Full Time Employee Benefits

Package

2019

2019 SINGLE PLANS Pipestone County

What is My Monthly Premium?

Emerald Ruby Sapphire Diamond

Monthly Premium $557.06 $609.80 $653.30 $707.06

Monthly County

Contribution $616.50 $616.50 $616.50 $616.50

Your Cost ($59.44) ($6.70) $36.80 $90.56

Pipestone County also contributes $1,350.00 into a Health Savings Account annually for you and your family’s medical expenses.

-$2

,00

0$

0$

2,0

00

$4

,00

0$

6,0

00

Emerald Ruby Sapphire Diamond

$1,350 $1,350 $1,350 $1,350

$1,000 $2,000

$3,000

$5,200 $4,200

$3,200 $2,200

Cla

ims

Co

st

Plan Pays (claims beyond $6,550)

Member Pays

Plan Pays

HSA/VEBA

Preventive (covered 100%)

2019 FAMILY PLANS Pipestone County

What is My Monthly Premium?

Base Rate $_____________

Spouse Rate + $_____________

Child(ren) Rate + $_____________

Subtotal = $_____________

Employer Contribution - $824.00

Your monthly total or Your balance remaining for additional HSA contributions or other benefits (e.g., vision, dental)

=

$_____________

HSA Family Non-HSA Family

Base Rate $560.46 $922.96

Employer’s HSA/VEBA contribution

$2700.00 annual

$0.00

-$2

,00

0$

0$

2,0

00

$4

,00

0$

6,0

00

$8

,00

0$

10,

00

0

HSA Plan Non-HSA Plan

$2,700

$4,350

$5,475 $7,125 Individual deductible

$6,550

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ims

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Plan Pays (claims beyond $9,825)

Member Pays

Plan pays

HSA/VEBA

Preventive (covered 100%)

How much does it cost to include my family? Age-Banded Family Rate Schedule

Spouse Rates Age on 1/1/19 Rate Age on 1/1/19 Rate Age on 1/1/19 Rate 20 or under $255.92 35 $351.38 50 $513.54

21 $287.54 36 $353.68 51 $536.26

22 $287.54 37 $355.98 52 $561.28

23 $287.54 38 $358.28 53 $586.58

24 $287.54 39 $362.88 54 $613.90

25 $288.70 40 $367.48 55 $641.20

26 $294.44 41 $374.38 56 $670.82

27 $301.34 42 $381.00 57 $700.72

28 $312.56 43 $390.20 58 $732.64

29 $321.76 44 $401.70 59 $748.46

30 $326.36 45 $415.20 60 $780.38

31 $333.26 46 $431.30 61 $807.98

32 $340.16 47 $449.42 62 $826.10

33 $344.48 48 $470.12 63 $848.82

34 $349.08 49 $490.54 64 and over $862.62

Child(ren) Rates 1 Child $255.92

2+ Children $511.84

Pipestone County also contributes $2,700.00 into a Health Savings Account annually for you and your family’s medical expenses.

Costs summary

Employee + 1

child

Employee + 2

children

Employee /

Spouse

Employee /

Spouse/ Children

Monthly Premium $816.38 $1,072.30 Varies by age

of spouse

Varies by age of

spouse

Monthly County

Contribution $824.00 $824.00 $824.00 $824.00

Your Cost ($7.62) $248.30 varies varies

EMPLOYEE AND SPOUSE LIFE INSURANCE

The group pays for a Basic Life Insurance for eligible employees of $37,500

Benefit eligible employees may apply for additional life insurance for themselves and their spouse. Life insurance includes Accidental Death & Dismemberment.

Amounts of Insurance: Employee- Up to $300,000 in $5,000 increments Spouse- Up to $150,000 in $5,000 increments

Age of Employee Your Monthly

or Spouse Cost Per $1000 Under 25 $.06

25 to 29 $.06 30 to 34 $.06 35 to 39 $.10 40 to 44 $.12 45 to 49 $.17

50 to 54 $.25 55 to 59 $.45 60 to 64 $.68 65 to 69 $1.29 70 to 74 $2.08

CHILD LIFE ($1.30 / month per family)

Term life insurance protecting your children for $10,000 each is also available. Children are eligible from live birth to age 26. .

LONG TERM DISABILITY

□ Benefits begin after three months of a disability and are payable for injury, sickness or pregnancy up to your normal retirement age, as defined by Social Security. (ex. Age 65, 66, 67)

□ You may elect any level of coverage, in increments of $100 between $500 and $5,000 per month, provided you don’t insure more than 60% of your monthly income.

VISION INSURANCE –

The VSP vision care program is available for employees and their

dependents to help save on vision care costs.

The monthly rates are as follows:

Employee only: $6.31 Employee + Spouse $10.09

Employee + Child(ren): $10.32 Employee + Family: $16.57

Note: Because dental premiums are deducted on a pre-tax basis, your cost may be reduced on average between 27% and 39%;

depending on your tax bracket.

DENTAL INSURANCE – Health Partners

The Health Partners Voluntary Dental plan provides you the opportunity to save money on

dental care. See attached summary.

Monthly Rates

Employee $20.26

Employee + 1 $40.52

Family $60.78

Note: Because dental premiums are deducted on a pre-tax basis, your cost may be reduced on average between 27% and 39%;

depending on your tax bracket.

Voluntary Dental Plan

* If your out-of-network dentist charges more than the maximum allowable amount, you may be responsible for the difference.

Emergency Care

Refer to the Group Dental Member Contract for coverage of emergency dental services.

Little PartnersSM Benefit: Services for children 12 years old and under will be covered at 100% without

deductible, annual maximum, or frequency limitations, when provided by a HealthPartners network dentist.

Excluded services: Orthodontics, dental implants, services that are provided during the waiting period, and

services that are not covered for all members.

Diabetes and Pregnancy: Additional periodontal services (exams, cleanings, scaling and root planing, and

debridement) for our members who are diabetic and/or pregnant are covered at 100% in-network.

Deductibles, annual maximums, and frequency limitations will be waived on these specific services for

members referred into the program by a HealthPartners network dentist.

The following is an overview of your HealthPartners coverage. For exact coverage terms and conditions, consult your plan materials, or call Member Services at (952) 883-5000 or 1-800-883-2177.

Plan highlights

Partial listing of covered services

HealthPartners Network

Care from a network provider

No Network

Care from an out-of-network provider*

Single $20.26 Single + 1 $40.52 Family $60.78 Annual Maximum Annual maximums are combined in and out-of-network

Annual maximum Plan pays $750 per calendar year

Deductible Deductibles are combined in and out-of-network

- Applies to Basic Care, Special Care &

Prosthetics $50 per person per calendar year

Preventive and Diagnostic Care

- Teeth cleaning, exams, dental x-rays and

fluoride treatments

- Sealants

You pay nothing

You pay nothing

Basic Care (6 month waiting period**)

Basic Care I - Fillings (amalgam and anterior composite) You pay 50% You pay 50%

- Simple extractions You pay 50% You pay 50%

- Non-surgical periodontics You pay 50% You pay 50%

- Endodontics (root canal therapy) You pay 50% You pay 50%

Basic Care II - Posterior composite (white) fillings You pay 50% You pay 50%

- Surgical periodontics You pay 100% You pay 100%

- Complex oral surgery You pay 100% You pay 100% Special Care (12 month waiting period*)

- Restorative crowns & onlays You pay 100% You pay 100% Prosthetics (12 month waiting period*)

- Bridges, dentures & partial dentures - Dental implants

You pay 100% You pay 100%

Retirement Benefits

Public Employees Retirement Association (PERA) administers three defined benefit plans—The

General Plan, the Police & Fire Plan, and the Correctional Plan. PERA also administers the

Statewide Volunteer Firefighter Retirement Plan (SVFRP) and the Defined Contribution Plan (DCP).

General Plan: Members of this plan include employees from cities, counties, and school districts.

The General Plan is PERA’s largest plan.

Employee Contribution – 6.50% County Contribution – 7.50%

Police & Fire Plan: Members of this plan include most local governmental firefighters and law

enforcement officers who meet job-related duties specified by statute.

Employee Contribution – 11.30% County Contribution – 16.95%

Correctional Plan: Members of this plan are responsible for the security, custody, and control of the

correctional facilities and the inmates.

Employee Contribution – 5.83% County Contribution – 8.75%

DCP: Members are physicians, elected local government officials, city managers, and governmental

volunteer ambulance service personnel.

Employee Contribution – 5.0% County Contribution – 5.0%

Pipestone County also offers three different Deferred Compensation Plans (457b)

which are voluntary retirement accounts.