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YourBenefitsEffective January 1, 2024 - December 31, 2024

You must request a change to your benefitswithin 30 days of your life event (60 days forchanges involving Medicaid eligibility). Documentation may be required.Your are eligible to begin benefits on date of hire. Your benefit selections will be in effect throughDecember 31. When you're first eligible Open Enrollment is your one chance each year toreview your coverage options and make changes toyour benefits.Your choices are in effect from January – Decemberof the following year unless you have a qualifyinglife event. At Open Enrollmentmarriage or divorce, birth or adoption, death of a covered dependent, and a change in eligibility through Medicare,Medicaid, or a spouse or parent's coverage. Qualifying life events allow you to change yourcoverage during the year outside of OpenEnrollment. These include: If you have a qualifying life eventYour benefit plans are in effect January 1, 2024 –December 31, 2024. In general, there are threetimes you can make benefit selections:Making benefit selectionsGetting startedEligibility Enrolling in coverageFor youYou are eligible for benefits as a full-time employeeworking at least 20 hours per week.Your Spouse You may also cover your eligible dependents whenyou elect coverage for yourself.Covering your familyDependent children are eligible until age 26regardless of student or marital status.You may cover your legal spouse.Your children

Balance billingWhen you use an out-of-networkmedical or dental provider, theymay bill you the difference betweenwhat they charge and the amountyour insurance pays.Medical: balance billing is inaddition to – and does not counttowards – your out-of-pocketmaximum.CoinsuranceAfter you’ve met your deductible,you’re sometimes responsible for apercentage of the cost of themedical care, dental care, orprescription medication youreceived. This percentage iscoinsurance.CopayA flat fee you pay each time youreceive a copay-eligible medical,dental, or vision service orprescription medication. DeductibleThe amount you’re responsible forpaying in care expenses before themedical or dental plan starts payingdeductible-eligible expenses.In-networkIn-network care is always yourlowest-cost option. Networks aregroups of medical, dental, andvision providers, pharmacies, andfacilities that agree to discount thecost of their care or service.Out-of-pocket maximumThe most you’ll pay for covered in-network medical care in a year. Thisincludes your deductible, anycoinsurance or copays, andprescription drugs. The out-of-pocket maximum doesnot include your premium (theamount you pay for coverage), non-covered expenses, or out-of-network care that’s been balancebilled.Primary care physicianA primary care physician (PCP) isyour main medical doctor – usuallya general practitioner (GP), familydoctor, internist, OB/GYN, orpediatrician (for children).Referral/pre-authorizationSome specialty medical providersand services require a referral froma primary doctor. These may include- but are not limited to -cardiology, psychiatry, orthopedicsurgeons, rheumatology, surgery,and imaging (CT or MRI).How to handle medicalbills (4:46)Helpful terms & resourcesGetting startedWe've removed as much jargon as possible.But you’ll probably still encounter some terms as you enroll in and use your benefits, and wewant you to be prepared!

Medical/RxDentalHealthPartnersMember Services:Toll Free: 1-800-883-2177Phone: 952-883-5000VisionVSPMember Services:Toll Free: 1-800-877-7195Flexible Spending Account (FSA) VEBAWexMember Services: Toll Free: 833-225-5939Human Resources at Inver Grove Heights Schools:Pachia XiongEmail: xiongp@isd199.orgClient PortalAnnual NoticesWe’re required to tell you about certainrights and responsibilities you have as anemployee of Inver Grove Heights Schools. View Your NoticesContact informationGetting startedClient PortalClient Portal

In-NetworkBenefits (OpenAccess Network)$15 Copay$30 Copay$30-$500 IPCopay$20 Copay$1000 VEBAOther FeaturesEmbeddedAnnual Deductible (DED)Out-of-pocket maximum$0 single $0 family$1,000 single $5,000 family$0 single$0 family$3,000 single$5,000 family$0 single$0 family$3,000 single$5,000 family$0 single $0 family$1,500 single $5,000 family$1,000 single$2,000 family$2,000 single$4,000 familyPreventive carePrimary care visitSpecialist visit100% Covered$15 Copay$15 Copay100% Covered$30 Copay$30 Copay100% Covered$30 Copay$30 Copay100% Covered$20 Copay$20 Copay100% CoveredDED then you pay 20%DED then you pay 20%Urgent careEmergency room$15 Copay$75 Copay$30 Copay$75 Copay$30 Copay$75 Copay$20 Copay$75 CopayDED then you pay 20%DED then you pay 20%Inpatient CareNo ChargeNo Charge$500 Copay20%DED then you pay 20%Prescription drugsRx Formulary GenericRx Formulary BrandRx Non-FormularyRx SpecialtyRetail / Mail$12 / $24 Copay$35 / $70 Copay$50 / $100 Copay20%, $200 Max/Rx/MonthRetail / Mail$12 / $24 Copay$35 / $70 Copay$50 / $100 Copay20%, $200 Max/Rx/MonthRetail / Mail$12 / $24 Copay$35 / $70 Copay$50 / $100 Copay20%, $200 Max/Rx/MonthRetail / Mail$12 / $24 Copay$35 / $70 Copay$50 / $100 Copay20%, $200 Max/Rx/MonthRetail / Mail$12 / $24 Copay$35 / $70 Copay$50 / $100 Copay20%, $200 Max/Rx/MonthMedical insuranceSee plan detailsThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Refer to the carrier benefits summaries for the exact benefits associated with yourplan.Review your three medical plan options through HealthPartners.See your plan documents for out-of-network benefits.Find an In-Network Provider Here:Network DirectoryHealthPartners Open Enrollment Guide:Learn MoreSee plan detailsSee plan detailsSee plan detailsSee plan details

The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Health Reimbursement(HRA) AccountA health reimbursement account (HRA) is a unique, tax-freehealth care savings plan funded entirely by your employer. It canpay for qualified medical expenses now or in the future, plus itcan be used to pay health insurance premiums when you retire.All Employees who who are eligible based on their employment agreement.EligibilityAs soon as your employer funds the account, the money belongs to you.You don’t pay taxes on the account balance, interest earned or on qualified withdrawals.HRA funds can be used to pay for eligible medical expenses now or later, even in retirement.Once retired, you can use HRA funds to pay for health insurance premiums like COBRA or Medicare.Funds rollover from year to year so you don’t have to worry about forfeitures.Highlights Please see the benefit cost sheet for District HRA contribution

Eligible expenses2023 maximum contribution$5,000Married filing separately? You can contribute up to $2,500 per person.2024 maximum contribution$3,200FSA - Limits & RegulationsHealth care FSADependent care FSAPay for eligible child or disabled adult care while youwork or attend school.Pay for eligible medical, prescription, dental, andvision expenses.Only the amount you’ve actually contributed isavailable for use at any one time.Estimate carefully! Unused funds will be forfeited at theend of the year per IRS regulations.Flexible Spending Accounts (FSAs)The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Health care expensesHealth and dependent care expenses can add up. Paying with tax-free fundscan help. Enroll in one or more flexible spending accounts (FSAs) dependingon your needs.Pay for qualifying expenses with tax-free money using yourFlexible Spending Account through Optum.

Stay in-network to avoid balance billing (the difference between what an out-of-network provider charges and the amount your insurance pays). Dental insuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.You'll get in-network preventive, diagnostic and basic care at100% along with coverage for major dental services andorthodontic care.Your dental coverage is through HealthPartners.Find an In-Network Provider Here:Network DirectoryIn-Network BenefitsAnnual Deductible (DED)NoneAnnual maximum benefitUnlimitedPreventive and Diagnostic careTeeth cleaning, exams, dental x-rays, fluoride, sealants100% coveredBasic Care 1Fillings, Simple Extractions, Endodontics, Non-Surgical Periodontics100%Basic Care 2White Fillings, Surgical Periodontics, Complex Oral Surgery100%Special CareRestorative Crowns & Onlays80%ProstheticsBridges, Dentures, Dental Implants50%Orthodontic CareDependents age 18 or under50% with unlimited lifetime maximumSee plan details

In-network careVision planBenefit FrequenciesExamLensesFramesContacts12 months12 Months12 Months12 MonthsVision Exam$10 copayLenses & FramesSingle Vision LensesFrames$25 CopayIncluded in $25 Copay Total$150 AllowanceContacts(Instead of Glasses)$150 AllowanceSee plan detailsVision insuranceFind an In-Network Provider:Network DirectoryYou'll get coverage for annual exams, lenses, and contacts, with an allowancefor contacts and frames.Your vision coverage is through VSP.The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.

The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Additional perksThere's more to love with these extra benefits. Get 24/7 Help when you are away from home.See plan detailsSee plan detailsAssist AmericaMouthWise MattersHearing Aid DiscountSee plan detailsSee plan detailsMy PregnancyRelief from Back PainSee plan detailsPersonal Nurse SupportSupport for financial, well-being, behavioral & mentalhealth topics.Covered dental care for those that are diabetic orpregnant and at risk of gum disease.Important anytime, anywhere parent education and funextras for every stage of pregnancy, newborn care andmore.Work with a nurse one-on-one at no cost to help makeliving with a health condition easier.Personalized support and resources with a nurse.See plan detailsQuit Smoking for GoodSee plan detailsSign up with a health coach to help you quit.WellbeatsSee plan detailsOn-demand fitness, nutrition and mindfulness classes.

2024 Benefits