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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 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 30 hours per week.Your Spouse Your benefits begin on the first day of the monthfollowing 30 days of employment; this is youreffective date. Be sure to submit your selectionswithin your first 30 days of employment. 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 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 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!

MedicalDentalHealthPartnersMember Services:Toll Free: 1-800-883-2177Phone: 952-883-50007:00am - 6:00pmPharmacyMaxorPlusMember Services:1-800-687-0707VisionEyeMedCustomer Service:Toll Free: 1-866-804-0982Life / AD&DLong Term DisabilityThe StandardMember Services:1-888-937-4783EAP Phone: 888-293-6948Flexible Spending Account (FSA) Health Reimbursement Account(HRA) Health Savings Account (HSA)BRiMember Services:1-800-473-9595Cindy Gustafson, Assistant Director of HRPhone: 651-407-7548 Email: cynthia.gustafson@isd624.orgDarla Phillips, HR Benefits SpecialistPhone: 651-407-7547 Email: darla.phillips@isd624.orgClient PortalClient PortalClient PortalClient PortalAnnual NoticesWe’re required to tell you about certainrights and responsibilities you have as anemployee of White Bear Lake Schools. View Your NoticesClient PortalContact informationGetting startedHuman Resources at White Bear Lake Schools:EAP Portal

In-Network BenefitsHRA PlanHSA PlanOther Features(Embedded)(Embedded)Annual Deductible (DED)Out-of-pocket maximum$2,000 single $4,000 family$2,000 single $4,000 family$3,200 single $6,400 family$3,200 single $6,400 familyPreventive carePrimary care visitSpecialist visit100%DED then you pay 0%DED then you pay 0%100%DED then you pay 0%DED then you pay 0%Urgent careEmergency roomDED then you pay 0%DED then you pay 0%DED then you pay 0%DED then you pay 0%Prescription drugsRx Generic FormularyRx Brand FormularyRx Non-FormularyRx Specialty(Retail / Mail)$12 / $24 Copay$30 / $60 Copay$65 / $130 Copay80%, up to $100 per Rx unit or refillDED then you pay 0%DED then you pay 0%DED then you pay 0%DED then you pay 0%Medical insuranceSee plan detailsNetwork DirectoryHealthPartners Open Enrollment Guide:Learn MoreSee plan detailsLearn MoreThe 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 benefit levels associatedwith your plan choice. Pharmacy benefits managed by MaxorPlus.Select from three medical options through HealthPartners.See your plan documents for out-of-network benefits.Find an In-Network Provider Here:Find the Best Plan with Plan for Me:

If you coveryourself onlyIf you coverdependents2024 IRS maximumcontribution $4,150$8,300Learn how HSAs canhelp you save fortoday and tomorrow.HSA GuideHealth SavingsAccount (HSA)55 or older? You can contribute an extra $1,000 peryear in catch-up contributions.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.ContributionsYou may contribute tax-free funds to save for currentand future health expenses - and retirement!HSA fundsSpend your HSA balance on health care expenses(medical, prescription, dental, and vision) for youand your tax dependents, ORLet your balance grow for retirement.Using your moneyThe money in your HSA is always yours and availablefor qualified health care expenses - even if you changejobs or health plans. Before retirement, any funds usedfor non-healthcare expenses are subject to taxpenalties. Keep your receipts!Growing your money + tax savingsHSA dollars go in tax-free, grow tax-free, and comeout tax-free when you use them for qualified healthexpenses. You may also be able to invest part of yourbalance once it meets a certain level.In retirementAt age 65, you can withdraw the funds in your HSA forany use (not just health care!) without tax penalties. Eligibilitybe enrolled in a qualified High Deductible HealthPlan (HDHP),not be covered under any other non-HDHP healthcoverage, including a full health care FSA throughyour spouse,not be anyone else’s tax dependent, and not be eligible for or enrolled in Medicare A or B,Tricare, or VA benefits.In order to make – or receive – contributions to aHealth Savings Account (HSA), you must:An HSA through Benefit Extras is paired with a HighDeductible Health Plan (HDHP).Save pre-tax money for health care expenses – or retirement!HSA Academy

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.Highlights Health Reimbursement(HRA) AccountThe 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.A 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.HRA VEBA Guide

Eligible expenses2024 maximum contribution$5,000Married filing separately? You can contribute up to $2,500 per person.2024 maximum contribution$3,2002024 maximum contribution$3,200Health care FSA Limited purpose FSADependent care FSAFSA GuidePay for eligible child or disabled adult care while youwork or attend school.Pay for eligible medical, prescription, dental, andvision expenses.Pay for eligible dental and vision expenses whenyou're also contributing to an HSA.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 expensesEnrolled in an HDHP plan and eligible for HSA contributions? You’re not eligible for a health care FSA; you can contribute to alimited purpose FSA instead.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 BRi.

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 care at 100% along withcoverage for basic and major dental services.Orthodontic care is covered for children under the age of 19.Your dental coverage is through HealthPartners.Find an In-Network Provider Here:Network DirectoryBenefit Level 1Benefit Level 2Benefit Level 3Annual Deductible (DED)NoneNone$25 per person$75 familyAnnual maximum benefit$2,000 per person $1,500 per person $1,000 per person Preventive careTeeth cleaning, exams,dental x-rays, fluorideSealants100% covered100% covered100% coveredBasic ServicesFillingsSimple ExtractionsRoot Canal TherapyPeriodonticsComplex Oral Surgery100%100%80%Special ServicesRestorative Crowns &Onlays, White Fillings75%75%70%ProstheticsBridges, Dentures, DentalImplants$500 Implant Maximumincluded in the AnnualMaximum60%60%50%Orthodontic careChild50% up to $1,500 lifetimemaximum50% up to $1,000 lifetimemaximum50% up to $1,000 lifetimemaximumSee plan details

In-network careVision planBenefit FrequenciesExamLensesFramesContacts12 months12 Months24 Months12 MonthsVision Exam$0 copayLenses & FramesSingle Vision LensesFrames$0 Copay$0 Copay, 20% off balance over $140*ContactsConventionalDisposableMedically Necessary$0 Copay, 15% off balance over $140*$0 Copay, plus balance over $140*$0 Copay, Paid in fullSee plan detailsVision insuranceYou'll get coverage for annual exams, lenses, and contacts, with an allowancefor contacts and frames.Your vision coverage is through EyeMed.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.*For In-Network, this is an Allowance AmountFind an In-Network Provider, Select"Insight Network" Here:Network Directory

Carrier NameThe StandardLife and AD&D BenefitVaries by Class, Refer to Employment Contractfor detailsSee plan detailsEmployeeSpouseChild(ren)Election increments$10,000$5,000$10,000Coverage AmountMaximum$150,00050% of employee amount up to$75,000$10,000New Hire GuaranteeIssue$150,000$75,000$10,000Medical question limitWhen you’re first eligible (a newhire), you can purchaseadditional life insurance up tothis limit without any medicalquestions required. Medical questions and approvalwill be required for all futureincrease and purchase requests.You may also purchase additional coverage for you, your spouse, and youreligible child(ren). Voluntary life and Accident 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 The Standard.Life and AD&D insuranceMake sure to designate a beneficiary for your life insurance coverage to ensureyour 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.Basic life insuranceWhite Bear Lake Schools provides life and AD&D insurance at no cost to you.Coverage varies by employment class, please review contract for applicablecoverage details.

If you make a disability claimwithin the first year of beingcovered, check your plan detailsto see how pre-existingcondition limitations mightimpact your coverage.Pre-existing conditionlimitations Carrier NameThe StandardBenefitVaries by Class; Please Review Employment Contract forAdditional DetailsMaximum Monthly BenefitVaries by Class; Please Review Employment Contract forAdditional DetailsMinimum Monthly Benefit$100Pre-Existing LimitationPre-Existing Condition Period 3/12Cost100% Employer PaidWish you knew moreabout finances? Nowyou can - at no cost!Disability 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.Protect your paycheck with disability insurance through TheStandard.Disability coverage insures your paycheck, replacing a portion of your income ifyou’re unable to work due to a covered illness or injury.Long-term disability coverage can provide lasting income protection if youremain unable to work. This is an employer-paid coverageLong-term disability

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 MattersSee plan detailsSee plan detailsEmployee Assistance ProgramLife Services ToolkitSee plan detailsSee plan detailsTravel AssistVirta - COMING SOON!See 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.Information and Tools to help you make informedimportant life decisionsGet help for you and your family while preparing fortrips and during critical situations while away fromhomeWork with a nurse one-on-one at no cost to help makeliving with a health condition easier.Starting in January 2024, eligible members will havefully covered access to Virta Health’s diabetes reversalprogram. Virta is a virtual clinic that helps membersmanage or reverse type 2 diabetes. Virta uses food asmedicine and teaches members how to eat their way tobetter health with a nutrition plan made just for them.

2024 Benefits