2. Who is eligible for benefits?
• The District will contribute a portion of the employee
health, dental and vision insurance premiums for each
employee working 30 or more hours per week in a
regularly budgeted position per the negotiated
agreements.
• Any employee participating in district insurance plans
has the option to waive health coverage only or to
waive health and dental coverage. (No cash in lieu of
the benefit.)
• Employees working less than 30 hours per week are
not eligible for insurance coverage under the district
plans.
3. Can the employee's dependents be
covered under the benefit plans?
• Employees may add eligible dependents (spouse, same-sex or
opposite sex domestic partner and children) to their health, dental
and vision plans at their own expense.
• Coverage options chosen for dependents must match those of the
employee. Employees must enroll dependents within the first 30
days of employment or wait until the annual open enrollment
period during the month of May.
• Dependents can be added or removed from insurance coverage due
to a "qualifying event" (i.e. status change such as marriage, divorce,
birth, death, change in spouse’s employment causing them to lose
or gain coverage, gain or loss of coverage with Medicare, Medicaid,
CHP or other governmental medical plan, etc.)
• The appropriate District 27J Insurance Change Form and written
verification of prior/lost coverage are submitted to the Office for
Human Resources within 30 days of the status change.
4. Once employed, when does insurance
coverage begin?
• Insurance coverage begins the first of the month following the
first day on the job as a benefited employee (employee working 30
or more hours per week in a regularly budgeted position.)
5. What is the cost to the employee for
insurance benefits?
• Premiums to cover the employee only for the Kaiser DHMO Medical Plan,
the Kaiser High Deductible Medical Plan, dental, vision and life/accidental
death and dismemberment insurance are paid by District 27J.
• Employees must pay premiums to cover eligible dependents. Employees
are only allowed to add dependents to their plans during the first 31 days
of employment, during the annual open enrollment period or due to a
"qualifying event" as defined by the insurance carriers (i.e. birth, marriage,
death, divorce, loss of coverage through a spouse's plan, gain or loss of
coverage with Medicaid, Medicare, CHP, or other governmental medical
plan, etc.).
• All changes allowed due to a "qualifying event" must be submitted within
30 days of the qualifying event along with the appropriate written
documentation otherwise the change cannot be made until the next open
annual enrollment period during the month of May. (Dependents are
defined as legal spouse, common law spouse, same sex domestic
partner and eligible children.)
6. Kaiser DHMO Plan:
• Kaiser DHMO members will pay a co-payment for doctor
office visits ($20 for a Primary care office visit and $40 for a
Specialist) and a co-payment for prescription drugs ($10
Generic and $20 Brand name for 30-day supply).
• This DHMO plan will have an annual $1,000 individual
deductible with a $3,000 family deductible for most other
medical services. After the annual deductible is met, a
Kaiser DHMO member will pay a 10% coinsurance until the
annual out-of-pocket maximum of $3,000 for individuals
and $6,000 for families is met. Per IRS rules, employees
enrolled on this DHMO plan cannot have money sent to a
health savings account.)
7. Kaiser High Deductible HSA-
Compatible Plan
• The deductibles on the Kaiser High Deductible HSA-Compatible
Plan increased to $5,000 for an individual and $10,000 for a family
effective July 1, 2012.
• The good news is that the District 27J’s contribution to the employee’s
health savings account (HSA) increased significantly from $1,400 annually
to $2,500 annually for an individual and from $2,800 annually to $5,000
annually for family coverage.
• The school district contribution to the employees’ HSA covers half the
annual deductible! Even though the deductible increased, the potential
out-of-pocket cost to the employee was lowered. The increase in district
contribution to your health savings account will go a long way towards
helping you accumulate savings in future years, as any unspent money in
your health savings account is yours to keep even if you leave School
District 27J. District 27J will deposit funds into your health savings account
in twelve (12) equal monthly installments.
