Teacher Benefit Information for the Fiscal Year

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1 Please note! This document is a worksheet to assist you in gathering information only. Do not fax or mail! The actual survey must be completed online. Teacher Benefit Information for the Fiscal Year For the purpose of this survey, a full-time teacher is defined as a certificated employee who provides direct, daily instruction to district students. This definition includes counselors and librarians. A full-time teacher works for the district approximately nine months per school year. My District is: District Code: Benefit Information 1. If the district provides health insurance to full-time teachers as of July 1, 2015, please fill out the information below. If the district provides more than one HMO or PPO/POS option, please list the option that results in the lowest cost to the district per month. If you use an HMO answer the following questions: HMO - Monthly employee contribution for individual coverage: HMO - Monthly employer contribution for individual coverage: HMO - Co-pay for regular office visit: HMO - Deductible for individual coverage: 1

2 HMO - Does the plan include prescription drug coverage? If you use a PPO/POS answer the following questions: PPO/POS - Monthly employee contribution for individual coverage: PPO/POS - Monthly employer contribution for individual coverage: PPO/POS - Co-pay for regular office visit: PPO/POS - Deductible for individual coverage: PPO/POS - Does the plan include prescription drug coverage? Name of Insurance Carrier (not the broker): If the district's carrier is not listed, select "Other" and provide the name of the carrier. Select answer: Aetna, Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Kansas City, CIGNA, Community Health Improvement Solutions (formerly CHP), Coventry, Group Health Plan, Cox Healthplans, First Health, Greater Missouri Educational Trust (GMET), Great-West Healthcare, Group Health Plan, Healthlink, Humana, Mercy Health Plans, Missouri Consolidated Health Plan, Missouri Educators Trust, Missouri Educators Unified Health Plan, United Healthcare, Other 2

3 If your district is self-insured, answer the following question: If your district is self-insured for health-related costs, please name the company that administers the program. If the district's administrator is not listed, select "Other" and provide the name of the administrator. Select answer: Benefit Management, Inc., Benefit Administrative Systems, Coventry, FMH Benefit Services, Inc., Med-Pay Inc., Meritain Health, Missouri Educators Trust, Missouri Educators Unified Health Plan, Other 2. If the district offers a Health Savings Account (HSA) as an insurance option for teachers: (An HSA is an insurance option where the district takes out high-deductible insurance and then places funds in a protected account for the employee to use for medical costs that arise below the deductible. Employees may also contribute to this protected account. An HSA is not a flexible spending account, a cafeteria plan option, a Section 125 Plan, or a healthcare spending account.) What is the monthly premium for the high deductible insurance?: What is the district s annual contribution to each teacher s HSA account, if any?: Name of high deductible insurance carrier or administrator (not the broker): Select answer: Aetna, Anthem Blue Cross and Blue Shield, Assurant, Blue Cross and Blue Shield, Blue Saver (HSA), Celtic, Cigna, Coventry, Cox Health Plans, Everest Reinsurance Company, Group Health Plan, Health Equity, Humana, Lumenos, Lumenos HSA-BC Choice, Mercy Health Plans, Missouri Educator's United Health Plan, Midwest Public Risk, Resource One Administrators, United Healthcare, UnitedHealthOne/Golden Rule, Wells Fargo, Zurich, Other 3

4 Does your district pay for more insurance options for teachers than those listed in the past few pages? If your district provides teachers a set or capped amount to apply towards health insurance or a combination of health/vision/dental benefits, list the amount provided for full-time teachers: Set or Capped Amount: 3. If the district provides dental insurance to full-time teachers, answer the following as of July 1, ONLY list options that the district at least partially pays for. Do NOT list cafeteria plan options where the employees pay all of the cost. If your district pays for multiple plans, list the plan with the least cost to the district: DENTAL INSURANCE - Monthly employee contribution for individual coverage: $ DENTAL INSURANCE - Monthly district contribution for individual coverage: $ Name of Dental Insurance Carrier (not the broker): Select answer: Aetna, AFLAC, Always Care, Ameritas, Anthem Blue Cross and Blue Shield, Assurant, BlueCross Blue Shield of Kansas City, Brokers National, Cigna, Delta Dental, Dental Network, Essex, Guardian, Humana Dental, Lincoln Financial, MetLife, Morgan White, Principal, Prudential, Reliance Standard, Security Life, Shenandoah Life Insurance Company, Standard, Sun Life, United Healthcare Dental, United Concordia, Other 4

5 4. If the district provides vision insurance (separate from the health insurance referenced earlier) to full-time teachers, answer the following as of July 1, ONLY list options that the district at least partially pays for. Do NOT list cafeteria plan options where the employees pay all of the cost. If your district pays for multiple plans, list the plan with the least cost to the district: VISION INSURANCE - Monthly employee contribution for individual coverage: $ VISION INSURANCE - Monthly district contribution for individual coverage: $ Name of Vision Insurance Carrier (not the broker): Select answer: AlwaysCare, Ameritas, Anthem Blue Cross Blue Shield, BlueCross BlueShield of Kansas City, Essex, EyeMed Vision Care, First Look Vision of Missouri, Guardian, Security Life, Spectera, Superior Vision, United Healthcare, Vision Benefits of America, Vision Service Plan, Other Does the district pay for more than one vision insurance option? 5. If the district provides life insurance to full-time teachers, answer the following as of July 1, 2015: Amount paid to beneficiary (If the amount varies, list the minimum amount.): OR Percentage of compensation paid to beneficiary (Please provide the actual percentage, not the decimal amount. For example, one percent is recorded as 1% and two and a half percent is recorded as 2.5% If the amount varies, list the minimum amount.): 5

6 Name of Life Insurance Carrier (not the broker): Select answer: Anthem Blue Cross Blue Shield, Cigna, Assurant, EMC National, Fidelity Security, Fort Dearborn, Guardian, Hartford, Humana, Kansas City Life, Lincoln Financial, MetLife, Mutual of Omaha, Principal, Prudential, Standard, Sun Life Financial, Unimerica, United Healthcare, Unum, USAble Life, Other 6. Does the district pay (in full or in part) for short-term disability insurance for full-time teachers? 7. Does the district pay (in full or in part) for long-term disability insurance for full-time teachers? 8. Does the district pay (in full or in part) the health insurance premiums for regular, parttime teachers? (A regular, part-time teacher is a teacher who works a fixed schedule, but teaches fewer periods than a full-time teacher.) Comments and Concerns Please use the following space to provide additional information or to comment about the quality of the survey or special circumstances regarding benefits specific to your district. If there is any information you believe should have been included in the survey, please comment. Don t Forget! salary schedules and union agreements to 6

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