If employment commences on the first of the month, benefits will be effective on the first day of the same month.
If employment commences after the first day of the month, benefits will be effective the first of the month following employment.
Employee Insurance and Benefits Enrollment Forms
2020 -2021 Comprehensive Insurance and Benefits Enrollment Packet
This comprehensive packet provides an overview of the district-wide benefit and insurance options available to eligible employees. For specific information regarding the benefits in this packet, visit the Employee Insurance and Benefits page.
Insurance and Benefits Enrollment/Change/Cancellation Request Form
Important Information About Insurance
Following a recommendation by the Insurance Committee, the School Board has approved remaining with United Healthcare (UHC), Delta Dental and VSP for vision coverage for the new plan year starting on July 1, 2021. All employees and early retirees will begin paying their new premium amounts on July 1, 2021. Deductibles and Out-of-Pocket Maximums are calculated on a calendar basis from January 1 – December 31.
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Insurance for 2021-2022 Plan Year at a Glance |
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| Insurance | Company | Changes |
| Health | UnitedHealthCare | Premium decrease and no plan design change |
| Dental | Delta Dental | No premium change and no plan design change |
| Vision | VSP | No premium change and no plan design change |
| Flex | 121 Benefits | Plan Year: 7/1/2021-6/30.2022 New Vendor: WEX (Must fill out a new form every year) |
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Health Premium Changes |
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| Plan Year 2020-2021 | Plan Year 2021-2022 | ||
| Value Plan ($1,500 Deductable) | Employee Only | $947.00 | $899.00 |
| EE + Spouse | $1,988.00 | $1,888.00 | |
| EE + Child(ren) | $1,799.00 | $1,709.00 | |
| EE + Family (SP + CH) | $2,746.00 | $2,608.00 | |
| High Deductible ($3,500 Deductable) | Employee Only | $784.00 | $744.00 |
| EE + Spouse | $1,646.00 | $1,563.00 | |
| EE + Child(ren) | $1,489.00 | $1,414.00 | |
| EE + Family (SP + CH) | $2,272.00 | $2,158.00 | |
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Health Plan Design Comparison |
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| Single Medical Coverage | Value | HDHP | |
| Deductible | In-Network | $1,500 | $3,500 |
| Doctor Office Visit Co-Pay | In-Network | $25 | Deductible |
| Virtual Visit | In-Network | $10 | Deductible |
| Specialist Co-Pay | In-Network | $40 | Deductible |
| Coinsurance After Deductible | In-Network | 80% / 20% | Deductible |
| Out of Pocket Maximum | In-Network | $3,500 | $3,500 |
| Prescription Drug Coverage | Value | HDHP | |
| Tier One | $10 | Deductible | |
| Tier Two | $30 | Deductible | |
| Tier Three | $50 | Deductible | |
| DENTAL | ||||
| Plan Year 2021-2022 | ||||
| No premium change No design change |
Employee Only | $33.00 | ||
| +1 Dependent | $61.00 | |||
| +2 Dependents | $90.00 | |||
| +3 or More Dependents | $123.00 | |||
| VISION | ||||
| Plan Year 2021-2022 | ||||
| No premium change No design change |
Employee Only | $7.09 | ||
| +1 Dependent | $12.88 | |||
| +2 Dependents | $19.73 | |||
VSP
VSP does not send out insurance cards. If you would like to make a copy of your vision insurance information you can go to www.vsp.com, create an account, and then print a card. You can also use the link to find an in-network provider.
Long Term Disability (LTD) & Life Insurance
LTD plan is based on voluntary participation; rates are determined by age and salary.
Filling out Benefit Enrollment Forms
Please follow these steps to ensure that you are completing your forms correctly.
- Review information in Section 1 of the Benefits Information Enrollment Form.
- If you do not want to make any changes to health, dental or vision coverage (including covered dependents), checkmark the box toward the middle of the page.
- This will ensure that your insurance elections remain the same for the next plan year. (This does not include Life, LTD, or Flex elections, which will be completed on other forms.)
- Skip Section 2 and 3.
- Sign and date in Section 4.
- Return form to Human Resources at the ESC.
- If you do want to make changes, you will need to turn the form over and complete the other side.
- In Section 2, you will need to checkmark all health, dental and vision coverage you would like to receive, and enter information about your dependents you wish to cover.
- You will only sign Section 3 if you are electing to waive any of your current coverage.
- Sign and date in Section 4.
- Return form to Human Resources at the ESC.
Flex Plan Information
This year we will be moving to a new vendor, WEX. You are required to fill out a new Flex Enrollment Form for the plan year that starts July 1, 2021 and ends June 30, 2022. If you do not fill out a flex form for the new plan year, you will not be enrolled with the Flexible Spending Account for the 2021 – 2022 plan year.
ALL ENROLLMENT FORMS MUST BE RETURNED TO THE HR OFFICE BY MAY 31
If you do not submit your Benefit Information Enrollment Form or Flex Enrollment Form by May 31 Human Resources will assume that you have no change in your medical, dental, or vision coverage, and will have no Flex plan benefits. Please note that this is the only time you can make changes to your insurance coverage, other than through a qualifying event.
Kim Smith, Benefits Manager
712-279-6692 Ext. 6121
Ashley Dickerson, Benefits Administrative Assistant
712-279-6692 Ext. 6120