Balsz School DistrictEmployee Benefits Programs

2014-2015

Medical Insurance Rates

Monthly Annual AnnualEmployee Deduction

Employee Deduction

Premiums PremiumEmployee

Cost22 Pays 20 Pays

Traditional PPO Employee $482.95 $5,795.40 $1,025.76 $46.64 $51.30

Employee + Spouse $965.90 $11,590.80 $6,821.16 $310.06 $341.07

Employee + Child(ren)

$917.60 $11,011.20 $6,241.56 $283.72 $312.09

Family $1,352.27 $16,227.24 $11,457.60 $520.81 $572.89

 Traditional PPO Includes $75 Employer PREP Gift Certificate for Qualifying Employees

Medical Insurance Rates

    Monthly Annual AnnualEmployee Deduction

Employee Deduction

Premiums PremiumEmployee

Cost22 Pays 20 Pays

CDHP 2500 Employee $397.47 $4,769.64 $ - $ - $ -

Employee + Spouse $794.94 $9,539.28 $4,422.72 $201.04 $221.15

Employee +

Child(ren) $755.19 $9,062.28 $3,980.40 $180.94 $199.03

Family $1,112.91 $13,354.92 $7,960.80 $361.86 $398.05

 CDHP 2500 Includes $200 Employer PREP Contribution to HSA Account for Qualifying Employees

P.R.E.P. Prevention Reward Employee ProgramWELLNESS MATTERS!

TWO + ONE = $200 HSA Contribution or $75 Gift Card

Primary Requirements:

1.• Annual Wellness Exam

2.• Health Risk Assessment (HRA)

3.• Timeline: 4/1/2014 – 3/31/2015

P.R.E.P. Prevention Reward Employee Program

Additional Options: Complete a Smoking Cessation ProgramEnroll in DPCA ProgramDental ExamFlu VaccinationPreventive Cancer Screening Complete Eight Months of the Work It Off Exercise ProgramParticipate in a Community Wellness RunAttend Two District Sponsored Wellness ClassesNon-Benefited employees may participate in PREP,

see website for more information.

ING Life InsuranceBasic Group Term Life Insurance • Equal to $50,000 at no cost to you!• Accidental Death & Dismemberment (AD&D)

insurance – pays additional benefit if you suffer a loss due to an accident.

• Benefits are reduced at age 70.• Includes travel assistance and funeral planning

services

Voluntary Term Life Insurance• For you, your spouse and/or your children.• Evidence of Insurability forms may be required,

depending on level of coverage.• You may also have the opportunity to take

supplemental coverage with you if you leave your employer.

ING Short Term Disability

If you elect or apply for short‐term disability coverage, the elimination period is 7 calendar days for injury, 7 calendar days for sickness.

Short‐term disability benefits are payable for up to 6 months for injury or sickness during a continuous period of disability.

There is a 12 month pre-existing conditions clause.

Applications available during enrollment periods.

Total Dental Administrators Plan: A Dental Discount Program

TDA Plan Rates    Monthly Annual Annual

Employee Deduction

Employee Deduction

Premiums Premium Employee Cost 22 Pays 20 Pays

TDA Employee $ 9.50

$ 114.00

$ 114.00

$ 5.19

$ 5.71

Employee + Spouse

$ 18.78

$ 225.36

$ 225.36

$ 10.25

$ 11.28

Employee + One Child

$ 21.05

$ 252.60

$ 252.60

$ 11.49

$ 12.64

  Family $ 23.10

$ 277.20

$ 277.20

$ 12.61

$ 13.87

Exams and cleanings covered at 100% No deductible and no annual maximum Select dental office ahead of time Discounts on vision, hearing and prescriptions included in plan

Delta Dental Benefit Plan:A Dental Insurance Benefit

Delta Dental Checkup Plus Plan Rates    Monthly Annual Annual

Employee Deduction

Employee Deduction

Premiums Premium Employee Cost 22 Pays 20 Pays

Delta Employee $ 34.04

$ 408.48

$ 408.48

$ 18.58

$ 20.43

Employee + Spouse

$ 69.42

$ 833.04

$ 833.04

$ 37.88

$ 41.66

Employee + Child(ren)

$ 84.66

$ 1,015.92

$ 1,015.92

$ 46.19

$ 50.81

  Family $ 112.20

$ 1,346.40

$ 1,346.40

$ 61.21

$ 67.33

• Preventive care covered at 100%• Annual deductible and benefit maximum• Plan includes vision care savings through EyeMed

Vision Care

BASIC Flexible Spending Account (FSA) Do you pay medical expenses? Insurance premiums? Child

care?

A Flex Account can reduce some of the burden of medical, dental, vision and dependent care bills.

With BASIC Flex, you elect to have a certain dollar amount transferred from your paycheck into a special account to pay for expenses as they occur. This money is taken from your gross pay prior to taxes.

You save by not having to pay federal and most state and local taxes, as well as Social Security and Medicare taxes, on the amount you set aside.

IMPORTANT NOTE: If you have an HSA Account, then Flex is limited to Dental, Vision and Child Care.

VSP Vision Program

Vision Plan Rates

Monthly Annual AnnualEmployee Deduction

Employee Deduction

  Premiums Premium Employee Cost 22 Pays 20 Pays

VSP Employee $ 8.23

$ 98.76

$ 98.76

$ 4.50

$ 4.95

Employee + One

$ 11.93

$ 143.16

$ 143.16

$ 6.52

$ 7.17

Family $ 21.39

$ 256.68

$ 256.68

$ 11.68

$ 12.84

VSP Vision Services

In Network Pricing:

Well Vision Exam Every 12 months - Copay $10Prescription Glasses

Lenses Every 12 months - Copay $20 Frame Every 12 months - $130 Allowance; 20% off

amount over allowanceContact Lens Care - Fitting and evaluation - Copay $60

Contact Lenses - $130 Allowance

Additional discounts and savings on sunglasses and Laser Vision correction. Additional coverage for diabetic eye disease.

No insurance cards

Balsz School District Benefits: Information Online Pt.1

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Balsz School District Benefits: Information Online Pt.2

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