Prior Lake 2025 Benefits Guide : simplebooklet.com

Enroll now!Making Benefit SelectionsGetting StartedYou must request a change to your benefitswithin 30 days of your life event (60 days forchanges involving Medicaid eligibility). Documentation may be required.Your benefit plans are in effect July 1, 2025 – June 30, 2026. EligibilityEnrolling in coverageYour Spouse Open Enrollment is your one chance each year toreview your coverage options and make changes toyour benefits.Your choices are in effect from July - June of thefollowing year unless you have a qualifying lifeevent.Open EnrollmentQualifying life events allow you to change yourcoverage during the year outside of OpenEnrollment. These include:marriage 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.If you have a qualifying life eventYou 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 childrenHow to EnrollRead your materials and make sure youunderstand all of the options available.Login to your benefits site to add or dropdependents, change plans, waive coverage.Come prepared with dates of birth, socialsecurity numbers, and legal names of anydependents you live with to enroll in benefits.Remember to review your beneficiaries.Complete and submit your EOI form if yourenrollment requires it.IneligibleDivorced or Legally separated spouseCommon law spouse, even if recognized byyour stateDomestic partners, unless your employer statesotherwiseFoster childrenSisters, brothers, parents or in-laws, etc.View your Open Enrollment Video Now!Employee Benefits Open EnrollmentWebpage

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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).Pre/Prior-authorizationSome specialty medical providers,services and prescriptions requireprior authorization from yourinsurance company. These mayinclude - but are not limited to -surgery, imaging (CT, MRI) andcertain prescription medicationsHow to handlemedical bills (2:04)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, andwe want you to be prepared!

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MedicalBlueCross BlueShieldCustomer Service:800-382-2000DentalDelta DentalCustomer Service:1-800-448-3815Life & AD&DLong-Term DisabilityEmployee Assistance ProgramVoyaCustomer Service:800-955-7736EAP Phone:877-533-2363WebID: My5848iVEBA AccountFlexible Spending AccountOne BridgeCustomer Service:1-888-865-1628403(b) Retirement PlanPrior Lake-Savage Area SchoolsPlease contact HR with any questions!Contact InformationGetting StartedClient PortalPlease contact HR with any questions!Terrie Schoenbauer, Benefits Specialisttschoenbauer@plsas.orgMichael Knutson, Assistant Director of Human Resourcesmichaelknutson@plsas.orgClient PortalClient PortalClient PortalClient PortalAnnual NoticesWe’re required to tell you about certain rightsand responsibilities you have as an employeeof Prior Lake-Savage Area SchoolsView Your NoticesMorgan Ziskovsky, HR Specialistmziskovsky@plsas.orgRachel Hockford, HR Specialistrhockford@plsas.orgEAP Portal

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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.In-network careHigh DeductibleJuly 1 - June 30VEBAJuly 1 - June 30Double OptionJan 1 - Dec 31Triple OptionJan 1 - Dec 31Plan Year Deductible(DED)$6,450 per person $12,900 family max(Embedded)$1,200 per person$2,400 family max(Embedded)NonePremium / In-Network$0 / $200 per person$0 / $600 family maxOut-of-Pocket Maximum$6450 per person$12,900 family max(Embedded)$1,200 per person$2,400 family max(Embedded)$2,500 per person$14,300 family max(Embedded)$500 / $2,500 per person$1,000 / $5,000 family max(Embedded)Office VisitsPrimary Care, Specialist,Urgent careDED then 100%DED then 100%$20 copay$20 copay / DED then 80%ProceduresInpatientOutpatientEmergency RoomDED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%No chargeNo charge$40 copayNo charge / DED then 80%No charge / DED then 80%$40 copayPrescription DrugsGenericBrandNon-Preferred GenericNon-Preferred BrandSpecialtyDED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%DED then 100%(Retail / Mail)$30 / $9 copay$30 / $9 copay$30 / $9 copay$60 copay$30 copay(Retail / Mail)$30 / $9 copay$30 / $9 copay$30 / $9 copay$60 copay$30 copayMedical InsuranceRefer to the carrier benefits summary for the exact benefit levels associatedwith your plan.Review your medical benefits provided by BlueCross BlueShield.Eligibility for the Medical options is determined by your contract.Find an In-Network Provider Here:BCBS Member Resource Guide:Aware NetworkView Plan DetailsView Plan DetailsView Plan DetailsMember GuideView Plan DetailsTriple Option Network: BluePerformance Regional NetworkMedsYourWay Prescription DrugsPlease Refer to your plan documents for full out-of-network benefits

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Connection to your passion, the reason you get out of bed every day.PurposeFeeling connected to where you live, work and play through activities such as volunteering and mentoring.CommunitySocial & EmotionalHealthy, supportive relationships with family, friends, and mostimportantly, yourself. Effectively managing feelings and emotions andpracticing healthy ways to manage stress and adapt to challengesPhysicalHaving good health and the energy to perform your job life outside of work, such as spending time with familyand friends, or participating in activities you enjoy. Think of physical wellbeing as nutrition, staying hydrated,getting rest, avoiding illness through vaccines, preventive screenings, and following doctors’ orders!The ability to effectively understand and plan for day-to-day expenses, short-term, and long-term goals, likepaying back student loans, saving for a house, sending children to college, retirement, or caring for agingfamily membersFinancialThe 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.Access your EAP now!24/7/365 access to care. 877-533-2363guidanceresources.comWeb ID: My5848iSee plan detailsThe recipe to living wellWellness BenefitsThere are five ingredients to wellbeing — each is just as important as the others:Employee Assistance ProgramYou encounter more than just health concerns throughout your life. Managelife’s curveballs with a confidential program designed to provide counseling,support, and resources for a variety of personal issues like stress and anxiety,relationship struggles, substance abuse, eldercare, financial worries, andmuch more!This coverage us available to you when you are enrolled in Group TermLife Insurance coverage through Voya.

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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.Highlights A VEBA is offered exclusively to enrollees of the VEBA compatible medical plan.Your employer sets up this account for you and puts money into it. As soon as your employer funds theaccount, the money belongs to you.You are not able to contribute to a VEBA, this is done by your employer.Because the money isn’t part of your wages, you won’t pay taxes on it. You can use this money to help pay your health care costs at medical facilities.Once retired, you can use VEBA funds to pay for health insurance premiums like COBRA or Medicare.Savings PlansA voluntary employee beneficiary account (VEBA) is a unique, tax-free health care savings plan fundedentirely by your employer. It can pay for qualified medical expenses now or in the future, plus it can be usedto pay health insurance premiums when you retire.Health 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 OneBridge.Eligible expenses2025 maximum contribution$3,300Annual rollover amount$660See plan detailsHealth care expensesPay for eligible medical, prescription, dental, andvision expenses. Health care FSA2025 maximum contribution$5,000Married filing separately? You can contribute up to $2,500 per person.Pay for eligible child or disabled adult care while youwork or attend school. Dependent care FSAOnly the amount you’ve actually contributed isavailable for use at any one time.Estimate carefully! Unused funds will be forfeited atthe end of the year per IRS regulations.Flexible Spending AccountVOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION (VEBA) ACCOUNT

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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.Stay in-network to avoid balance billing (the difference between what an out-of-network provider charges and the amount your insurance pays). You'll get in-network preventive care at 100% along with coverage for basicand major dental services.Your dental coverage is through Delta Dental.In-network careDelta Dental PPO & PremierCalendar Year DeductibleNoneCalendar Year Maximum Benefit$1,000 per personDiagnostic & Preventive ServicesCleanings, X-rays, Exams, Fluoride, Sealants,Spacers100% coveredBasic ServicesEmergency Treatment for Pain, Fillings,Endodontics, Periodontics, Oral SurgeryYou pay 20%Major ServicesCrowns, RepairYou pay 50%ProstheticsDentures, Bridges, RepairsYou pay 50%Orthodontic ServicesDependent Children only, ages 8 through 1850% up to $1,000 Lifetime MaximumSee plan detailsFind an In-Network Provider Here:Network DirectoryPlease Refer to your plan documents for full out-of-network benefits

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EmployeeSpouseChild(ren)Election Increments$10,000$5,000$2,000Coverage AmountMaximum$400,000 not to exceed 5xAnnual Earnings$200,000 up to EmployeeAmount$10,000Reduction ScheduleAge 70: 50%Age75: 30%Age 70: 50%Age 75: 30%NoneYou may also purchase additional coverage for you, your spouse, and your eligible child(ren). Voluntary Life and AD& InsuranceLife insurance pays a benefit if you pass away while you're covered.Accidental Death and Dismemberment (AD&D) insurance offers additionalsupport if you pass away or are seriously injured due to an accident.Financial peace of mind through Voya.Life and AD&D andDisability InsuranceThe 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.Employer Paid Basic Life and AD&D InsuranceThe district offers basic life and AD&D coverage. Please refer to your employment contract for plan details.Make sure to designate a beneficiary for your life insurance coverage to ensure your family is cared for according toyour wishes.Going forward you will have the chance to elect two increments at each open enrollment without needing to completean EOI.Long Term Disability InsuranceThe District may also provide Basic Life & AD&D and Long Term Disability benefits; refer to employment contract fordetails

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Prior Lake 2025 Benefits Guide

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