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What benefits are available and how much do they cost?

Who are the district's insurance carriers?

Medical Insurance: PreferredOne

Dental Insurance: Delta

Life and LTD Insurance: VOYA

Workers' Comp Insurance: EMC

When is Open Enrollment?

Medical Insurance: May for July 1st start

Dental Insurance: May for July 1st start

403(b): May for June 1st start; December for January 1st start

Flexible Spending Account: May for July-June

Life Insurance: Automatically enrolled per terms and conditions of employment

Dependent Life: All Year

Supplemental Life: All Year

LTD: Automatically enrolled per terms and conditions of employment

When do my deductibles reset?

The appropriate terminology for this question is “plan cycle dates.”

Dental Insurance coverage plan cycle runs January to December.

Medical Insurance coverage plan cycle runs July to June.

What medical insurance plans does PLSAS have?

  • PreferredOne Open Access 200 (Double Gold)
  • PreferredOne Care Team (Triple Gold)
  • PreferredOne VEBA with HRA

Click here for more information.

What are the differences between the medical insurance plans?

With Open Access 200 (Double Gold), a plan member can go to any clinic of their choice within the network.

A Care Team (Triple Gold) member must designate a specific clinic within the network and can only go to that designated clinic or obtain a referral to another clinic.

The VEBA with HRA plan is an open access plan with a high deductible. The district provides an HRA in the amount of the deductible. More info: PreferredOne Plan Summaries

What does HRA and VEBA mean, and how does it work?

It stands for Health Reimbursement Arrangement (HRA) with Voluntary Employee Beneficiary Association (VEBA). This is an open access high deductible medical insurance plan combined with an HRA account. The HRA account may be used to offset the high deductible.

Can I buy medical insurance if I work 30 or more hours per week?

You must work in a position that offers insurance in order to be eligible. If your position does not offer insurance, there is not an option purchase medical insurance at this time.

Why isn’t my payroll medical deduction half of my portion of the monthly premium? (Time card staff only)

Short answer: Because you are paying ahead for the months of July and August. Your monthly premiums are calculated on an annual basis, and divided by the number of remaining payrolls.

If you are a returning employee (or begin employment in August), 12 months of premiums (September through August) are divided by 19 payrolls (September 15 through June 15).

So what does this mean in real numbers?

Let's say you are an employee that is paid during the school year (19 pays per year) with a benefit of single coverage. You elect a two-party health plan. The monthly premium is $1368.46.

$1368.46 times 12 months = $16,421.52 annual cost.

The district pays the single premium portion (657.73x12=$7892.76). Your portion is the balance (16,421.52 – 7892.76 = $8,528.76).

$8528.76 divided by 19 payrolls = $448.88 deduction per paycheck.

This way the premiums for July and August are already taken care of and paid for so you do not need to worry about coverage during the summer months while you are off.

If I don't work summers, will I still have medical & dental coverage through the summer?

Yes. We calculate your premiums on an annual basis, and we divide those premiums by the number of payrolls during the school year.

If you start at the beginning of the year and you are on contract receiving equal payments, you will have 24 payroll deductions that will pay for coverage during the summer months.

If you start mid-year, we will calculate the number of months remaining through August, and then divide that premium by the number of remaining paychecks through August.

If you start at the beginning of the year and you timecard, you will have 19 payroll deductions (September 15–June 15) that will pay for coverage from September through August.

If you start mid-year, we will calculate the number of months remaining through August, and then divide that premium by the number of remaining paychecks through June 15.

It's open enrollment and I want to switch plans. What is the cost of another plan?

The premium cost is determined by the language in your terms and conditions of your position. Please refer to the first question.

When can I change my medical insurance plan?

Plan changes can be made during open enrollment only.

How are my benefits affected by my medical leave?

Your benefits depend upon FMLA eligibility. If you are an “eligible employee” as determined by Policy #410 Family and Medical Leave Policy, your benefits will be covered up to 12 weeks (3 months) by the District. You remain responsible for any portion of your health or dental insurance that you have deducted from your paycheck. As long as you continue to receive sick leave pay, your benefits will remain. Once FMLA leave is exhausted, the district can no longer pay your medical or dental insurance and you will be offered Cobra by Corporate Health Systems.

My spouse was laid off and it's not open enrollment. Can I add him/her to my insurance?

Yes, this is considered a qualifying event, and he or she can be added to your insurance plan. You have 30 days from the qualifying event date to complete a Request for Benefit Status Change Form.

What is a qualifying event?

A qualifying event is a family status change such as birth of a child, adoption, marriage, divorce, death, loss of benefits due to job loss.

Can I switch to a different medical plan during a qualifying event?

No. During a qualifying event, the only change can be adding or reducing coverage. For example: Employee gets married, so changes the plan from Single to Single+1.

What should I do if I have a medical issue while out of state/country?

If you have Emergency Services outside of the country, please follow the following steps:

  • Pay for your claim at time of service
  • Request an itemized receipt
  • Submit the itemized receipt along with your name and ID number, copy of proof of payment (such as credit card receipt) and an explanation of what occurred and forward to the following address:

PO Box 59212
Minneapolis, MN 55459-0212
Fax: (763) 847-4010

If you are traveling out of state, the district does have a travel network with PreferredOne, PHCS Healthy Directions.

To access network providers for PHCS Healthy Directions you may call customer service at (763) 847-4477, 7:00 am – 7:00 pm CT, Monday – Friday or go to http://preferredone.com.

  • Choose the PHCS Health Directions then submit
  • Choose a provider type: Doctor or Facility
  • Search for a provider based on your location

I have a VEBA HRA account. Should I have a Flex Spending Account too? What is an FSA anyway?

If you have a VEBA HRA account (because you are on the school district's VEBA deductible health plan), it is still a good idea to flex funds, because your VEBA HRA account will roll over year after year and continue to build and grow. VEBA is accessible to you until you use it, even if you leave the school district. Upon retirement you can use any money left in your VEBA account to reimburse yourself for health care premiums and other medical expenses.

A Flexible Spending Account is an easy way to lower your taxable gross income and increase your spendable income.

With a Flexible Spending Account, you set aside part of the money you earn each year before taxes are calculated thereby lowering your gross income. Then, that money is paid back to you as reimbursement for health care and/or dependent care expenses that you incurred and have to pay out of your own pocket.

You may Flex up to $2,500 for medical expenses and $5,000 for dependent care expenses. Corporate Health Systems is the company who oversees both the VEBA HRA and Flexible Spending programs. They ensure that your Flex money is always used first before accessing your VEBA HRA account.

The Flex money you elect to have deducted from your paycheck must be claimed by the end of the plan year. Our Flexible Spending plan year ends December 31st. Spend your money by that date and remember to claim it no later than February 28th or it will be lost! (This is the reason it is sometimes called the "Use It or Lose It" policy.)

What dental plans are available?

The district has one plan with Delta Dental; however, you are covered under both the Delta Dental PPO and the Delta Dental Premier networks.

PLSAS is self-insured. What does that mean and how does it affect me?

Effective July 1, 2011 the district moved to self-insured medical insurance and effective July 1, 2012 moved to self-insured dental insurance. The biggest difference between a self-insured plan and a fully insured plan, is that the district no longer pays premiums for each covered employee to the insurance company. Instead, the district pays PreferredOne a fee each month per covered employee to process claims and to handle other administrative matters. The district reimburses PreferredOne the amount it has paid in claims for district employees and enrolled dependents. The district, not the insurance company, is directly paying medical claims and bears the risk for those costs. The premiums taken from employees checks each pay period are deposited into an account set up specifically for health insurance. Laws prohibit these funds from being used for anything other than the healthcare plan.

Employees enrolled in the district self-insured health and dental plans have a unique incentive to be concerned about the costs that their doctor or clinic is charging for their services. Employees need to have hands on approach in managing their costs because these costs are being paid by the employer directly out of the district's health care and dental accounts. As those costs increase, employees may have to assume more of those costs through higher insurance premium payroll deductions for their health benefits. Since there is no traditional insurance involved, all the expense risk and the benefits of saving money go to the district and its employees.

How do I compare clinics and cost of procedures?

Log in to your PreferredOne account at www.preferredone.com and use the “medical cost tools to get the most value from you benefit dollars” program.

For Delta Dental Clinics, go to www.deltadental.com and log in to your account. Click on “Find a Dentist.”