AFLAC

Aflac benefits are portable (can take them with you if you leave). Aflac benefits are rate stable (whatever rate you lock in to, will be the rate for as long as you keep that plan). And Aflac benefits do not coordinate with any other benefits that you have in place! (These plans will pay YOU cash regardless of what your health insurance does or does not pick up). Come by for additional information when Joe and Eric visit your school!

Dental

United Concordia

You get access to a nationwide network of high-quality, cost-effective dental providers. And the assurance that your claims will be paid promptly – and accurately. Want proof? United Concordia just earned an A (Excellent) rating from A.M. Best, a global credit rating organization that measures an insurance company’s financial strength and creditworthiness.

Flexible Spending

Security Benefit

What is an FSA?

A Flexible Spending Account (also known as a flexible spending arrangement) is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You don’t pay taxes on this money. This means you’ll save an amount equal to the taxes you would have paid on the money you set aside

Medical

Capital Blue Cross

We’re more than a health insurance company. We’re your partner in health. Learn about our plans and all the ways we can help you be healthy and stay well.

Prescription

Express Scripts

Just like your medical plan covers visits to your doctor, your Express Scripts prescription plan covers the medicine your doctor prescribes. We’re the largest independent manager of pharmacy benefits in the United States and one of the country’s largest pharmacies.

Vision

National Vision Administrators (NVA)

National Vision Administrators (NVA) is the Administrator for the vision plan. NVA has a network of participating Ophthalmologists, Optometrists, and Opticians to serve you. Benefits are also available from non-participating providers.

403(b) Plan

What is a 403(b) Plan?

A 403(b) plan, also known as a tax-sheltered annuity (TSA) plan, is a retirement plan for certain employees of public schools, employees of certain tax-exempt organizations, and certain ministers.

What Are the Benefits of Contributing to a 403(b) Plan?

There are three benefits to contributing to a 403(b) plan.

The first benefit is that you don’t pay income tax on allowable contributions until you begin making withdrawals from the plan, usually after you retire. Allowable contributions to a 403(b) plan are either excluded or deducted from your income. However, if your contributions are made to a Roth contribution program, this benefit doesn’t apply. Instead, you pay income tax on the contributions to the plan but distributions from the plan (if certain requirements are met) are tax free.

The second benefit is that earnings and gains on amounts in your 403(b) account aren’t taxed until you withdraw them. Earnings and gains on amounts in a Roth contribution program aren’t taxed if your withdrawals are qualified distributions. Otherwise, they are taxed when you withdraw them.

The third benefit is that you may be eligible to take a credit for elective deferrals contributed to your 403(b) account. See chapter 10, Retirement Savings Contributions Credit (Saver’s Credit) , for more information.

Frequently Asked Questions

Health Benefit Terms Glossary

Adapted from a glossary on the web site of the Health Care.gov
For more information about open enrollment, visit: https://www.healthcare.gov/glossary/primary-care-provider/

Co-insurance

A percentage of a health care cost—such as 20 percent—that the covered employee pays after meeting the deductible.

Co-payment

The fixed dollar amount—such as $25 for each doctor visit—that the covered employee pays for medical services.

EOB (Explanation of Benefits)

The EOB provides details about a medical insurance claim that has been processed and explains what portion was paid to the health care provider and what portion of the payment, if any, is the patient’s responsibility. The EOB is not a bill. Any portion of the medical expense not covered by the insurance company, such as a deductible or a co-pay, will be billed by the provider and should be paid directly to the provider.

Premium

The amount that must be paid for a health insurance plan by covered employees, by their employer, or shared by both. A covered employee’s share of the annual premium is generally paid periodically, such as monthly, and deducted from his or her paycheck.

Primary Care Provider

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.

Deductible

A fixed dollar amount that the covered employee must pay out of pocket each calendar year before the plan will begin reimbursing for non-preventative health expenses. Plans usually require separate limits per person and per family.

Formulary

A list of prescription drugs covered by the health plan, often structured in tiers that subsidize low-cost generics at a higher percentage than more expensive brand-name or specialty drugs.

In-network

Doctors, clinics, hospitals and other providers with whom the health plan has an agreement to care for its members. Health plans cover a greater share of the cost for in-network health providers than for providers who are out-of-network.

Out-of-network

A health plan will cover treatment for doctors, clinics, hospitals and other providers who are out-of-network, but covered employees will pay more out-of-pocket to use out-of-network providers than for in-network providers.

Out-of-pocket limit

The most an employee could pay during a coverage period (usually one year) for his or her share of the costs of covered services, including co-payments and co-insurance.

COBRA

What is COBRA?

On April 7, 1986, a federal law was enacted (Public Law 99-272, Title X) requiring that most employers sponsoring group health plans offer employees and their dependents the opportunity for a temporary extension of health coverage (called “continuation coverage”) at group rates in certain instances where coverage under the plan would otherwise end.  This notice is intended to inform you, in a summary fashion, of your rights and obligations under the law.  Both you and your spouse should take the time to read this notice carefully and sign the bottom.

If you are an employee of the Brandywine Heights Area School District covered by its Group Health Plan, you have a right to choose this continuation coverage if you lose your group health coverage because of a reduction in your hours of employment or the termination of your employment (for reasons other than gross misconduct on your part).

When is COBRA continuation coverage available?

If you are the spouse of an employee covered by the Group Health Plan of the Brandywine Heights Area School District, you have the right to choose continuation coverage for yourself if you lose group health coverage for any of the following four reasons:

  1. A termination of your spouse’s employment (for reasons other than gross misconduct) or reduction in your spouse’s hours of employment with the Brandywine Heights Area School District;
  2. The death of your spouse;
  3. Divorce or legal separation from your spouse; or
  4. Your spouse becomes entitled for Medicare.

In the case of a dependent child of an employee covered by the Brandywine Heights Area School District, he or she has the right to continuation coverage under the Group Health Plan if group health coverage is lost for any of the following five reasons:

  1. A termination of the employee’s employment (for reasons other than gross misconduct) or reduction in the employee’s hours of employment with the Brandywine Heights Area School District;
  2. The death of the employee;
  3. The employee’s divorce or legal separation;
  4. The employee becomes entitled for Medicare; or
  5. The dependent child ceases to be a “dependent child” under the Group Health Plan

What Constitutes as LQE (Life Qualifying Events)

A change in your situation, like getting married, having a baby, or losing health coverage that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

If you have any questions about your Benefits, please the Benefits Specialist, Ilyse Moyer at ext.1302 or ilymoy@bhasd.org

Loss of Health Coverage

  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent’s plan

Changes In Household

  • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family

Other Qualifying Events

  • Changes in your income that affect the coverage you qualify for
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration (jail or prison)
  • AmeriCorps members starting or ending their service