HUMAN RESOURCE BENEFITS AND REQUIREMENTS
Editor’s Note: Policies
included in this handbook are only those to which employees may need to refer
more frequently. No attempt is made in
this section to be all-inclusive.
Complete information on all policies may be found in Board Policy
Manuals available in each school library and from each school
Benefits are offered to all
employees who expect to work 30 hours or more per week for at least six months
per year. Part-time teachers are
eligible for health, dental, MoneyPlus and vision care on a prorated
basis. Below are insurance programs that
are offered by the state. Initial
enrollment must be made within 31 days of hire.
Complete descriptions and rules
for all insurance programs listed can be found in the Insurance Benefits Guide and are the responsibility of the
employee. New Insurance Benefits Guides are distributed to employees through the
District’s Pony mail each year in January.
Please call the Benefits Office to request an Insurance Benefits Guide if you did not receive one or it is
The State of
Late Entrant: To enroll in the State Health Plan as a late entrant, employees must enroll within 31 days of a special eligibility situation which may be marriage, birth, adoption, placement, or involuntary loss of other coverage applying only to those (spouses or eligible dependents) who lost the coverage or may enroll during an Open Enrollment*.
*Note: Open Enrollment is held in October of every ODD year (ex. 2003, 2005, 2007). All Open Enrollment changes take effect Jan. 1 of the following year.
Changes: Changes in coverage may be made during an Open Enrollment period or within 31 days of a status change. A status change may be marriage, birth, adoption, placement, legal custody, legal separation, divorce, death or change in job status.
Preexisting Condition: Benefits for a preexisting condition are payable only for treatment rendered 12 months after the enrollment date of a covered person. Certification of prior continuous coverage can be applied toward the waiting period for services related to a preexisting condition to be payable. One’s former insurance company provides this certification known as a Certificate of Creditable Coverage. This certificate must then be submitted to the Benefits Office so that it can be mailed to the Employee Insurance Program for processing.
Prescription Drug Program: The Prescription Drug Program is administered by Medco Health Solutions, Inc. An employee shows their State Health Plan identification card when purchasing prescriptions from a participating pharmacy and pays a copayment for either generic or brand name medications for up to a 31-day supply. If the price of the prescription is less than the copayment amount, an employee pays the lesser amount.
Additional Benefits: When an employee enrolls in the State Health Plan, he/she is provided with the following additional benefits at no charge (the employer pays the premiums):
¨ Basic Life Insurance - $3,000 coverage to employees under age 70 and $1,500 to employees age 70 or older
¨ Basic Long Term Disability – provides 62.5% of an employee’s basic monthly salary ($800 maximum) after a 90-day waiting period
What Is It? Medi-Call is the State Health Plan's utilization review program. Medi-Call makes sure you and your covered family members receive appropriate medical care in the most beneficial, cost-effective manner.
When Must I Call? Participation
in Medi-Call is mandatory. You must call 803-699-3337 in
inpatient care in a hospital;
outpatient surgery for septoplasty, hysterectomy or sclerotherapy;
You need a MRA,
MRI or CT Scan;
You will be
receiving chemotherapy or radiation therapy;
outpatient services result in a hospital admission (you must call again);
You need a second
You are admitted
to a hospital in an emergency situation (your admission must be reported within
48 hours or the next working day);
You are diagnosed
as being pregnant (you must call within the first three months of your pregnancy)*;
You have an
emergency admission during pregnancy*;
You deliver your
Your newborn has
complications at birth;
You are admitted
to a skilled nursing facility, utilize home health care, hospice care or an
alternative treatment program or need durable medical equipment;
You or your
covered family members decide to undergo any In Vitro Fertilization (IVF)
You or your
covered family member need to be evaluated for a transplant;
inpatient rehabilitative services and related outpatient physical, speech and
that may potentially be considered cosmetic in nature must be received in
writing by Medi-Call seven days prior to surgery (i.e., blepharoplasty,
reduction mammoplasty, TMJ or other jaw surgery).
*Contacting Medi-Call for the delivery of your baby does not add that baby to your health insurance. You must add your child by completing and filing an NOE with the Benefits Office within 31 days of birth for benefits to be payable. Medi-Call approval does not guarantee payment of benefits. Claim payments are still subject to the rules of the Plan.
The State of
State Optional Life
Optional Life is a term life plan insured by The Hartford. All eligible employees may enroll within 31 days of hire without medical evidence. Employees may elect coverage in $10,000 increments up to 3 times their basic annual earnings. Medical evidence of good health will be required to increase optional life, and it is necessary to refer to the Insurance Benefits Guide for specific rules as to when optional life increases and decreases are allowed. Premiums are calculated according to age and coverage amounts. Benefits are reduced for active employees who reach age 70.
Dependent Life Spouse and Child are insured by The Hartford. An employee may purchase Dependent Life Spouse coverage ($10,000 or $20,000) for their spouse. An employee may also purchase Dependent Life Child coverage ($10,000) for their eligible children. Employees may enroll their dependents within 31 days of hire or within 31 days of when an eligible dependent is acquired. Employees may enroll their spouses throughout the year by providing medical evidence of good health and may enroll their children throughout the year, but medical evidence is not required.
Employees may enroll in the Supplemental Long-Term Disability benefit, administered by Standard Insurance Company. Benefits are payable at 65% of an employee’s basic monthly salary ($8,000 maximum). Employees may choose one of two benefit waiting periods (90 day or 180 day). This is a coordinated benefit with Basic Long Term Disability, the State Retirement Disability, Social Security, annual leave, sick pay, Worker’s Compensation, etc. Premiums are based on salary, the benefit waiting period and age bracket.
MoneyPlus, administered by Fringe Benefits Management Company, is a flexible benefits program that helps an employee keep more spendable income by enabling an employee to pay health, dental and optional life premiums from their pretax income. MoneyPlus can be used to pay dependent-care expenses and out-of-pocket medical expenses with money that is not taxed. The three MoneyPlus features an employee can choose are the Pretax Group Insurance Premium Feature, the Dependent Care Spending Account, and the Medical Spending Account. Each benefit has its own small administrative charge.
VISION CARE PROGRAM
The Vision Care Program offers discounted vision care services to full-time or part-time employees, retirees and their dependents free of charge. An employee does not have to subscribe to the State Health Plan for vision benefits. Participating ophthalmologists charge no more than $50 for a routine, comprehensive eye exam. Participating providers, which also include opticians, give a 20% discount on all eyewear (except disposable contact lenses).
State Optional Retirement Program (ORP): A defined contribution plan. In a defined contribution plan, you invest your funds within the plan’s investment choices and then bear the risk, or enjoy the benefit, based on the performance of your investments. Your retirement benefit is based on the balance in your account when you retire.
For either plan, the employee contributes 6% of his/her salary and the district also makes a contribution. In addition, if an employee dies while actively employed, his/her beneficiary is entitled to an amount of life insurance equal to the annual salary of the employee (provided the employee has been employed for one year).