All Employees Separating from Prince William County Schools. Exit Interview and Procedures for Separation and Conversion of Employee Benefits

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1 TO: FROM: SUBJECT: All Employees Separating from Prince William County Schools Department of Human Resources Exit Interview and Procedures for Separation and Conversion of Employee Benefits You have received this package from the Prince William County Schools Department of Human Resources because we were notified of your separation. Please read this packet thoroughly and respond to those items which apply to you. Please read the following carefully: Direct Deposit: Your current direct deposit will remain in effect through your last paycheck. Pay statements will be mailed to you. It will be necessary to notify the Payroll Office, in writing, of any change to your direct deposit account. Call for forms and information. Exit Survey: We would like for you to take a few moments to complete an exit survey located on the Prince William county Schools Web site 1) Click on the EMPLOYMENT tab at the top menu, then, 2) Click on the "Current Employee Information" Link located on the left side menu 3) Then, select "Exit Information" and "Exit Survey." Enter PWCSEXIT for the password to complete the Exit Interview Survey. We appreciate your participation and hope that you will assist us in our efforts to provide leadership and support for excellence and equity in education. If you have any questions or concerns, please contact Darlene Faltz at Contact Information: If you have any questions regarding any of the forms or information contained in this packet, please see the following page for contact information. Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 1

2 Summary of Contents Form/Information Page Department Contact Phone Number Change of Address 3 Compensation Office Teachers & Administrators Classified I.D. Badge Reminder 4 Risk Mgmt. & Security Insurance Office of Benefits Insurances & Other PWCS Benefits COBRA Group Life Leaves Time and Leave Office Sick 8 Annual 9 Retirement Office of Benefits Supplemental Retirement Virginia Retirement System Place employee badge in the enclosed postage paid envelope and return all completed forms to: Prince William County Public Schools Attention: Benefits P.O. Box 389 Manassas, VA Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 2

3 CHANGE OF NAME AND/OR ADDRESS FORM Please type or print the information CHECK ONE: Classified Teacher/Admin NAME: SOCIAL SECURITY # WORK LOCATION: NAME CHANGE: Please note, to process a name change, additional documentation such as a copy of a Marriage Certificate or court document must be provided. FROM: Last First Middle TO: Last First Middle CHANGE OF ADDRESS: FROM: Street Address City State Zip Code TO: Street Address City State Zip Code CHANGE OF PHONE NUMBER: FROM: Area Code Phone Number TO: Area Code Phone Number EFFECTIVE DATE OF CHANGE(S) LISTED ABOVE: SIGNATURE: DATE: Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 3

4 I.D. Badge Reminder If you have not turned in your badge to the Risk Management and Security Office, place it in the selfaddressed, postage-paid, envelope provided. Thank you. Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 4

5 Insurances and other PWCS Benefits If you separate employment with the Prince William County Schools during the plan year, your right to various benefits will be determined in the following manner: Dependent Care Flex Benefit: After your separation, your participation will cease and no further salary contributions will be contributed to your account. You will still be able to request reimbursement for qualifying dependent care expenses for the remainder of the plan year from the balance remaining in your dependent care account at the time of your separation of employment. Health Care Flex Benefit: Your participation will cease after your separation and no further salary contributions will be made to your account. You will be able to submit claims for reimbursement of health care expenses incurred prior to your date of separation. Insurance(s): You will remain covered by insurance, but only for the period for which premiums have been paid. This includes: Anthem BC/BS Delta Dental Premier Delta Dental EPN Vision Service Plan (VSP) Standard Long Term Disability Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 5

6 COBRA Guidelines for Continued Group Health Insurance Coverage Individuals separating from the Prince William County School System are no longer eligible for employer paid contributions toward group health care coverage. However, the option to continue coverage in the group health plan is available to employees leaving the system provided the employee is not covered by another health care plan or eligible for Medicare. If this option is selected, the employee must pay the total cost of participation in the group health care plan. Eligible employees and dependents have a maximum of 60 calendar days from the date of a qualifying event (see below) to notify the employer that continuing coverage is desired. The cost for this continued health insurance coverage is 102% of the school division group rate. Payment will be retroactive to the date regular coverage ceased. If the decision to enroll is not made until the end of the 60-day period, the first payment will be for two months of coverage. QUALIFYING EVENTS Employees and enrolled family members may continue coverage for 18 months if they: Are laid-off or discharged (except for gross misconduct). Leave work voluntarily for any reason. The 18 months may be extended to 29 months if an individual is determined to be disabled (for Social Security disability purposes) and the Benefits Office is notified of that determination within 60 days. Eligibility for continued coverage ends when any one of the following events occurs: The participant becomes eligible for Medicare. The participant enrolls in another health care program. The participant does not make monthly payments in the manner prescribed. Group health care coverage is no longer available to active employees The period of eligibility for continued group health care coverage expires (18 months or 36 months). The participant extended coverage for up to 29 months due to disability and there has been a final determination that the participant is no longer disabled. It is the employee s responsibility to notify the Benefits Office immediately of any change in eligibility. If insured, a COBRA quote and application will be issued to your home address. You have 60 days from the date your insurance coverage ends to notify the Office of Benefits that continued coverage is desired. If you have any questions about COBRA, please call Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 6

7 Important Life Insurance Information How to keep your life insurance going even if your group coverage ends. You may continue your life insurance protection that has been provided to you as a PWCS employee by taking out an individual life insurance policy. This is called a conversion and your right do so is called a conversion privilege. In order to exercise your conversion privilege, you must - within 31 days after your group insurance ends - submit the completed conversion enrollment form and the first premium payment to Minnesota Life. The conversion packet is located at varetire.org, click on Forms, go to Minnesota Life/VRS Life Insurance Forms Page, and select Conversion Brochure or contact the Office of Benefits & Retirement Services at For more information about your conversion privilege, contact Minnesota Life at Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 7

8 Disposition of Accumulated Sick Leave (Return this form to the Time and Leave Office) (Please Print) Employee Name: Social Security No: Current Home Address: Street Address City State Zip Code Work Location: Work Phone: Date of Last Working Date: Employee Type: Type of Separation: Classified Teacher Administrative Eligible employees separating employment with the Prince William County School System must select one of the options listed below within sixty (60) days of separation or all rights to accrued, unused sick leave will be relinquished. Sick leave will be prorated for final pay purposes and any sick leave days (as represented in hours and minutes) used in excess for those hours earned shall be deducted from the employee s final pay check. Eligible employees may be compensated for accrued, unused, sick leave at 10% of their daily rate of pay at the time of separation within the limitations of School Board regulations. 1. Receive one lump-sum payment for sick leave accumulated in Prince William County Public Schools. Payment is subject to the limitations of the School Board regulations 2. Transfer all accumulated sick leave to another school division. If no such transfer has occurred within one year from the date of separation, this option will be forfeited. 3. Transfer days of sick leave and be paid for days of sick leave. Name/Address of Receiving Employer: Signature: Employee Signature: Approval of School Board Representative Date: Date: Accumulated sick leave hours eligible for transfer and/or payment Daily Rate of Pay $ Daily Rate $ X Eligible Days = Total Amt Due $ Date of Disbursement: Date of Transfer: # Days Processed by: Date: Rev. 9/13

9 Disposition of Accumulated Annual Leave (Return this form to the Time and Leave Office) (Please Print) Employee Name: Social Security No: Current Home Address: Street Address City State Zip Code Work Location: Work Phone: Date of Last Working Date: Employee Type: Type of Separation: Classified Administrative Eligible employees terminating/retiring with the Prince William County School System shall be paid for the unused portion of their annual leave at their per diem rate at the time of separation. Annual leave will be prorated for final pay purposes and any annual leave days (as represented in hours and minutes) used in excess of those hours earned shall be deducted from the employee s final pay check. Eligible employees may be compensated for accrued, unused, leave at their hourly rate of pay at the time of separation within the limitations of School Board regulations. Receive one lump-sum payment for annual leave accumulated in Prince William County. Payment is subject to the limitations of the School Board regulations. Signature: Employee Signature: Approval of School Board Representative Date: Date: Accumulated annual leave hours eligible for transfer and/or payment Daily Rate $ X Eligible Days = Total Amt Due $ Date of Disbursement: Processed by: Date: Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 9

10 Supplemental Retirement Plan 403(b)/457 Employees who separated employment with Prince William County Schools (PWCS) and participated in a Supplemental Retirement Plan have the following options regarding the funds in their Supplemental Retirement Account(s). Participants who have an account balance over $5,000 may: o Leave the funds in existing account(s). Employees may decide, at a later date, to take a distribution or rollover. o Rollover the funds to a similar plan. o Cash out the funds (taxes and fees may apply). Participants with an account balance between $1,000 and $5,000 may: o Request a cash distribution within 90 days (taxes and fees may apply). o Rollover funds to a similar plan within 90 days. o Those who do not request a distribution/rollover within 90 days will automatically have their funds rolled over into a Lincoln IRA. This IRA will earn 3.75% interest the first year, and 3.6% for all remaining years. A $30 annual fee is assessed on a quarterly basis ($7.50 per quarter).* Participants who have an account balance less than $1,000 may: o Request a cash distribution within 90 days (taxes and fees may apply). o Rollover the funds to a similar plan within 90 days. o Those who do not request a distribution/rollover within 90 days will automatically have their funds dispersed to them. The employee will be responsible for taxes and any applicable fees.* * Lincoln reserves the right to process force-outs anytime after the 90 day period has been satisfied. Employees are always 100% vested. Employee and employer matching contributions may be withdrawn or rolled over following the date of separation. You may contact Lincoln Financial at the number below or via web at to request balance information and appropriate up-to-date forms. Employees who would like to exercise an option are encouraged to contact the applicable company representative(s): Lincoln Alliance AIG/Valic Great-West ING (Aetna) Lincoln Life Any additional questions may be forwarded to the Office of Benefits at , or via Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 10

11 Retirement Virginia System (VRS) Refunds The General Assembly adopted several benefit plan changes for current and future VRS members during the 2010 session. Effective July 1, 2010, VRS members are identified as either enrolled in Plan 1 or Plan 2. Members hired prior to July 1, 2010 are in Plan 1. Members hired on or after July 1, 2010 are in Plan 2. Legislation was also adopted that affects refunds to VRS members. Members must be vested (have at least five years of service credit) to receive a full refund of their member contribution account balance. Taking a refund cancels membership and eligibility for any future VRS benefits including retirement. Plan 1 members who leave employment and take a refund will be rehired under Plan 2 if they return to a covered position with any VRS-participating employer. VRS members are eligible to purchase the refunded prior service once they are rehired. The service purchased is credited to their Plan 2 service. Vested Members Members who request a refund and are vested will be eligible for a full refund of member contribution account balances, including any employer-paid member contributions. Non-vested Members Non-vested members with employer paid contributions made prior to July 1, Non-vested members will be eligible to receive a refund of any employer-paid contributions and interest made to the member s account before July 1, Non-vested members who have employer and member paid contributions made after July 1, Non-vested members will not be eligible for refunds of any employer contributions paid to the member account and interest made after July 1, If a member takes a refund of the contribution and interest in their account, the member will be eligible to receive the member-paid contributions only and the additional employer-paid contributions will be moved to the employer s Retirement Allowance Account. These funds will not be refunded directly to the employer. Non-vested members who have only member paid contributions made after July 1, The member is eligible for all member-paid contributions and interest. Look up Your Member Information in myvrs View your member contribution account balance, earliest unreduced and reduced retirement eligibility dates, estimated retirement benefit amounts and other information from your member record. If you are thinking of leaving employment, this information can help you decide the option that will best meet your needs. Login and create a secure online account at If you need additional assistance, contact the Office of Benefits & Retirement Services at or call VRS toll free at VARETIR ( ). Refund Application The Request for Refund, VRS-3, is located at Please complete and forward to the Payroll Department. Rev. 07/12 P.O. Box 389, MANASSAS, VA Page 11

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