2021 BENEFITS GUIDE EMPLOYEE HEALTH & WELFARE - Grand Forks Public Schools
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EMPLOYEE
2021
HEALTH & WELFARE
BENEFITS GUIDEWHAT’S IMPORTANT
INSIDE CONTACTS
03 Eligibility
04 Medical
MEDICAL DENTAL
07 Virtual Care Medica Delta Dental
800-952-3455 800-448-3815
www.medica.com www.deltadentalmn.org
08 Omada
09 POPS
10 Vision
VISION FLEXIBLE SPENDING
Avesis ACCOUNT (FSA)
800-828-9341
11 Dental
www.avesis.com
Educators Benefit Consultants
1-888-507-6053
12 Basic Life, AD&D, LTD aviben.com
Supplmental Life
13 Insurance LIFE, ACCIDENTAL
DEATH AND
14 Whole Life Insurance EAP
DISMEMBERMENT UNUM/Health Advocate
15 Critical Illness (AD&D) 800-854-1446
UNUM www.unum.com/lifebalance
16 Accident Insurance Information: 800-421-0344 Uer ID and Password: lifebalance
Claims: 800-858-6843
www.unum.com
17 Short Term Disability
LONG TERM
Flexible Spending
18 Account DISABILITY (LTD)
VOLUNTARY UNUM
19
Aviben Mobile & WEX CRITICAL ILLNESS, 800-421-0344
Card www.unum.com
WHOLE LIFE &
21 WEX Card FAQ INDIVIDUAL STD
UNUM
TRAVEL
Employee Assistance 800-635-5597 ASSISTANCE
23 Program www.unum.com Assist America
800-872-1414
24 Retirement medservices@assistamerica.com
25 Enrollment Instructions
22 BENEFITSGUIDE
BENEFITS GUIDE || 2021
2020WHO’S ELIGIBLE FOR HEALTH & WELFARE
BENEFITS
ELIGIBILITY GUIDELINES Grand Forks Public Schools strives to provide a balanced,
All employees working at least 30 hours per week are comprehensive benefits program for their employees. The Grand
eligible for coverage on the first day of the month following Forks Public Schools Employee Benefits program offers you core
the date of hire with continuous full-time employment. Eligibility benefits, such as Medical, Dental, Vision and Life insurance as well as
hours vary for certain lines of coverage, these are noted in voluntary & supplemental benefits that help maximize your coverage
each benefits section. If you terminate employment or move to options.
a part-time status, your coverage will terminate on the last day This manual is designed to help you understand the coverage,
of the month the change/termination occurs. premiums and options for this year. This is a reference for you and
Please note: It is important that you enroll in a timely manner. your family to make informed insurance decisions based on your
If you do not enroll within your first 30 days of employment, specific needs.
you will not be eligible to enroll without a qualifying life event If you have questions, please contact your Human Resources
change until the next open enrollment period. Department.
ELIGIBLE DEPENDENTS Enroll in your benefits at www.grandforks.bswift.com.
+ Legal Spouse
INFORMATION FOR 2021
+ Children under age 26 for medical, dental and vision
There will be no rate or plan changes for medical, dental and vision
+ Children who are disabled, live with you and depend plans for this year. There are two plans to choose from for health
on you for support insurance: Altru & You with Medica or Medica Choice Passport.
Switching from one plan to the other is allowed during open
QUALIFYING LIFE EVENTS enrollment. Premiums depend on which plan you choose.
The following events allow you to change your benefits
Altru & You with Medica: This is a closed network, which means
outside the benefit enrollment period (July 29 - August 13,
medical services must be used at Altru or one of Altru’s preferred
2021)
providers; this is a coordinated care model or Accountable Care
+ You get married, divorced, or legally separated Organization (ACO).
+ You add a dependent child through birth, adoption, or Medica Choice Passport: This is an open network, which means
change in custody medical services can be used outside of the Altru network.
+ Your spouse or a dependent passes away Flex enrollment will be included in your benefits enrollment process.
The medical flex account maximum will remain at $2,750.
+ Your dependent loses coverage or gains other
coverage If you have a change in status, you must notify Human Resources to
complete the necessary change forms within 30 days of the change.
+ Your spouse loses or qualifies for coverage through his
You may need to present documentation, such as a social security
or her employer
card, birth certificate, marriage certificate, death certificate or divorce
Not sure if you have a qualifying event?
Need help changing your elections?
Please contact Human Resources.
2021 | BENEFITS GUIDE 3MEDICAL
PLANS
The Company’s Medical Plans are
administered by Medica. These plans
are designed to help you maintain your
health through preventive care services,
TERMS TO KNOW
access to an extensive network of
providers, and affordable prescription Co-pay—A fixed amount paid for
medication. receiving a specific healthcare service.
Deductible—The amount you pay for
WHAT IS A PPO PLAN? covered services before the Plan will pay.
PPO stands for “Preferred Provider
Co-insurance—Your share of the cost
Organization.” PPO Plans allow you
for covered services, calculated as a
to visit any in-network physician or
percentage of the total eligible expenses.
healthcare provider you wish without first
requiring a referral from a primary care Out-of-Pocket (OOP) Maximum—
physician. Protects you from major expenses with a
maximum annual limit on the amount you
WHAT IS AN ACO PLAN?
pay for covered services. Your OOP max FIND A NETWORK DOCTOR
An Accountable Care Organization, includes your deductible, co-insurance www.medica.com or call
ACO, is a group of doctors, hospitals and co-payments, but not your employee 1-800-952-3455.
and other healthcare providers that work contributions.
together to deliver the most coordinated WELCOME TO MEDICA!
treatment and care and may prevent you Once you reach the OOP max, the Plan
HTTP://GFSCHOOLS.STAGING.
from having costly tests and treatments pays 100% of covered services for the WELCOMETOMEDICA.COM/HOME
you may not need. remainder of the year.
4 BENEFITS GUIDE | 2021MEDICA CHOICE PASSPORT PLAN
Employees working 30 hours or more per week are eligible
Medica Choice Passport
Benefits In-Network Out-of-Network
Plan Year Deductible $1,000 Single $2,000 Single
$1,500 Single + Child(ren) $3,000 Single + Child(ren)
$2,000 Family $4,000 Family
Plan Year Out-of-Pocket $3,000 Single $6,000 Single
Maximum $4,500 Single + Child(ren) $9,000 Single + Child(ren)
$6,000 Family $12,000 Family
Preventive Care Covered 100% 40% AD
Office Visits $25 copay, then 20% 40% AD
Emergency Room $150 copay
Urgent Care $25 copay, then 20%
Inpatient Hospital 20% AD 40% AD
Outpatient Hospital 20% AD 40% AD
Chiropractic Visits $25 copay, then 20% 40% AD, 15 visits per year
Mental Health
Outpatient $25 copay, then 20% 40% AD
20% AD 40% AD
Inpatient
Prescriptions - Retail and Mail Order *In-network
Generic $15 copay, then 20%
Preferred Brand $20 copay, then 20%
Non-preferred Brand $20 copay then 50%
Specialty Preferred $20 copay, then 20%
Specialty Non-Preferred $20 copay, then 50%
AD= After Deductible
2021 | BENEFITS GUIDE 5ALTRU & YOU MEDICAL Altru & You
PLAN Benefits In-Network Out-of-Network
Employees working 30 hours or more per week Plan Year Deductible $1,000 Single $2,000 Single
$1,500 Single + Child(ren) $3,000 Single + Child(ren)
are eligible. $2,000 Family $4,000 Family
Plan Year Out-of-Pocket $3,000 Single $6,000 Single
Maximum $4,500 Single + Child(ren) $9,000 Single + Child(ren)
$6,000 Family $12,000 Family
Preventive Care Covered 100% 40% AD
Office Visits $25 copay, then 20% 40% AD
Emergency Room $150 copay
Urgent Care $25 copay, then 20%
Inpatient Hospital 20% AD 40% AD
Outpatient Hospital 20% AD 40% AD
Chiropractic Visits $25 copay, then 20% 40% AD, 15 visits per year
Mental Health
Outpatient $25 copay, then 20% 40% AD
20% AD 40% AD
Inpatient
Prescriptions - Retail and Mail Order *In-network
Generic $15 copay, then 20%
FIND A NETWORK DOCTOR Preferred Brand $20 copay, then 20%
To find a network doctor, visit Non-preferred Brand $20 copay then 50%
www.medica.com or call Specialty Preferred $20 copay, then 20%
Specialty Non-Preferred $20 copay, then 50%
1-800-952-3455
AD= After Deductible
6 BENEFITS GUIDE | 2021VIRTUAL CARE
You can access virtual care through 24/7 ACCESS TO CARE
providers in your plan’s network. Check
your virtual care options at Virtual care, also known as online care of an e-visit, is a convenient way to get care for many
Medica.com/FindaDoctor. Your virtual common conditions. Connect with a provider from your computer or mobile device to get a
care options may include: diagnosis, treatment plan and prescription (if needed).
With a virtual care visit, you:
AMWELL (In-Network for Medica and Altru)
• Save time – avoid a trip to the doctor’s office and get care from the comfort of your home,
Mobile - download the Amwell app
work or wherever you are
Web - visit Amwell.com/cm
• Initiate the visit at your convenience – no appointment needed
Phone - call 1-844-733-3627
• Get care when you need it – visits are often available after clinic hours, sometimes even
24/7
• May save money – a virtual care visit costs Grand Forks Public School plan participants only
VIRTUWELL (In-Network for Medica)
$10 copay + 20%, which is less than a regular doctor visit.
(Out of Network for Altru Plans)
Web - visit Virtuwell.com + Allergies + Cold and Cough + High Blood Pressure
+ Bladder Infection + Ear Pain + Migraines
+ Bronchitis + Flu + Pink Eye
SEE A DOCTOR OR THERAPIST:
1. Launch the online visits app or
website, and log in to your account
2. Choose a service: medical, therapy
or psychiatry
3. Pick a doctor or begin a scheduled
visit and enter your payment
information
4. Meet with a doctor or therapist online
5. Get a prescription, if appropriate,
sent to a local pharmacy
6. Send a visit summary to your primary
care doctor or other health care
provider at the end of the online visit
2021 | BENEFITS GUIDE 7OMADA
WHAT IS OMADA?
As a Medica member you can help reduce your risk for chronic disease through Omada, a digital lifestyle change program.
Combining the latest technology with ongoing personal support, you can make the changes that matter most - whether that’s around
eating, activity, sleep or stress. It’s an approach that can help you lose weight and reduce your risks for type 2 diabetes and heart
disease.
JOIN OMADA TO BUILD HEALTHY HABITS THAT LAST YOU WILL GET YOUR OWN:
Omada can help you learn how to make smart food choices, + An interactive program with an engaging app
discover easy ways to boost your activity and overcome
+ A wireless smart scale
challenges preventing you from getting healthier. You’ll get
support and strategies to motivate you to set and reach your + Weekly online lessons
goals. + A professional health coach
Eat healthier, move more: discover easy ways to sneak + A small online group of participants
healthy choices into daily life.
GET STARTED WITH OMADA
Develop a personalized plan: whether it is meditation or
Visit omadahealth.com/gfps
medication, zero in on your needs.
Track progress seamlessly: monitor your activity to discover $0 COST TO YOU!
what is (and is not) working.
If you or your adult dependents are Medica members and
Break barriers to change: gain powerful problem-solving skills are at risk for type 2 diabetes or heart disease, Omada is
to overcome challenges. available at no additional cost. Watch for more program
information from your employer when your Medica health
Feel healthy for life: set and reach your evolving goals with
plan starts.
strategies and support.
*Omada is not available with all Medica health plans. To check if you are eligible for this benefit, call Medica Customer Service. The
number is on the back of your ID card.
8 BENEFITS GUIDE | 2021POPS
POPS DIABETES CARE
As a Medica member, you now have the option of participating on the Pops Diabetes Management program. This health and wellness
benefit is available to employees and their dependents that are covered under the Medica Health Plan and have been diagnosed
with diabetes. We are partnering with Pops Diabetes Care to offer a simple solution for managing diabetes. No need to carry around
a separate meter, lancets, lancet device, and test strips. It’s all-in-one, and at no cost to you!
How to Enroll
1. Download the Pops Rebel app from the App Store or Google Play
2. Open the app and select “I’m New Here”
3. Enter your personal details including your name, address, member ID
listed on your Medica ID card and Customer Code: 52GFS.
4. Receive your welcome kit in the mail about seven business days after
you enroll. Your welcome kit will include your testing equipment and
supplies along with instructions.
It’s Different. It’s Unique. You won’t ever be defined by diabetes again - Own Your LIfe.
Pops Support Squad
1-800-767-7268 | supportsquad@popsdiabetes.com | popsdiabetes.com
2021 | BENEFITS GUIDE 9VOLUNTARY Comprehensive Exam
In-Network
$10 copay
Out-of-Network
Up to $35
VISION PLAN (every 12 months)
Standard Plastic Lens
Single $10 copay Up to $25
Employees working 30 hours or more per
week are eligible. Bifocal $10 copay Up to $40
Trifocal $10 copay Up to $50
The Company offers a comprehensive
Vision Plan provided by Avesis. The Vision Standard Frames Up to $150 allowance Up to $45
Plan helps pay the cost of periodic eye Contacts (in lieu of frames) Up to $130 allowance $110
examinations and necessary lenses and
Medically Necessary Covered in full $250
frames, if prescribed. The Plan covers
(Pre-Auth required)
services from any licensed provider, but
benefits are paid at a higher level when
you use an in-network provider.
Coverage Type Employee Cost Per Year
In-network co-payments are paid directly
Employee $92.16
to the provider. Out-of-network co-
payments are deducted from the out-of- EE + 1 $161.04
network reimbursement. Family $239.40
Vision Plan
LOOKING FOR AN IN-NETWORK PROVIDER? In-Network
Highlights
For more information about the Vision Plan, and Examinations One every 12 months
to find in-network doctors visit:
Lenses Once every 12 months
www.avesis.com or call 1-800-828-9341
Frames Once every 24 months
LASIK PROVIDER:
877-712-2010
10 BENEFITS GUIDE | 2021DELTA DENTAL PLAN
Your dental health is a priority. We offer generous coverage through
Delta Dental of Minnesota.
VOLUNTARY
The Dental Plan encourages preventive treatment and allows you to
achieve good oral health while minimizing your out-of-pocket dental
DENTAL PLAN
expenses.
Employees working 30 hours or more
Your out-of-pocket costs will be lower and you may even qualify for per week are eligible.
in-network discounts. How?
Check your ID card for your Network. Go online to:
www.deltadentalmn.org or call 800-247-4695.
Select the PPO & Premier Networks.
In-Network Out-of-Network
Plan Year Deductible $50 Individual $50 Individual
$150 Family $150 Family
Annual Benefit Maximum $1250 per participant $1250 per participant
Preventive & Diagnostic Covered 100% 100% of maximum
(Deductible Does Not Apply) allowable fee
Basic Services 20% AD 20% of maximum
(Fillings, Extractions) allowable fee
Major Restorative Services 50% AD 50% of maximum
(Crown, Root Canal, Implants) allowable fee
Orthodontics - Adult Not Covered
Orthodontics - Dependent Not Covered
Child(ren) under age 19
AD=After Deductible
Coverage Type Employee Cost Per Year
Employee $519.36
EE + Spouse $1171.20
Employee + Child(ren) $999.12
Family $1671.36
LOOKING FOR A DENTIST?
Visit deltadentalmn.org or call
1-800-448-3815
PPO & Premier Networks
2021 | BENEFITS GUIDE 11BASIC LIFE, AD&D AND
LTD BENEFITS
BASIC LIFE AND AD&D
Grand Forks Public Schools provides basic life coverage as well as Accidental Death and Dismemberment coverage
for all active employees working as follows:
Certified: 15 hours or more per week; Classified: 30 hours or more per week.
Basic Life and AD&D Benefits
Administrator $50,000
Certified & Classified $15,000
Accidental Death (AD&D) Mirrors Basic Life
Accelerated Death Benefit Pays a portion of the insured employee’s life benefit in the event the insured employee
becomes terminally ill, and the employees life expectancy has been reduced to less than
12 months.
Age Reduction Reduces to 92% of the original amount at age 65, reduces to 84% at age 66, 76% at age
67, 68% at age 68, 60% at age 69 and 50% at 70+ years.
Monthly Premium 100% Employer Paid
LTD COVERAGE
Grand Forks Public Schools provides LTD coverage for all active employees working as
follows:
Certified: 15 hours or more per week; Classified: 30 hours or more per week.
Long Term Disability
Maximum Benefit 66.67% to a defined maximum
Benefit Duration Age at Disability Maximum Period of Payment
(varies by the age of the Less than age 60 To age 65, but not less than 5 years
employee) Age 60 through age 64 5 years
Age 65 through age 69 To age 70, but not less than 1 year
Age 70+ 1 year
Elimination Period After 90 days or end of sick leave (whichever is greater)
Coverage Basis Administrators/Teachers Classified Employees
2 year own occupation Any occupation day one
Emergency Travel Assist Guaranteed hospital admission; Emergency medical evacuation; Prescription replacement
(when traveling 100 or more
miles; or to another country)
Monthly Premium 100% Employer Paid
12 BENEFITS GUIDE | 2021VOLUNTARY - SUPPLEMENTAL LIFE
INSURANCE
SUPPLEMENTAL LIFE INSURANCE
Supplemental Life Insurance is in addition to the basic life insurance. Supplemental Group Life Insurance provides term
life insurance at low rates. Current coverage includes financial protection in the event you, your spouse and/or one of
your dependents die while covered under this benefit.
Employees working as follows are eligible:
Certified: 15 hours or more per week; Classified: 30 hours or more per week
Voluntary Life Benefits
Certified & Classified Option of $20,000 or $40,000
Administrator $50,000
Dependent - Spouse and/or Children $5,000 per dependent
Accelerated Death Benefit Pays a portion of the insured employee’s life benefit in the event the
insured employee becomes terminally ill, and the employees life
expectancy has been reduced to less than 12 months.
Age Reduction Reduces to 92% of the original amount at age 65, reduces to 84%
at age 66, 76% at age 67, 68% at ae 68, 60% at age 69 and 50%
at 70+ years.
Guaranteed Issue If you enroll within 31 days of becoming eligible, then you qualify for
the Guaranteed Issue amounts listed without having to prove good
health. **
Late Enrollment If you do not enroll in the first 31 days of employment and want to
add the coverage at a later date, you will need to wait until the next
benefit enrollment period. At that time, you will have to provide proof
of good health. This may include a physical examination.
** Delayed Effective Date: Employee: Insurance coverage will be Coverage Amounts Annual Rates
delayed if you are not in active employment because of an injury, $20,000 $60.00
sickness, temporary layoff, or leave of absence on the date that
insurance would otherwise become effective. Regularly scheduled $40,000 $120.00
vacation time is considered active employment. $50,000 $150.00
Dependent: Insurance coverage will be delayed if the dependent Dependent $23.76
is totally disabled on the date that insurance would otherwise be
effective. Exception: infants are insured from live birth. “Totally
Disabled” means that, as a result of an injury, a sickness or a disorder,
your dependent is confined in a hospital or similar institution; confined
at home under the care of a physician for a sickness or injury.
2021 | BENEFITS GUIDE 13VOLUNTARY - WHOLE LIFE
INSURANCE
WHOLE LIFE INSURANCE
Grand Fork Public Schools offers voluntary Whole Life Insurance. Through UNUM, eligible employees can purchase permanent whole
life insurance for themselves, spouse, and dependents.
EMPLOYEE: Guaranteed issue for newly eligible in amounts up to $70,000; in $10,000 increments
SPOUSE: Guaranteed issue for newly eligible in amounts up to $30,000; in $10,000 increments
CHILD(REN): Guaranteed issue for amounts up to $3 a week.
Child Term Rider available in the amount of $10,000.
ELIGIBILITY
Employees working 30 hours or more per week are eligible. Spouses must be between the ages of 17 and 64. This benefit can be
added during initial eligibility period for new hires or during the district benefit enrollment period.
ADDITIONAL FEATURES
+ Individual Policies are owned by you; completely portable if you change jobs or retire.
+ Rates and amount of coverage will NOT CHANGE as you age.
+ Policy earns cash value at a guaranteed interest rate.
Who can have it? What’s the benefit amount? How long can they keep it?
Individual employee coverage You can choose to purchase $10,000, You can keep it as long as you want. If
$20,000, $30,000, $40,000, $50,000, you leave your employer, you would be
Ages 15-80
$60,000 or $70,000 of coverage for billed directly at home.
yourself.
Individual spouse coverage? You can choose to purchase $10,000, If you leave your employer, you can keep
$20,000, or $30,000 of coverage for your spouse’s policy and be billed directly
Ages 17-64
your spouse at home.
Individual child coverage You can purchase coverage for as low as Your children can keep it, even if you
$1 a week. Benefit amounts are based leave your employer. You would be billed
No employee or spouse purchase
on the child’s issue age and premium directly at home.
needed. Available to eligible children,
selected.
stepchildren, legally adopted children or
grandchildren (14 days until their 26th
birthday) of the primary insured adult.
Child Term Life Benefit $1,000 to $10,000 - one rider covers all children. Coverage ends when your policy ends or when the
children turn 25. At that time, children are guaranteed
With pruchase of employee or spouse policy,
the right to buy an individual Whole Life Policy at 5
available to eligible children, legally adopted
times the amount of their rider.
children and stepchildren (14 days until their 25th
birthday of the primary insured adult.
14 BENEFITS GUIDE | 2021VOLUNTARY -
CRITICAL ILLNESS
COVERED ILLNESSES & PAYMENT PERCENTAGES (NOT
ALL INCLUSIVE)
+ Heart Attack: 100% Grand Fork Public Schools offers voluntary Critical Illness
Insurance. Critical Illness Insurance is designed to protect your
+ Stroke: 100%
income and personal assets when your out-of-pocket expenses
+ Major Organ Failure: 100% increase as a result of an illness. Health insurance is not always
+ End Stage Renal (Kidney) Failure: 100% enough to cover all of the unforeseen expenses associated with
a serious medical condition like a heart attack or cancer.
+ Cancer - Malignant Tumors: 100%
CRITICAL ILLNESS INSURANCE
+ Coronary Artery Bypass Surgery: 25%
This pays a lump sum benefit that can be used any way you
+ Carcinoma in Situ: 25%
choose, and benefits are paid in addition to any other insurance
coverage you may have.
PLAN FEATURES
+ Coverage is Guaranteed Issue for amounts up to ELIGIBILITY
$30,000 for employee, $15,000 for the spouse and 50% Employees working 30 hours or more per week are eligible.
of the employee coverage amount for dependent children, Spouse must be between the ages of 17and 64. This benefit can
which means you will not be asked medical questions. be added during initial eligibility period for new hires or during
+ A health Screening Benefit Rider is included. the district benefit enrollment period.
+ Coverage is portable - you can take your policy with you
if you change jobs or retire.
+ Rates based on age and tobacco use.
+ 30 day benefit waiting period
+ 12/12 pre-existing condition limitation. This means
UNUM will not pay benefits for a claim that is caused
by, contributed to, or occurs as a result of a pre-exisiting
condition or any medical or surgical treatment for that
condition for which the date of diagnosis occurred during
the previous 12 months until you’ve been covered for 12
months.
+ For 2 or more covered illnesses, there needs to be a
separation period of 90 days and can’t be medically
related.
2021 | BENEFITS GUIDE 15VOLUNTARY - ACCIDENT INSURANCE ACCIDENT INSURANCE Grand Fork Public Schools offers voluntary Accident Insurance. UNUM’s Accident Insurance pays benefits based on the injury you receive and the treatment you need including emergency-room care and related surgery. The benefit can help offset the out-of-pocket expenses that medical insurance does not pay, including deductibles and co-pays. Benefits are paid for accidents that occur off-the- job. You can also elect to cover your dependents. EXAMPLES OF COVERED INJURIES AND ACCIDENT RELATED EXPENSES INCLUDE: + Hospitalization + Emergency room treatment + Fractures and dislocations + Physical Therapy + Doctor’s visits ELIGIBILITY Employees working 30 hours or more per week are eligible. Spouses must be between the ages of 17 and 64. This benefit can be added during initial eligibility period for new hires or during the district benefit enrollment period. ADDITIONAL FEATURES Your coverage is portable, which means you can take your policy with you if you leave the company. Policy pays the benefit directly to you, not the doctor or hospital. Wellness Benefit pays you $50/year for having a qualified screening exam. 16 BENEFITS GUIDE | 2021
VOLUNTARY - INDIVIDUAL
SHORT TERM DISABILITY
COVERAGE IS FOR EMPLOYEE ONLY SHORT TERM DISABILITY
(rates are based on salary and coverage A disabling injury or illness that keeps you out of work could have a devastating impact
elected) on your income, jeopardizing your ability to cover normal household expenses. With
the right disability insurance, your income is protected, relieving you of the anxiety of
+ Benefit Percentage: Options
depleting your savings to pay your bills.
of 40%, 50%, or 60% of base
earnings ELIGIBILITY
+ Maximum Benefit Amount: $3,000 Employees working 30 hours or more per week are eligible. This benefit can be added
during initial eligibility period for new hires or during the district benefit enrollment
+ Elimination Period Accident: 14
period.
Days
Short Term Disability Insurance replaces a portion of your income if an injury or illness
+ Elimination Period Sickness: 14
forces you out of work for an extended period of time.
Days
+ Benefit Period: 12 weeks
+ Eligibility: 30 or more hours week
+ Age Issuance: 17 to 69 years old
2021 | BENEFITS GUIDE 17VOLUNTARY
FLEXIBLE
SPENDING
ACCOUNTS
HEALTHCARE FSA
The Medical FSA allows you to set aside pre-tax money to pay for a variety of
qualified medical, dental, vision and pharmacy expenses. Some examples of
WHAT IS A FLEXIBLE SPENDING eligible health care expense are:
ACCOUNT?
+ Deductibles
The flexible spending account (FSA) is an
optional account where you can set aside money + Copays and coinsurance
for health care expenses and/or Dependent
+ Non-cosmetic procedures not covered by your medical or dental plan
Care on a pre-tax basis. In order to participate
in the Medical FSA you must be eligible to + Contact lenses and glasses
participate in your employer sponsored group + Hearing aids and eye surgery
health plan or another family member’s group
health plan. 2021 annual maximum contribution for your Medical FSA is
$2,750.
DEPENDENT CARE FSA
The Dependent Care FSA can be used to pay for A complete list of qualified expenses can also be found in IRS Publication 502 -
day care expenses for eligible dependents under Medical and Dental Expenses.
age 13, as well as adults who are physically or Participants have a 21/2 month grace period after the plan year ends to incur
mentally incapable of caring for themselves. eligible expenses. Participants have six months after this grace period to submit
2021 annual maximum contribution for the expenses that were incurred.
Dependent Care is $5,000 if you file your taxes
as married filing jointly or $2,500 per year if PLAN CAREFULLY! GROUP-TERM LIFE INSURANCE FSA
filing separately. Group-term life insurance FSA is for
• Annual contribution amounts you
certain life insurance premiums for
OUTSIDE HEALTH FSA elect must be set during enrollment
employer sponsored plans where
and can not be changed except for
Outside Health FSA is for certain limited policy coverage is for the employee only.
changes in family status.
insurance premiums individually purchased such
• Expenses must be incurred within the Note: Current participants must
as cancer policy premiums (as long as there
enroll each year to continue
is no return of premium feature in the plan), plan year and the 21/2 month grace
participating. Enrollment does NOT
hospitalization insurance premiums, specific period - This benefit is a “use it or
carry forward year to year.
illness policy premiums, and accidental death lose it”
and dismemberment policy. • IRS governed, save receipts!
No individually-purchased overall health or
HOW TO FILE A FLEX CLAIM
exchange purchase health policy premiums are
Go to gfschools.org/benefits to
allowed in this category.
find “How to File a Flex Claim”
18 BENEFITS GUIDE | 2021AVIBEN MOBILE BENEFITS
& WEX CARD
Introducing a different way to manage your healthcare finances.
With Aviben Mobile Benefits and the whole new WEX Health Payment card, managing your FSA account is easier than it’s ever been.
Make payments with ease
All it takes is a swipe of your benefits debit card to pay for a healthcare expense. Payments are automatically withdrawn from your
reimbursement account, so there are no out-of-pocket costs. And because the majority of your purchases are verified (or substantiated)
at the point of purchase, you will need to submit fewer receipts manually*. You can also have reimbursements direct deposited to the
account of your choice, select to pay the provider directly, and schedule recurring payments such as monthly prescriptions.
*Receipts may be required upon request in accordance to plan rules.
Access your accounts anytime, anywhere
With Aviben Mobile Benefits, you can get to the healthcare account
information you need—fast. Wondering whether you have enough money to
pay a bill or make a purchase? puts the answers at your fingertips.
• Quickly check available balances and account details for medical
and dependent care FSA, HSA, HRA, VEBA, 501(C)(9), and premium
reimbursement plans
• View charts summarizing account information
• Set account alerts and get notifications via text message
• View claims requiring receipts
• Link to an external web page to obtain helpful information such as a list of
eligible expenses
• Retrieve a lost username or password
• Use your device of choice – including iPhone®, iPad®, iPod touch®
and Android™ smartphones and tablet devices
2021 | BENEFITS GUIDE 19AVIBEN MOBILE BENEFITS
& WEX CARD CONTINUED
Get up and going quickly
Even if this is the first time using benefits software, you’ll find the experience is intuitive and easy-to-use; most importantly, you’ll have
24/7 access to your benefit accounts. When you log in to your portal, you can:
• See your balances in real- time
• File claims
• Upload receipts
• Visualize spending with charts and graphs
You’ll find everything you need to manage your healthcare finances simply.
See it, plan for it, manage it
Planning and budgeting for healthcare expenses is an important part of managing your finances. The consumer portal provides the
information you need to stay on top of your family’s healthcare expenses. Use the dashboard to dynamically interact with expenses
and claims. Graphic displays provide you with numbers that help you:
• Analyze out-of-pocket expenses
• Identify the providers who you’re spending the most money with
• Manage your HSA investments like your 401K
• Compare expenditures year-to-year
Save time
All the reasons mentioned so far will help save you time, but there are many more
ways to streamline your healthcare management. You can:
• Set up text alerts to be notified automatically when a contribution posts, a
deduction goes through or your account reaches a pre-set balance that you
determine
• Quickly locate forms you need for processing
Managing your healthcare and taking control of your decisions has never been
more convenient and fast, so you can spend more time doing the things you love
without the hassle or worry. If you have any questions, please contact HR.
20 BENEFITS GUIDE | 2021WEX HEALTH PAYMENT CARD FAQ
1. What is the WEX Health Payment card?
The all new WEX Health Payment card is a special-purpose Visa® card that gives participants an easy, automatic way to pay for eligible health
care/benefit expenses. The Card lets participants electronically access the pre-tax amounts set aside in their respective employee FSA benefits
accounts.
2. How does the WEX Health Payment card work?
The value of the participant’s account(s) contribution is stored on the benefits debit card. When participants have eligible expenses at a business that
accepts benefit debit cards, they simply use their Card. The amount of the eligible purchases will be deducted – automatically – from their account
and the pre-tax dollars will be electronically transferred to the provider/merchant for immediate payment.
3. Is the WEX Health Payment card just like other Visa® Card?
No. The WEX Health Payment card is a special-purpose Visa Card that can be used only for eligible health care/benefits expenses. It cannot be
used, for instance, at gas stations or restaurants. There are no monthly bills and no interest.
4. How many WEX Health Payment cards will the participant receive?
The participant will receive two Cards. If participants would like additional Cards for other family members, they should contact their Plan
Administrator at the telephone number or website address printed on the back of the Card.
5. Will participants receive a new WEX Health Payment card each year?
No. Although you must re-enroll each year to use the card, participants will not receive a new Card each year. If the participant will again have a
benefit associated with the Card for the following plan year – and he/she used the Card in the current benefit year – the participant will simply keep
using the same Card the following year. The Card will be loaded with the new annual election amount at the start of each plan year or incrementally
with each pay period, based on the type of account(s) the participant has.
6. What if the WEX Health Payment card is lost or stolen?
Participants should call their Plan Administrator at the telephone number or website address printed on the back of the Card. Report a Card lost or
stolen as soon as they realize it is missing, so the Administrator can turn off their current Card(s) and issue replacement Card(s). There may be a fee for
replacement cards.
7. What dollar amount is on the WEX Health Payment card when it is activated?
The dollar value on the Card will be the annual amount that participants elected to contribute to their respective employee benefit account(s) during
their annual benefits enrollment. It’s from that total dollar amount that eligible expenses will be deducted as participants use their Cards or submit
manual claims.
8. Where may participants use the WEX Health Payment card?
IRS regulations allow participants to use their WEX Health Payment cards in participating pharmacies, mail-order pharmacies, discount stores,
department stores, and supermarkets that can identify FSA-eligible items at checkout and accept benefit prepaid cards. Eligible expenses are
deducted from the account balance at the point of sale. Transactions are fully substantiated, and in most cases, no paper follow-up is needed.
Participants can find out which merchants are participating by visiting the web site on the back of the Card or consulting with Aviben.
Participants may also use the Card to pay a hospital, doctor, dentist, or vision provider that accepts prepaid benefit cards. In this case, auto-
substantiation technology is used to electronically verify the transaction’s eligibility according to IRS rules. If the transaction cannot be auto
substantiated, paper follow-up will be required.
9. Are there places the WEX Health Payment card won’t be accepted?
Yes. The Card will not be accepted at locations that do not offer the eligible goods and services, such as hardware stores, restaurants, bookstores,
gas stations and home improvement stores.
Cards will not be accepted at pharmacies, mail-order pharmacies, discount stores, department stores, and supermarkets that cannot identify HSA/
FSA-eligible items at checkout. The Card transaction may be declined. Participants can find out which merchants are participating by visiting the web
site on the back of the Card.
2021 | BENEFITS GUIDE 21WEX HEALTH PAYMENT CARD
FAQ CONTINUED
10. If asked, should participants select “Debit” or “Credit”?
If the participant has elected to use a PIN (Personal Identification Number) with their WEX Health Payment card, they should select “Debit” and enter
the PIN when prompted. If the participant is not using a PIN with their WEX Health Payment card, they should select “Credit” and will be asked to
sign for the benefit card purchase. Participants cannot get cash with the WEX Health Payment card.
11. Why do participants need to save all of their itemized receipts?
Participants and their other eligible users should always save itemized receipts for FSA purchases made with the WEX Health Payment card. They
may be asked to submit receipts to verify that their expenses comply with IRS guidelines. Each receipt must show: the merchant or provider name, the
service received, or the item purchased, the date and the amount of the purchase. The IRS requires that every card transaction must be substantiated.
This can occur through automated processing as outlined by the IRS (e.g. copay matching, etc.). If the automated processing is unable to substantiate
a transaction, the IRS requires that itemized receipts must be submitted in order to validate expense eligibility.
12. How will a participant know to submit receipts to verify a charge?
The participant will receive a letter or notification from their administrator if there is a need to submit a receipt. All receipts should be saved per the IRS
regulations.
13. What if a participant fails to submit receipts to verify a charge?
If receipts are not submitted as requested to verify a charge made with WEX Health Payment card, then the Card may be suspended until receipts
are received. The participant may be required to repay the amount charged.
14. May participants use the WEX Health Payment card for prescriptions ordered prior to activating the Card?
No. The Card must be activated prior to the order and/or purchase date of prescriptions. In some cases, participants need to wait 1 business day
after activating the Card to purchase prescriptions at their pharmacy. For example, if the Card is activated on Tuesday, a prescription can be ordered
and picked up on Wednesday.
15. May participants use the WEX Health Payment card if they receive a statement with a Patient Due Balance for a
medical service?
Yes. As long as they have money in their account for the balance due, the services were incurred during the current plan year, and the provider
accepts prepaid benefit debit cards, participants can simply write the Card number on their statement and send it back to the provider.
16. What if participants have an expense that is more than the amount left in their account?
When incurring an expense that is greater than the amount remaining in their account, participants may be able to split the cost at the register. (Check
with the merchant.) For example, participants may tell the clerk to use the WEX Health Payment card for the exact amount left in the account, and then
pay the remaining balance separately. Alternatively, participants may pay by another means and submit the eligible transaction manually via a claim
form with the appropriate documentation.
22 BENEFITS GUIDE | 2021EMPLOYEE ASSISTANCE
PROGRAM (EAP)
An Employee Assistance Program (EAP) offers short-term counseling on all aspects of life. Grand Forks Public Schools provides this
program at no additional cost to you. Employees and household members can confidentially address and resolve personal and
work related challenges including:
EVERY DAY CHALLENGES
+ Childcare and/or eldercare referrals
WHO IS COVERED?
+ Personal relationship information Unum’s EAP services are available to
+ Health information and online tools all eligible employees, their spouses or
domestic partners, dependent children
+ Legal consultations with licensed attorneys
and parents-in-law
+ Financial Planning Assistance
+ Career Development
PROTECT YOURSELF FROM FINANCIAL FRAUD
ALWAYS BY YOUR SIDE
+ Online research and information on ID theft and financial fraud
+ Expert support 24/7
+ Toll-free telephone access to master’s level work-life balance consultants
+ Convenient website
+ Referrals to a local counselor
+ Short-term help
WILL PREPARATION
+ Referrals for additional care
+ Estate Planning
+ Monthly webinars
+ Advance directive or living will
+ Medical Bill Saver
+ Power of Attorney
- helps you save on medical bills
+ Final arrangements memorandum
HELP IS EASY TO ACCESS
+ Telephone Consultations: Speak confidentially with a master’s level
consultant to clarify your need, evaluate options and create an action
plan
+ Face-to-Face meeting: Meet with a local consultant up to 3 times per
issue for short-term problem resolution
+ Educational materials: Receive information through our online library of
downloadable materials and interactive tools
Confidential assistance is available 24 hours a day, 7 days a week
1-800-854-1446 | www.unum.com/lifebalance
Username and Password: lifebalance
2021 | BENEFITS GUIDE 23RETIREMENT INFORMATION TEACHERS & ADMINISTRATORS Certified teachers and administrators participate in the North Dakota Teacher’s Fund For Retirement (TFFR) program. TFFR was established under North Dakota Century Code to provide retirement income to public educators. It is a qualified defined benefit public pension plan covered under Section 401(a) of the Internal Revenue Code. In 2015-2016, ND state law requires that 11.75% of your salary is deducted from payroll for this program. The school District contributes an additional 12.75% on your behalf. Social Workers, Occupational Therapists, and Physical Therapists, covered under the teacher negotiated agreement but not eligible to participate in the TFFR program, and non-certified administrators will authorize an 11.75% payroll deduction to a Tax Sheltered Annuity (TSA/403b) and receive a 12.75% employer contribution to this account. The employee must open an account with a Vendor from the approved vendor list. In addition, TFFR covered teachers and administrators have the opportunity to authorize a payroll deduction to a Tax Sheltered Annuity (TSA/403b). There are no employer contribution in this circumstance. CLASSIFIED EMPLOYEES For Classified Employees working 30 hours or more per week, the School District matches the employee’s contribution to a Tax Sheltered Annuity (TSA/403b), dollar for dollar, up to 5.0% of the employee’s earnings. This contribution must be made through payroll deduction. TSA/403b deductions are FICA taxable only. Employees working less than 30 hours per week may contribute to a TSA/403b through payroll deduction without an employer match. To participate, an employee must have an account established with a Vendor from the approved list (contact Human Resources). Employees can start, suspend, or change the contribution amount at anytime. 24 BENEFITS GUIDE | 2021
ENROLLMENT INSTRUCTIONS
LOG IN ENROLLMENT: THREE STEPS
URL: www.grandforks.bswift.com
Please note: you must complete all steps of your enrollment in
Username: Your username is your Employee ID located on your order for your elections to be saved!
badge.
Click the Start Your Enrollment button to get started. You
Password: Your birth date (MMDDYYYY). You will be prompted may access your confirmation statement and other important
to change your password when you log in. documents from this page at any time.
If you need more help or information on this process, please
reach out to your Human Resources Department.
2021 | BENEFITS GUIDE 25STEP 1: VERIFY YOUR PERSONAL AND FAMILY + If you would like to waive coverage, scroll to the bottom of the
INFORMATION benefit plan’s page and select the “Waive Medical” plan.
Personal Information
+ When you have finished making all of your benefit elections
+ Verify your personal information for accuracy and fill in any (the boxes will have a green checkmark and be marked √
required fields. If you need to make changes to any non- Completed), click the Continue button on the right hand side of
editable fields, please contact HR. the screen. If you would like to edit any of your selections, click
on the plan’s View Plan Options button. Note: you will not be
+ Verify that all information is accurate.
able to complete your enrollment until each benefit has been
+ Check the checkbox next to “I agree.” completed.
+ Click the Continue button. + If applicable, you will be taken to Beneficiary Designation,
Family Information Questions, or Other Coverages pages.
+ Please be sure to add all dependents to the Family Information BENEFICIARIES
section before proceeding to the next section (enrollment). To + You may add beneficiaries that are not your dependents
do so, click on the + Add Dependents link. To edit an existing (parents, siblings, etc) by clicking + Add New Beneficiary. Enter
dependent, click on Edit > under his or her name. all required information and then click Save or Save & Add
+ Once you have finished entering a dependent, you may either Another.
Save & Add Another or Save & Continue. + You may split the amount amongst your beneficiaries, but both
+ After confirming all your family information is accurate, check the primary and secondary percentages must total 100%.
box next to “I agree.” + When you are finished with beneficiaries, questions, and/or
+ Click the Continue button to proceed with your enrollment. other coverages, click the Continue button to proceed to the
final step of enrollment.
STEP 2: SELECT YOUR BENEFITS
STEP 3: LAST STEP - CONFIRM AND SAVE YOUR ELECTIONS!
After completing your personal and family information, you will be
taken to Your Benefits page. During this portion of the enrollment, + Please review your selections
you will be able to view and edit you and your dependents’ benefit If needed, you may still edit your elections by clicking Edit Selection
elections. You must make an election, whether enrolling or waiving, on the bottom of any plan type.
in each box with the *Selection Required warning before you may
+ Please read over any agreement text at the bottom of the page.
continue to the next step. As you make your elections, your total cost
per pay period will accumulate on the right side of the screen. + Check the “I agree, and I’m finished with my enrollment”
checkbox and click the Complete Enrollment button.
+ Under each plan type, you may keep your prior selection,
waive, or View Plan Options to see what choices are available CONFIRMATION STATEMENTS
to you.
When you reach the Confirmation Statement (pictured below), you
+ If you click View Plan Options, you will be asked to choose have completed your enrollment.
any dependents you intend to cover on this plan. You will also
be able to make changes on the next step.
+ Click Continue.
+ As you add and remove dependents, the costs and tiers next to
each plan will change. Click the blue arrow next to the cost to
view the company contribution. + You may access a copy of your confirmation statement at any
time by clicking My Benefits in the upper right-hand corner of
+ To view all plan details next to each other, click the View All
your homepage.
Plans Side-by-Side button; or for just one plan, click View plan
details underneath the plan name. + You may edit your enrollment until the end of your enrollment
window by clicking the Change My Elections button on your
+ When you have decided on a plan, click the Select button to
homepage.
the right of the plan name.
26 BENEFITS GUIDE | 2021IMPORTANT NOTICES
HIPAA PRIVACY NOTICE FAMILIES
A portion of the Health Insurance Portability and Accountability Act of If you or your children are eligible for Medicaid or CHIP and you’re eligible
1996 (HIPAA) addresses the protection of confidential health information. for health coverage from your employer, your state may have a premium
It applies to all health benefit plans. In short, the idea is to make sure that assistance program that can help pay for coverage, using funds from their
confidential health information that identifies (or could be used to identify) you Medicaid or CHIP programs. If you or your children aren’t eligible for
is kept completely confidential. This individually identifiable health information Medicaid or CHIP, you won’t be eligible for these premium assistance
is known as “protected health information” (PHI), and it will not be used or programs but you may be able to buy individual insurance coverage
disclosed without your written authorization, except as described in the Plan’s through the Health Insurance Marketplace. For more information, visit www.
HIPAA Privacy Notice or as otherwise permitted by federal and state healthcare.gov.
health information privacy laws. A copy of the Plan’s Notice of Privacy
If you or your dependents are already enrolled in Medicaid or CHIP and you
Practices that describes the Plan’s policies, practices and your rights
live in a State listed below, contact your State Medicaid or CHIP office to find
with respect to your PHI under HIPAA is available from your medical plan
out if premium assistance is available.
provider. For more information regarding this Notice, please contact
Human Resources. If you or your dependents are NOT currently enrolled in Medicaid or CHIP,
and you think you or any of your dependents might be eligible for either of
WOMEN’S HEALTH AND CANCER RIGHTS ACT these programs, contact your State Medicaid or CHIP office or dial 1-877-
Your medical plan, as required by the Women’s Health and Cancer Rights KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you
Act of 1998, provides benefits for mastectomy-related services. These services qualify, ask your state if it has a program that might help you pay the premiums
include: for an employer-sponsored plan.
+ All stages of reconstruction of the breast on which the mastectomy was If you or your dependents are eligible for premium assistance under Medicaid
performed or CHIP, as well as eligible under your employer plan, your employer must
+ Surgery and reconstruction of the other breast to produce symmetrical allow you to enroll in your employer plan if you aren’t already enrolled. This
appearance is called a “special enrollment” opportunity, and you must request coverage
+ Prostheses and treatment of physical complications resulting from mastectomy within 60 days of being determined eligible for premium assistance. If you
(including lymphedema) have questions about enrolling in your employer plan, contact the Department
of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
COBRA RIGHTS
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), MINNESOTA – MEDICAID
Federal law makes it possible for certain employees and their eligible Website: http://www.dhs.state.mn.us/
dependents to continue participation in health care plans if the coverage
would have otherwise been terminated. Phone: 1-800-657-3629
Visit healthcare.gov for information on health plans available through the NORTH DAKOTA – MEDICAID
Healthcare Marketplace in your area. Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
INDIVIDUAL COVERAGE MANDATE Phone: 1-800-755-2604
Federal law requires that you have health care coverage or you may
To see if any other states have added a premium assistance program
be subject to an income tax penalty. You can enroll in this health plan, or
you may want to consider visiting www.healthcare.gov for information on
since July 31, 2019, or for more information on special enrollment rights,
health plans available through the Healthcare Marketplace in your area. contact either:
U.S. DEPARTMENT OF LABOR
NEWBORN’S AND MOTHER’S HEALTH PROTECTION ACT
The Newborn’s and Mother’s Heath Protection Act of 1996 (NMHPA) affects Employee Benefits Security Administration
the amount of time you and your newborn child are covered for a hospital
www.dol.gov/agencies/ebsa
stay following childbirth. In general, health insurers and HMOs may not restrict
benefits for a hospital stay in connection with childbirth to less than 48 hours 1-866-444-EBSA (3272)
following a vaginal delivery or 96 hours following a delivery by cesarean
section. If you deliver in the hospital, the 48 hour (or 96 hour) period starts at U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
the time of delivery. If you deliver somewhere other than the hospital and you Centers for Medicare & Medicaid Services
are later admitted to the hospital in connection with the childbirth, the period
begins at the time of admission. Also, a health insurer or HMO cannot require www.cms.hhs.gov
you or your attending provider to obtain prior authorization for your delivery
or show that the 48 hour (or 96 hour) stay is medically necessary. However, 1-877-267-2323, Menu Option 4, Ext. 61565
a health insurer or HMO may require you to get prior authorization for any This is not an all inclusive list of states. Please contact Human
portion of a stay after the 48 hours (or 96 hours). Resources for detailed information on these federal laws and a full
copy of the notice
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
OFFER FREE OR LOW-COST HEALTH COVERAGE TO CHILDREN AND 2021 | BENEFITS GUIDE 27You can also read
