Gasconade County R-I School District 2023-2024 Employee Benefits Overview
Gasconade County R-I School District offers a comprehensive benefits program for eligible employees and their families, with open enrollment effective from July 1, 2023. Employees can enroll in various plans including Medical, Dental, Life, AD&D, Vision, and worksite plans. Changes outside open enrollment require a qualified event. The medical benefits include Anthem in-network coverage with different deductibles, out-of-pocket maximums, coinsurance, and prescription tiers.
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GASCONADE COUNTY R-I SCHOOL DISTRICT 2023-2024 EMPLOYEE BENEFITS
OPEN ENROLLMENT Elections made during open enrollment will become effective on July 1, 2023. Gasconade County R-I School District offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. Enrollment will be completed on Employee Navigator. All enrollment must be completed online by May 12, 2023.
WHO IS ELIGIBLE? Benefit eligible employees may enroll in Medical, Dental, Basic Life, Voluntary Term Life, Voluntary AD&D, Voluntary Vision and worksite plans. Spouses and dependent children of eligible employees may enroll in Medical, Dental, Voluntary Term Life, Voluntary AD&D, Voluntary Vision and worksite plans.
HOW TO MAKE CHANGES Unless you have a qualified event, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified events include: Marriage Divorce Legal separation Birth or adoption of a child Change in child s dependent status Death of spouse, child, or other qualifying dependent Change in spouse s benefits or employment status Dependent s loss of Medicaid status If you experience a qualified event the change must be made within 30 days from the date of the event.
MEDICAL ANTHEM IN-NETWORK BENEFITS $3,000 HSA KIDZ Plan $5,000 HSA $4,000 HSA $3,000 HSA $2,500 PPO Calendar Year Deductible Individual Family $5,000 $10,000 $4,000 $8,000 $3,000 $6,000 $2,500 $5,000 $3,000 $6,000 Out-of-Pocket Maximum Individual Family $6,450 $12,900 $5,000 $10,000 $5,000 $10,000 $6,000 $12,000 $5,000 $10,000 100% 100% 80% 80% 80% Coinsurance 100% 100% 100% 100% 100% Preventive Care $30 Primary Care Physician $50 Specialist Deductible then Coinsurance Deductible then Coinsurance Deductible then Coinsurance Deductible then Coinsurance $50 Urgent Care Deductible then $250 Emergency Room Deductible then: $10 $35 $125 25% to $250 Deductible then: $10 $35 $125 25% to $250 Deductible then: $10 $35 $125 25% to $250 Deductible then: $10 $35 $125 25% to $250 Prescriptions $10 $35 $125 Tier 1 Tier 2 Tier 3 Tier 4 25% to $250
ANTHEM NETWORKS Blue Access Choice (BAC) Network Includes BJC Providers. BJC Providers: MO Baptist St. Louis, St. Louis Children s Hospital, Barnes, Christian Northeast and Northwest, and Washington University Physicians. Blue Preferred Select (BPS) Network Does NOT include BJC Providers. The BPS Network does include Missouri Baptist Sullivan Hospital, Phelps County Regional Medical Center, St. Mary s Hospital (Jeff City), Capital Region Hospital, University of MO Health System (Columbia) and Boone Hospital.
FULL-TIME EMPLOYEE MEDICAL MONTHLY DEDUCTIONS Plan 5 $3,000 HSA KIDZ Plan Plan 5 $3,000 HSA KIDZ Plan Plan 1 $5,000 HSA Plan 2 $4,000 HSA Plan 3 $3,000 HSA Plan 4 $2,500 PPO Plan 1 $5,000 HSA Plan 2 $4,000 HSA Plan 3 $3,000 HSA Plan 4 $2,500 PPO Plan Name BPS BPS BPS BPS BPS BAC BAC BAC BAC BAC Anthem Network $0.00 $0.00 $0.00 $72.51 $0.00 $3.71 $30.95 $108.09 Employee Only $506.25 $550.91 $581.64 $741.14 $538.56 $589.79 $649.71 $819.40 Employee & Spouse $193.95 Per Child $206.33 Per Child $400.53 $435.86 $460.18 $601.52 $426.09 $467.40 $520.50 $670.86 Employee & Children $906.76 $986.80 $1,041.80 $1,270.14 $964.64 $1,053.50 $1,139.25 $1,382.16 Family $62.85 $25.60 $0.00 N/A N/A $35.91 $0.00 $0.00 N/A N/A District HSA Contribution Teacher Team Employee & Spouse $84.24 $91.65 $96.78 $256.28 $89.61 $104.93 $164.85 $334.54 $193.95 Per Child $206.33 Per Child Teacher Team Family $484.75 $527.54 $556.94 $785.28 $515.69 $568.64 $654.39 $897.30 Teacher Team HSA Contribution $125.70 $51.20 $0.00 N/A N/A $71.82 $0.00 $0.00 N/A N/A
RETIREE MEDICAL MONTHLY RATES Plan 5 $3,000 HSA KIDZ Plan Plan 5 $3,000 HSA KIDZ Plan Plan 1 $5,000 HSA Plan 2 $4,000 HSA Plan 3 $3,000 HSA Plan 4 $2,500 PPO Plan 1 $5,000 HSA Plan 2 $4,000 HSA Plan 3 $3,000 HSA Plan 4 $2,500 PPO Plan Name BPS BPS BPS BPS BPS BAC BAC BAC BAC BAC Anthem Network $422.01 $459.26 $484.86 $557.37 $448.95 $488.57 $515.81 $592.95 Retiree Only $928.26 $1,010.17 $1,066.50 $1,226.00 $987.51 $1,074.65 $1,134.57 $1,304.26 Retiree & Spouse $193.95 Per Child $206.33 Per Child $822.54 $895.12 $945.04 $1,086.38 $875.04 $952.26 $1,005.36 $1,155.72 Retiree & Children $1,328.77 $1,446.06 $1,526.66 $1,755.00 $1,413.59 $1,538.36 $1,624.11 $1,867.02 Family
HEALTH SAVINGS ACCOUNT (HSA) An HSA is a specialized savings account that allows you to set aside pre-tax dollars to pay for eligible medical, dental, and vision expenses. Cannot contribute to both a FSA and HSA during the same calendar year.
BENEFITS OF AN HSA TRIPLE TAX ADVANTAGE! Pre-tax contributions lower your current taxable income Tax-free growth of interest Tax-free disbursements of principal and interest to pay for qualified expenses, now or after employment THE ACCOUNT IS YOURS! It s a simple process. You may set-up an HSA at bank of your choosing. You will need to provide Sarah your bank routing information and the amount of the deduction. There are no use it or lose it rule like FSA s You decide when to spend the money for qualified health expenses (this year or future years)! If you were to leave the School District or switch insurance plans, your HSA money goes with you!
HSA ELIGIBILITY You are eligible to open and contribute to an HSA if you: Are covered by an eligible High Deductible Health Plan AND Are not covered by any other health plan that is not Qualified High Deductible Health Plan Are not enrolled in Medicare, Medicaid, or TRICARE Have not received VA benefits within the past 3 months Are not claimed as a dependent on someone else s tax return Are not participating in a healthcare FSA
HSA RULES & ELIGIBILITY Funds must actually be in your account before disbursements can be made No request for reimbursement required You pay your provider directly by using your HSA debit card or HSA checks Withdrawal of funds for Qualified expenses are tax free HSA expenses must be IRS-qualified expenses for yourself, your spouse or tax dependents. Some examples include: Section 213 expenses Medical Deductible Expenses COBRA premiums Prescriptions Medicare premiums Dental Expenses including Orthodontia Qualified long-term care premiums Vision Expenses Save Your Receipts!! Retiree health insurance after age 65, but not Medigap/Supplement plans For a complete list of Rules and Restrictions visit the web and Google HSA Rules
IRS HSA CONTRIBUTION LIMITS 2023 Individual Coverage Family Coverage Catch Up (Age 55 to 65) $3,850 $7,750 $1,000
CARELON RX Carelon RX (Formerly Ingenio RX) is your pharmacy care provider. Essential PDL Anthem offers a list of Preventive Drugs at $0 cost on the HSA Plans. To lookup prescriptions use the Sydney app or www.anthem.com to price medications. Mail Order is available and can be requested through the Sydney app or www.anthem.com.
WWW.ANTHEM.COM AND SYDNEY APP You will need to Register for the Sydney App View ID cards Access Plan Information Locate In-Network Physicians & Facilities Track your deductible and out-of-pocket maximum View Claims / Obtain Explanation of Benefits (EOB s) Track Prescriptions / Order Refills / Research Lower-Cost Pharmacy Options Compare Costs
ANTHEM ID CARD Your Network
LIVE HEALTH ONLINE Immediate doctor visits through live video 24 hours a day, seven days a week, 365 days a year. Private, secure and convenient online visits. Your choice of U.S. board-certified doctors. Cost is $0 copay for the PPO plan or $59 per visit for HSA plan. Most common uses include: Cold and flu symptoms such as cough, fever and headaches. Allergies Sinus Infections Pink Eye Rashes / Poison Ivy
DENTAL THE STANDARD In-Network Out-of-Network Deductible (Applies to Basic & Major Services) Individual Family $50 $150 $50 $150 Preventive Services Oral Evaluations, X-Rays, Cleanings, Sealants 100% 100% Basic Services Fillings, Emergency Exams, Oral Surgery, Root Canals, Periodontics, Anesthesia 80% 80% Major Services Dentures, Crowns, Bridges, Implants 50% 50% 50% $1,000 $1,000 50% $1,000 $1,000 Orthodontic (Child Only up to Age 19) Annual Maximum Ortho Maximum (Lifetime) Rollover UCR Yes 90th Find a Dentist https://dentalnetworkpartners.ameritas.com
DENTAL THE STANDARD MONTHLY DEDUCTIONS EMPLOYEE ONLY $0.00 EMPLOYEE & SPOUSE $25.08 EMPLOYEE & CHILD(REN) $30.09 FAMILY $57.68
DENTAL THE STANDARD RETIREE MONTHLY RATES EMPLOYEE ONLY $25.07 EMPLOYEE & SPOUSE $50.15 EMPLOYEE & CHILD(REN) $55.16 FAMILY $82.75
VISION THE STANDARD The Standard In-Network Out-of-Network Network Exam Materials Lenses: Single Lenses Lined Bifocal Lined Trifocal Frames Frequency VSP Choice $10 Copay Up to $45 $25 Copay Once Every 12 Months 100% after Copay Up to $30 100% after Copay Up to $50 100% after Copay Up to $65 Once Every 24 Months in Lieu of Contacts $130 Allowance + 20% off amount over allowance Frames Up to $70 Contacts Frequency Contacts Once Every 12 Months in Lieu of Lenses and Frames $130 Allowance Up to $105
VISION THE STANDARD MONTHLY RATES EMPLOYEE ONLY $7.65 EMPLOYEE & SPOUSE $13.85 EMPLOYEE & CHILD(REN) $15.59 FAMILY $23.37
BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) The Standard is your Basic Life & AD&D Carrier. The Gasconade County R-I School District provides employees that are enrolled in the medical plan with a $25,000 Basic Life and AD&D Policy.
ADDITIONAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) The Standard is your Additional Life and AD&D Carrier. Employee Benefit: Elect in Increments of $10,000 Maximum Benefit $500,000 Employee Guarantee Issue: $150,000 Spouse Benefit: Elect in increments of $5,000 Spouse Maximum Benefit: 100% of the Employee s amount up to $200,000 Spouse Guarantee Issue: $30,000 Children Benefit: $10,000 The Standard is offering a one-time true open enrollment for the July 1, 2023 effective date.
VOLUNTARY SHORT-TERM DISABILITY (STD) THE STANDARD Short-Term Disability Plan 1 Short-Term Disability Plan 2 Short-Term Disability Plan 3 Short-Term Disability Plan 4 Employee is responsible for 100% of premium Employee is responsible for 100% of premium Employee is responsible for 100% of premium Employee is responsible for 100% of premium Employer Contribution Benefit Amount 60% to $1,500 60% to $1,500 60% to $500 60% to $500 Accident Elimination Period Benefits Begin on Day 15 Benefits Begin on Day 31 Benefits Begin on Day 15 Benefits Begin on Day 31 Illness Benefits Begin on Day 15 Benefits Begin on Day 31 Benefits Begin on Day 15 Benefits Begin on Day 31 Elimination Period Maximum Benefit Duration Up to 165 Days Up to 150 Days Up to 165 Days Up to 150 Days Late enrollees will not be required to submit evidence of insurability. They will instead be subject to a 60-day benefit waiting period for sickness or pregnancy during their first 12 months in the plan. Also, no evidence of insurability is required for those eligible for insurance under the prior plan for more than 31 days but not insured, those requesting reinstatement, nor those requesting increases in coverage. They too will be subject to a 60-day benefit waiting period. Pre-Existing Condition The Standard is offering a one-time true open enrollment on this benefit. The Pre-exiting condition clause will not apply to employee that enroll during this open enrollment. It will apply to any late entrant enrollees.
VOLUNTARY LONG-TERM DISABILITY (LTD) THE STANDARD Employer Contribution Employee is responsible for 100% of premium. Benefit Amount 60% to $6,000 Elimination Period 180 Days Maximum Benefit Duration SSNRA Pre-Existing Condition 3/12 Future late entrant enrollees will be required to submit an EOI. Evidence of Insurability (EOI) The Standard is offering a one-time true open enrollment on this benefit.
ACCIDENT THE STANDARD Employee is responsible for 100% of premium Employer Contribution $60 Initial Physician s Office 25% of total benefits Youth Organized Sports $60 Urgent Care $60 X-Ray $200 Emergency Room Benefit $300 Major Diagnostic Exam Ambulance Ground / Air $600 / $1,500 Hospital Admission General / ICU $1,500 / $1,000 Hospital Confinement General / ICU $400 Day / $200 Day For a full list of benefits and exclusions for Accident Insurance, please refer to the benefit summary or certificate.
ACCIDENT THE STANDARD MONTHLY PAYROLL DEDUCTION EMPLOYEE ONLY $14.22 EMPLOYEE & SPOUSE $22.30 EMPLOYEE & CHILD(REN) $26.92 FAMILY $42.20
HOSPITAL INDEMNITY THE STANDARD Employer Contribution Employee is responsible for 100% of premium Hospital Admission $1,500 per Calendar Year Health Maintenance Screening $50 Hospital Confinement Benefit $350 per Day up to 15 Days Pre-Existing Limitation None MONTHLY PAYROLL DEDUCTION EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILD(REN) $25.87 $43.94 $37.06 FAMILY $65.65 For a full list of benefits and exclusions for Hospital Indemnity Insurance, please refer to the benefit summary or certificate.
CRITICAL ILLNESS THE STANDARD Employee Spouse Children Employee is responsible for 100% of premium Employee is responsible for 100% of premium 50% of Employee Amount $5,000 to $10,000 (Increments of $5,000) $10,000 Employee is responsible for 100% of premium Employer Contribution $10,000 to $20,000 (Increments of $10,000) 50% of the Employee Amount Coverage Amount $20,000 N/A Guarantee Issue $50 per insured per calendar year Health Maintenance Screening Included Included Included Portability None None None Pre-Existing Condition Included with Employee Premium Attained Age & Tobacco Status Attained Age & Tobacco Status Rates Based On Cancer 100% / 25% 100% / 25% 100% / 25% Invasive / Non-Invasive Stroke Coma 100% 100% 100% 100% 100% 100% 100% 100% 100% Major Organ Failure 100% 100% 100% Heart Attack Diagnosis must occur after the July 1, 2023 effective date. For a full list of benefits and exclusions for Critical Illness Insurance, please refer to the benefit summary or certificate.
HOW TO FILE A CLAIM WITH THE STANDARD 1. Log in or create an account at www.standard.com 2. After logging in, go to the Accident, Critical Illness/Specified Disease or Hospital Indemnity Benefits section and click Get Started. 3. This will take you to the claims page. Under Start a New Claim, choose the insurance that applies to your claim and follow the instructions. Our in-office claims specialist are able to assist you with this process.
NAVIGATOR EMAIL NOTIFICATION Hello Employee, Gasconade County R-I School District is hosting your annual Open Enrollment. Open Enrollment is an annual event that allows you to make changes to existing benefits or elect new benefits for the first time. If this is your first time enrolling, you can register by accessing this Registration link. During the registration process, you will be required to enter personal identifying data as well as the following company identifier: GCRSD If you are already registered, start making changes to your insurance elections today through this Login link. Thank you, Gasconade County R-I School District **This is an automated email. Please do not reply.**
REMINDER Open Enrollment ends May 12, 2023. Your new benefits are effective July 1, 2023. Open Enrollment will be facilitated on the Employee Navigator Admin system. All employees must login and complete the enrollment.
QUESTIONS QUESTIONS? For benefit plan questions, please feel free to contact our office. 1424 W 5th Street Washington, MO 63090 Benefit Plan Inquiries Wanda Gilbert wanda.gilbert@sbins.net / 636-369-7120 Claim Inquiries : Sharon Eckhoff - sharon.eckhoff@sbins.net / 636-369-7119 or Kayla Vondera - kayla.vondera@sbins.net / 636-369-7121
