (Regence) for your dependents at a cost of $2.05 per month for your family. This will provide $10,000 of coverage on your spouse and $5,000 for each dependent child under age 26. You must check the box on the top of the Regence form to enroll in dependent coverage. Optional life insurance is also available for yourself, your spouse, and your dependents through LifeMap (Regence). The optional life has a guarantee issue amount of $200,000 for you and $50,000 for your spouse available at initial enrollment. If you want to request a larger amount of coverage, you must medically qualify for it. Coverage will not be effective until approved by LifeMap (Regence). The rates for optional life are determined by your age. To add optional life insurance coverage for your dependents, you must increase your coverage amount. Voluntary Life coverage for your dependent children is available at $.63 per $5,000 up to $10,000 maximum. Optional Life Insurance Premiums Uni-Smoker, Unisex Rates (cost per $1,000 of coverage) Ages Monthly Rate per $1,000 of Benefit Under 30 $ $ $ $ $ $ $ $ $ $ $ $4.30 Child Optional Life (birth to age 26): $5,000 Monthly Cost: $0.63 Child Optional Life (birth to age 26): $10,000 Monthly Cost: $1.26 Optional Life Open Enrollment The employee may increase his/her existing Optional Life benefit one level ($10,000) at open enrollment without submitting evidence of insurability. This is available for one level increase only. The employee may increase the spouse amount at this time; however, the spouse amount may not be increased more than $10,000 without evidence of insurability. Satisfactory evidence of insurability is required for those employees and spouses not initially enrolled, for those insured previously declined for coverage or declined for an increase in coverage, and for an increase other than the one time one level increase. Vision Insurance You may purchase vision insurance through Avesis which is sponsored by Delta Dental. This is voluntary coverage, and you will be responsible for the full premium. Please review the Avesis packet (located in your Delta Dental benefits booklet) for coverage information. 11

12 Avesis Vision Insurance Premiums Coverage Type Monthly Premium Employee Only $10.48 Employee + Spouse $19.80 Employee + Child(ren) $21.58 Employee + Family $27.76 Cafeteria Plan - Flexible Spending Accounts Idaho Falls School District 91 is making available a valuable benefit that will reduce your taxes and increase your spendable income. This plan, which is approved by the Internal Revenue Service, is called a Section 125 Flexible Compensation Benefit or the Flex Plan, as it is more commonly known. It can save you up to 30% on your out-of-pocket medical, dental, vision, hearing and dependent care costs - depending on your tax bracket. You will meet with an American Fidelity representative to review the flex plan and enroll (if you choose) after your District 91 Human Resources appointment. Wages may be sheltered from social security, federal and state income taxes to pay for certain insurance premiums and qualifying out-of-pocket healthcare and/or dependent care expenses. Medical insurance, dental insurance, and certain supplemental insurance premiums can be deducted from your check before taxes are calculated. When you receive your W-2, this amount is not included in your taxable income. Be sure to meet with American Fidelity and complete the required form to take advantage of this valuable benefit. The flex plan is for qualifying out-of-pocket medical, dental, vision, hearing, and/or dependent care expenses. You project your annual expenses and make an election of the amount to be deducted from your check for the flex plan. Your election amount is divided by the months remaining in the plan year. You pay for the expense and then file for reimbursement. The MasterCard Debit Card is also available with the Flex Plan. The MasterCard Debit Card allows you to pay for some expenses using your card. The amount of the expense will automatically be deducted from your account. You may be required to submit documentation for these expenses, so be sure to save your receipts and explanations of benefits. There are some stipulations with the card, so be sure to discuss the MasterCard Debit Card with the American Fidelity Representative. Full-time employees are eligible to participate in the District s flexible reimbursement program (SEC 125). Employees who wish to participate in this program must enroll each year before September 1 st. New employees may enroll when hired for the remainder of the plan year beginning on the first of the month following enrollment. PERSI For more information on PERSI, please visit their website at Public Employee Retirement System of Idaho or PERSI is the state retirement system and is mandatory for all full-time employees. Contributions will be withheld from your paycheck at a rate of 6.79% of your gross wages for the PERSI Base Plan which is a 401(a) defined benefit plan. To become vested in PERSI, you must have 5 years - 60 months - of creditable service. After you are vested, you will be eligible to receive a retirement benefit from PERSI when you reach retirement age. If you terminate your employment, you are entitled to the money that you have paid into PERSI plus any interest it has earned. You can roll it over into an IRA or other qualified retirement plan. You can also receive a direct payment from PERSI minus 20% withholding, and you may have to pay an additional 10% tax. 12

13 PERSI Choice Plan PERSI also has a voluntary 401(k) option called the PERSI Choice Plan. You may make voluntary pre-tax contributions to the Choice Plan. There are various investment options. This money is in addition to your regular PERSI Base Plan account. Call PERSI at (800) for more information. 403(b) Retirement Plans You are eligible to make contributions through payroll deduction for various qualified 403(b) plans. These voluntary contributions are deducted before taxes are calculated and are subject to the IRS rules on maximum contributions. A list of companies who have qualified for payroll deduction is available on the district website under Employees HR Benefits Retirement/PERSI or at the Administration Office. Roth 401(k) Retirement Plan You also have the choice of making after tax contributions to a Roth 401(k) retirement plan. The contributions are made after taxes are calculated, and the interest and earnings accrue tax free. Leave Benefits Leave benefits are available to full-time employees only and are awarded at the time of employment except for vacation which accrues monthly. Leave for employees who start after the beginning of the employment year will be prorated. Classified Employees Use of Leave During the initial 90-day review period, a new classified employee may only take paid leave for personal illness or a death in his/her immediate family. Sick Leave Sick leave may be used for absences caused by personal or immediate family illness, accident, injury, preventive treatment, or health assessment. Unused sick leave accumulates from year to year with no maximum cap. The number of days of sick leave awarded depends on the number of days you are scheduled to work. Number of Scheduled Sick Leave Days Employment Days Sick Leave Days * *Employee must work the entire employment year to be eligible for the days of sick leave as listed. The sick leave will be prorated for employees who start after the beginning of the employment year. 13

14 Unused sick leave has a benefit at retirement. Upon retirement with PERSI, the number of available sick leave days is multiplied by your daily rate, and then this number is multiplied by 0.5. The result is your sick leave entitlement benefit amount that can be used to pay for insurance during retirement. No other payments are made for sick leave upon termination of employment. Sick Leave Bank The sick leave bank is a bank of sick leave days contributed by the members of the bank. If you are a sick leave bank member who has a major illness and has used all of your sick leave and other appropriate leave, you may apply for a grant of sick leave days from the bank. This enables you to continue to receive a paycheck during the time you are unable to work. There are two sick leave banks a certified bank and a classified bank. Certified staff must have nine days of accumulated sick leave to join. New certified staff members are automatically enrolled and donate three days of sick leave unless they sign a waiver to opt out of the bank. To be eligible to join the Classified Sick Leave Bank, classified employees must have worked for the district for one full year and have twelve days of accumulated sick leave. They may apply for membership during open enrollment from August 15 th to September 30 th. Classified employees must go without pay for four days before receiving a grant from the bank. Personal Leave Personal leave is available for personal reasons. As a full-time employee, you will receive three days of personal leave at the beginning of your employment year, and you can accumulate up to a maximum of seven days of personal leave. At the end of your employment year, you will be reimbursed for any personal leave over the four days you can carry over to the next year. If you are a certified employee, you shall be reimbursed at the substitute teacher rate, and if you are a classified employee, you shall be reimbursed at the hourly rate of $6.25 for those hours over the equivalent of four days of personal leave at the end of the school or employment year. Upon separation of employment from the district, employees will be reimbursed for all unused personnel leave as listed above. Employees who have used their available personal leave may purchase two (2) additional personal leave day through a salary reduction of the current substitute pay per day. Use of more than the equivalent of four consecutive days of personal leave is contingent on approval of the building principal or direct supervisor and substitute availability. Death in the Immediate Family As a full-time employee, you will be eligible for up to three days of paid leave per occurrence for a death in your immediate family. Leave will be granted to attend the funeral and for travel to and from the funeral. Additional days may be granted upon written request to the Superintendent when circumstances require a lengthier absence. In the event of death in other than the immediate family where extenuating circumstances exist, a request should be directed to the Superintendent and said request will thereafter be considered.. The term immediate family is defined as your father, mother, spouse, child, sister, brother, father-in-law, mother-in-law, sister-in-law, brother-in-law, son-in-law, daughter-in-law, grandparent and grandchild. Vacation Full-time employees who are assigned to work in excess of two hundred forty days per employment year are eligible to accumulate vacation each month. New employees accumulate vacation at a rate of.8333 days per 14

15 month. The rate increases with years of service. Vacation requests must be made in advance to the immediate supervisor. Holidays Full-time employees will be eligible for paid holidays based on the number of days they are scheduled to work. Number of Paid Holidays Employment Days Sick Leave Days Payday Miscellaneous Information Payday is scheduled for the 20th of each month. Your paycheck will be sent to your building during the school year and mailed to your home as needed during the months you are not scheduled to work. It is your responsibility to ensure the Payroll Department has your correct address. Direct deposit information may be viewed on Skyward Employee Access under Check History. There is a link to Skyward on the district website at Direct Deposit Your check can be automatically deposited at the financial institution of your choice. Your money should be available to you on payday. You may enroll in direct deposit or change your information as needed. Income Protection, Cancer Insurance, Intensive Care Insurance, etc Supplemental insurances are not provided by the district. If you are interested, you may purchase this additional coverage through payroll deduction from American Family Life (AFLAC), American Fidelity, or Capital American. You must enroll during the open enrollment period from August 15 th to September 30 th. Company representatives visit schools at the beginning of the school year. Long Term Care Insurance A group long-term care insurance plan is available through John Hancock. If you are interested, you may contact the agents at You must enroll during the open enrollment period from August 15 th to September 30 th. United Way Every fall, the district participates in a United Way drive. You may make a lump sum contribution or you may contribute through payroll deduction. Participation is voluntary. 15

16 Wellness Program The district provides a wellness program for its employees. The district sponsors discounted health screenings and flu shots. Both you and your spouse are eligible to participate. You may also receive short Wellness Minute s with information on exercise, nutrition, diseases, etc. as well as links to more information for those who are interested. The Wellness Committee will also sponsor several activities during the year. Watch your or talk to your building wellness representative for more information. Welcome once again to the district. We hope you will enjoy your time here. 16

17 Detailed Instructions for Forms As a full-time employee for District 91, you should have already filled out the following forms electronically via Applitrack. If you are missing one of these forms, please fill it out through your Applitrack account as soon as possible. Electronic Forms CERTIFIED Applitrack Forms W-4 I-9 (except identification check) 403(b) Notice of Eligibility Certified Sick Leave Bank Waiver (optional) Certified Work Calendar Direct Deposit Authorization Emergency Contact Form HIPAA Notice Late Enrollee Insurance Notice Policy Packet Race and Ethnicity Form Release of Information on Past Job Performance Technology Use Notification Useful Information for New Hires CLASSIFIED Applitrack Forms W-4 I-9 (except identification check) 403(b) Notice of Eligibility Classified Employee Handbook Classified Work Calendar Direct Deposit Authorization Emergency Contact Form HIPAA Notice Late Enrollee Insurance Notice Policy Packet Race and Ethnicity Form Release of Information on Past Job Performance Technology Use Notification Useful Information for New Hires This section reviews the different forms in your packet and gives basic information on how to complete them. There is a check-off sheet to help ensure that all forms have been completed. Forms Included in your Packet Form I-9 Employment Eligibility Verification You should have already filled the first portion of this form out electronically. Be sure to bring the correct forms of documentation with you (see back of checklist) when you return your completed packet to Human Resources. See the back of the checklist for acceptable forms of identification. Blue Cross Medical Enrollment Form If it is not filled in already, the group number is Check the PPO box or the HSA box if you are opting for the economy option. Complete the applicant information section. The full-time hire date is the date you begin working in a full-time position. The employer s name is Idaho Falls School District 91. Complete the family member information section. List any eligible family members that you would like to enroll in medical insurance. The next section deals with prior or other current coverage. Be sure to provide the requested information. The next section deals with disability information. If you are requesting coverage for an adult child with a disability, additional documentation will be required. Be sure to request this form when you return the packet. On the back of the form, mark the type of enrollment. Do not complete the Change Request section. Be sure to sign and date the form. 17

18 Delta Dental (Complete this form only if you choose Delta Dental for your dental coverage) Mark Enrollment Form at the top. Complete the Employee Information section. List your social security number as the subscriber number. You will receive a Delta subscriber number when you receive your Delta ID card. Idaho Falls School District 91 is the employer name. Complete the Dependent Information section with the information for any dependents who you would like to cover. Complete the other dental coverage section. Do not complete the Change Request section. Be sure to sign and date the form. Willamette Dental (Complete this form only if you choose Willamette for your dental coverage) To complete the Willamette Dental form, mark new application at the top of the form. Complete the requested information. Refer to your check-off sheet for the effective date. The plan name is Z805. Idaho Falls School District 91 is the employer, and the district s address is 690 John Adams Parkway, Idaho Falls, ID Indicate whether you are enrolling yourself or yourself and dependents. List the requested information for any dependents you wish to enroll. Complete the other dental plan information and sign and date the bottom of the form. Life Map Insurance Enrollment Form Complete the personal information as requested. The group number is ID The form asks if you have dependents. Check the appropriate box. If you mark yes, you are then asked if you wish to enroll in dependent life coverage. Dependent life coverage provides $10,000 of coverage for your spouse and $5,000 for each dependent child under age 26 at a cost of $2.05 per month. Indicate if you would like to enroll in dependent life insurance. Indicate if you would like to enroll in life insurance by marking the appropriate box. Next, designate your beneficiary(ies) for your life insurance and sign and date the form. Instructions on how to designate a beneficiary are included on page 2. Life Map Life Insurance Enrollment Form (This is an optional form used to apply for additional life insurance only.) Complete Part 1 with the requested personal information. In the next three sections, indicate the amount of voluntary life for which you are applying for yourself, your spouse, and/or your children. Be sure to print your name and sign and date the form at the bottom of page 2. If you are applying for additional life insurance for your spouse, be sure to have your spouse sign in the appropriate spot at the bottom of page 2. Complete Part 2 if you are applying for coverage in an amount over the Guarantee Issue amount of $200,000 for you or $50,000 for your spouse. If you are required to complete Part 2, print your name and sign and date the form at the bottom of page 4. 18

19 Avesis Vision Insurance Enrollment Form (Provided through Delta Dental) (This is an optional form used to apply for vision insurance only.) Complete the personal information at the top of the form. Indicate if you would like to cover your eligible dependents and list the dependents you wish to enroll. Sign and date the bottom of the form. PERSI Beneficiary Designation This form allows you to designate beneficiaries to receive the funds in the PERSI Base Plan and, if applicable, Choice Plan accounts. Complete the personal information at the top. Review pages three and four for more information on designating your beneficiary (ies). Complete the beneficiary section on page one and if applicable, complete the Custodian Nominations for Minor Beneficiaries information on page two. Be sure to sign and date the bottom of page one. American Fidelity Benefit Overview This booklet contains information about American Fidelity Section 125 / Flexible Spending Account plan and includes contact information for the local representative. Please review the booklet to determine if one of these plans is right for you. You will complete the appropriate forms with the American Fidelity representative after your initial appointment with Human Resources. 19

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