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YourBenefitsEffective July 1, 2024 - June 30, 2025

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, 2024 – June 30, 2025. 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 PlanSource to add or dropdependents, change plans, waive coverageIn most cases, your username will be the firstletter of your first name + up to six letters ofyour last name + last four digits of your SSN.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.

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!

MedicalRxBlueCross BlueShieldCustomer Service:800-382-2000DentalDelta DentalCustomer Service:1-800-448-3815VisionEyeMedCustomer Service:1-866-804-0982Life & AD&DLong-Term DisabilityNew York LifeCustomer Service:1-888-842-4462HRA/VEBA AccountFlexible Spending AccountOneBridgeCustomer Service:1-888-865-1628Employee Assistance ProgramSandCreekEAP Phone:888-243-5744Passcode:WaconiaView Your NoticesContact informationGetting startedClient PortalPlease contact HR with any questions!Lisa Olsonlolson@isd110.orgAnnual NoticesWe’re required to tell you about certainrights and responsibilities you have as anemployee of Waconia Public SchoolsClient PortalClient PortalClient PortalClient PortalClient Portal

In-Network Benefits$0 Deductible$20 Copay Plan$500 Deductible Plan$1750 Deductible Planwith VEBA**Calendar YearDeductible (DED)None$500 per person*$1,000 family max*(Embedded)$1,750 per person*$3,500 family max*(Embedded)Out of PocketMaximumMedical$750 per person $1,500 family maxRx$300 per person$500 family max(Embedded)Medical$750 per person $1,500 family maxRx$300 per person$500 family max(Embedded)$3,000 per person$6,000 family max(Embedded)Office VisitsPrimary Care, Specialist,Urgent Care$20 CopayDED then 80%DED then 80%ProceduresInpatient, Outpatient,Emergency RoomNo Charge$40 CopayDED then 80%DED then 80%DED then 80%DED then 80%Prescription drugsGenericBrandNon-PreferredSpecialty(Retail / Mail)$15 / $30 Copay$25 / $50 Copay$40 / $80 Copay$40 Copay(Retail / Mail)$15 / $30 Copay$25 / $50 Copay$40 / $80 Copay$40 Copay(Retail / Mail)$20 / $40 Copay$35 / $70 Copay$50 / $100 Copay$50 CopayMedical insuranceSee plan detailsFind an In-Network Provider Here:BCBS Member Guide:Aware NetworkThe 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 summary for the exact benefit levels associatedwith your plan.Select from three Medical options provided throughBlueCross BlueShieldSee plan detailsSee plan details*Deductible Carryover Applies**Non-Teacher Enrollment OnlyPlease Refer to your plan documents for full out-of-network benefitsLearn More!

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; Only available to Non-Teacher members enrolled in the $1750 Deductible PlanYour 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 an HRA, 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.For any questions or concerns with your account, please contact OneBridge at 1-888-865-1628. Customerservice hours are Monday-Friday 8:00am - 7:00pm CentralSavings 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 expenses2024 maximum contribution$3,200Annual rollover amount$640See plan detailsHealth care expensesPay for eligible medical, prescription, dental, andvision expenses.Health care FSA2024 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 is available for use at any one time.Estimate carefully! Unused funds will be forfeited at the end of the year per IRS regulations.Flexible Spending AccountHealth Reimbursement Arrangement HRA/VEBA

Stay in-network to avoid balance billing (the difference between what an out-of-network provider charges and the amount your insurance pays). In-Network BenefitsDelta Dental PPO & PremierAnnual Deductible (DED)$25 Per PersonAnnual maximum benefit$1,000 Per PersonDiagnostic & Preventive ServicesCleanings, X-rays, Exams, Fluoride, Spacers100% CoveredBasic ServicesSealants, Emergency Treatment for Pain, Silver Fillings, Endodontics,Periodontics, Oral Surgery, White Fillings on Anterior TeethDeductible then you pay 20%Major ServicesCrowns, White Fillings on Posterior Teeth, Dentures, Bridges,Standard Implant CoverageDeductible then you pay 20%Orthodontic Services50% up to $1,000 Lifetime MaximumFind an In-Network Provider Here:Network DirectorySee plan detailsDental 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 care at 100% along withcoverage for basic and major dental services.Your dental coverage is through Delta Dental.Please Refer to your plan documents for full out-of-network benefits

In-network careVision planBenefit FrequenciesLensesFramesContact Lenses12 Months24 Months12 MonthsLenses & FramesSingle vision LensesFrames$20 Copay$0 Copay, 20% off balance over $150 AllowanceContactsConventionalDisposableMedically Necessary$0 Copay, 15% off balance over $150 Allowance$0 Copay, 100% off balance over $150 Allowance100% CoveredSee plan detailsVision insuranceFind an In-Network Provider:Select “INSIGHT Network”Network DirectoryThe 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 coverage for lenses, Frames, and contacts, with an allowance forcontacts and frames.Your vision coverage is through EyeMed.Please Refer to your plan documents for full out-of-network benefits

EmployeeSpouseChild(ren)Election Increments$10,000$5,000$1,000Coverage Amount Maximum$500,000$250,000 Not to Exceed100%of the Employees Benefit$10,000Guarantee Issue (GI)$100,000$50,000$10,000Employer Paid Basic life & AD&D insuranceLong Term Disability insuranceYou may also purchase additional coverage for you, your spouse, and youreligible child(ren). Voluntary life and AD&D insuranceLife insurance pays a benefit if you pass away while you're covered. AccidentalDeath and Dismemberment (AD&D) insurance offers additional support if youpass away or are seriously injured due to an accident.Financial peace of mind through New York Life.Life and AD&D & DisabilityinsuranceThe district offers basic life and AD&D coverage. Please refer to youremployment contract for plan details.Make sure to designate a beneficiary for your life insurance coverage toensure your family is cared for according to your wishes.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.The district offers long term disability coverage. Please refer to youremployment contract for plan details.New York Life is offering a full employee and spouse open enrollment up to the Guarantee Issue for eligible andparticipating employees/spouses for this year’s open enrollment.

Employee AssistanceProgram (EAP)24/7/365 access to care. 888-243-5744www.sandcreekeap.comCode: waconiaThe 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.EAP features:Confidential. Your employer will never know you called or what wasdiscussed.Available 24/7/365. Life doesn't happen during office hours. The EAP ishere when you need them.Family care is included. Anyone living in your home is eligible for EAPservices at no cost.Face-to-face visits. When needed, each person can receive up to xface-to-face (or virtual) visits with a licensed counselor per issue peryear. At no cost. Additional visits - if needed - will go through yourhealth insurance.Our Employee Assistance Plan (EAP) is a confidential service with access toguidance and resources at no cost for: mental health concerns (including substance abuse or addiction),adoption, parenting, or caregiving needs,financial or legal support,familial relationships and friendships,coping with day-to-day challenges, andso much more.Essentially, if it's part of your life, our EAP is here for you.Access support online, through live chat, or over the phone. 24/7/365.Everyone needs support sometimes (even superheroes)Care for your mind – and your life – with support throughSandCreek EAP.Confidential care designed for all that life brings.See plan details

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.Carrier ResourcesYour employer offers a handful of non-traditional benefitsthrough your insurance carriers to support you and your familyas you juggle life’s demands.See plan detailsSee plan detailsEAP and Wellness ServicesFinancial ConnectSee plan detailsEstate GuidanceSee plan detailsLegal ConnectSee plan detailsSecure TravelSee plan detailsAmplifon Hearing

2024 Benefits