FAQs- Medical Insurance
- What is the network for health insurance?
- I have the PEIP clinic directory list and I cannot find my OBGYN on it. I am wondering if there is a way to look it up by the clinic’s name?
- Where do I find my Certificate of Coverage?
- I heard that rates are going up x%? Why does the cost sheet show that my premium has double/tripled/increased/gone down y%?
- I carry district health insurance now but I don't want it next year. What should I do?
- How do I know if my adult child is eligible for medical insurance coverage?
- How do I know the history of my medical insurance usage?
- How do I know the retail cost of my drugs?
- I looked up my medication on HealthPartners and got a range instead of an exact price. How can I find out how much it really cost?
- On the $1500 deductible plan, is the overall cost of a medication the same as my out-of-pocket expense?
- How do benefits apply to part-time teachers?
- I’m a half-time teacher. How do I calculate my portion of the insurance premium?
- Will there be a calculator tool and a PowerPoint again for 2018?
- I’m an hourly teacher. How do I know what my portion of the insurance premium is?
- I am eligible for Medicare Part D (prescription drug) but I am still employed and eligible for benefits through the district. Do I have to sign up for the Medicare prescription drug plan to avoid a penalty?
- The Social Security Administration wants to know more about my plan so that I can prove I won’t owe a penalty. Can you provide that to them?
- What happens to my medical insurance if I go on parental leave?
- What happens to my medical insurance if I go on any kind of leave of absence?
- Can I elect Single coverage if I am married?
- Can I elect Single+1 coverage to get insurance for my life partner?
- I don’t like the plan I chose. When is the soonest I can switch my health insurance plan from the plan I chose to a different plan?
- I don't think our group's contract is settled yet. Should I wait to return my enrollment form, since the contributions might change?
- Is it true that there's no health club reimbursement?
- Does our medical insurance provide a hearing discount program?
- I can see what percentage my insurance pays for different procedures, but how do I know what the total cost is so I know what the amount could be?
- I got a letter in the mail from HealthPartners about a reimbursement. How do I get that?
EM/E: Teachers and others with health insurance through Education Minnesota (EM/E) have PEIP (Public Employees' Insurance Pool) and have three network options within that framework: Blue Cross Blue Shield, HealthPartners, and PreferredOne. The plan uses the widest network from each carrier (links to search them provided):
Open Enrollment for 2018: Use the 2018 Clinic Directory provided by Innovo Benefits to find a primary care clinic for PEIP insurance.Search the network above for the carrier you are interested in for specialists (providers) within the network. Please note: Some of the clinics change Cost Level from one plan year to the next. Be sure to check the cost level of your clinic under each carrier.
I have the PEIP clinic directory list and I cannot find my OBGYN on it. I am wondering if there is a way to look it up by the clinic’s name?
If you are not a teacher, your insurance is not through PEIP. Return to the non-EM/E medical page.
If your medical insurance is through PEIP, here is why you can't find your OBGYN. OBGYNs do not appear in the directory because they are specialists, and only primary care clinics are rated by cost level and included in the directory. You can self-refer to any OBGYN in your network and pay the same cost level amounts as your primary care clinic. Even if you use your OBGYN as a primary doctor (all do you is annual check-ups), you still have to elect a primary care clinic when you have PEIP insurance.
If what you need to check whether the OBGYN is in the network, do not look in the clinic directory. Instead, return to the network question above.
The certificate of coverage, sometimes known as a "benefits book," is the thick book of fine print describing your medical insurance coverage that used to be mailed to you every year. These days, insurance companies do not send these out to all members, but make them available in PDF on their websites. You will need to log in to the insurance company's website to access your certificate of coverage, and you will need your insurance card to create a login. If you prefer a paper copy, you may call the number on the back of your card to request they mail a paper certificate of coverage.
I heard that rates are going up x%? Why does the cost sheet show that my premium has double/tripled/increased/gone down y%?
What many people call "my premium" is just the employee contribution toward the overall premium. The percentage increase refers to the overall premium increase, the amount that the insurance company charges. You then need to subtract the district contribution to determine the employee cost. This varies by bargaining unit and by family status (single, single+1, family), and may change from one year to the next.Teachers, view your cost sheet on the medical page; others, please contact Cara Hendrickson for your cost sheet.
If you wish to change or drop your election(s) at open enrollment time, you MUST make any changes by completing the online enrollment through Corporate Health Systems. If you do nothing, your coverage (except for flex) will be carried over).
For status changes at any time of the year (outside of open enrollment for January 1), including medical insurance for EM/E, please contact Corporate Health Systems.
If you did not save your 2017 contribution sheet, you can calculate your monthly amount by looking at a current paycheck on the Employee Access Center. An explanation of calculations for insurance deductions is found on the Benefits page of the online Staff Handbook. To determine your monthly amount, work backward from your regular deduction amount:
current deduction multiplied by the number of paychecks you receive (19, 21, or 24) divided by 12 months = your portion of monthly premiumYou can also obtain 2017 cost sheets in pdf format from Cara Hendrickson by request. Teachers' 2018 cost sheets are posted on their medical page but please contact Cara for 2016 or earlier.
Look on the Department of Labor website. Here are two items that might be helpful.
Coverage Extended to More Children. The goal of this new policy is to cover as many young adults under the age of 26 as possible with the least burden. Plans and issuers that offer dependent coverage must offer coverage to enrollees' adult children until age 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent's tax return, or is no longer a student. There is a transition for certain existing group plans that generally do not have to provide dependent coverage until 2014 if the adult child has another offer of employer-based coverage aside from coverage through the parent. The new policy providing access for young adults applies to both married and unmarried children, although their own spouses and children do not qualify.
(from their fact sheet at http://www.dol.gov/ebsa/newsroom/fsdependentcoverage.html)
What plans are required to extend dependent coverage up to age 26?
The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26. Both married and unmarried children qualify for this coverage. This rule applies to all plans in the individual market and to new employer plans. It also applies to existing employer plans unless the adult child has another offer of employer-based coverage (such as through his or her job). Beginning in 2014, children up to age 26 can stay on their parent's employer plan even if they have another offer of coverage through an employer.
(from the FAQ’s at http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html)
You may have saved Explanations of Benefits when they came in the mail. If not, you can usually access that information online and use it when making decisions about your new carrier, provider, or plan. If you have not accessed that carrier online, call the service number of the back of their cards.
If you have already got a username & password for your network you can log in and look at it there. You can also look at general information about costs on their website without logging in, but not your personal medical history. Look at your network's website or call the customer service number on your card to find out how to create an online login.
You need a separate login for a spouse and for children over 14.
You can find this out from your pharmacy. Pharmacy receipts typically include this information. You can also look up different drugs at different locations on your network's website. There is usually a resource on your insurance provider's website. Here is an additional tool you can try: http://www.goodrx.com
I looked up my medication on my network's website and got a range instead of an exact price. How can I find out how much it really cost?
You might have looked only at the formulary, which shows a range. For actual costs for local purchases (as opposed to the formulary range which includes ANYWHERE that network serves) and for your exact prescription, try searching in a different way. The following example is from the HealthPartners website, but all carriers make this information available in different ways.
1. Log in at www.healthpartners.com
2. Look on the left side under Pharmacy. Click on Calculate my drug costs.
3. Another window opens, where you search for a medication.
4. It gives you dosage choices. Select yours.
5. Enter how much my doctor has prescribed & how often you are to take it.
6. It gives you the costs for pharmacies you use regularly, plus the option to check a different pharmacy.
7. The result is not a range, but instead your cost (could be a copayment) under your CURRENT plan, and then the overall cost.
Another way to find out your costs is to look at the receipt from your pharmacy, which should list both your cost and the overall cost.Note: This answer has not been updated since 2011 when the district carried HealthPartners insurance. If you carry HealthPartners insurance through PEIP and this method does not work for you, please let Emily know to update the website.If your network is BlueCross BlueShield or PreferredOne, please contact their customer service to find out details about your pharmacy costs. Or, contact Emily if you would like instructions in these FAQ's about how to check on those websites. This question has not been frequently asked since 2011.
On the $1,500 deductible plan, is the overall cost of a medication the same as my out-of-pocket expense?
There is no co-payment on the $1,500 deductible plan, so you are correct: the overall cost would equal your out-of-pocket (retail) expense. Once you meet the deductible, medications would be covered 100%.
Your master agreement explains how benefits apply to part-time teachers. You can find it on the district website: Staff Handbook - Contracts and Guidebooks
Teachers (except hourly teachers) whose regular teaching assignments total 0.75 FTE or more qualify for the full district contribution toward insurances. Find that amount on the cost sheet.Teachers who are between 0.5 and 0.74 FTE are eligible for benefits, with the district contributing a percentage of its contribution corresponding to the teacher’s FTE percentage (prorated district contribution).
- Look at the cost sheet, which says Education Minnesota/Edina on top and lists contributions. Look at the amount in the “DISTRICT PAYS PER MONTH” column. Multiply it by your FTE (0.5, or 067, or whatever). That is the district contribution for you. Note: This year's cost sheets are available on the medical page, as well as under "Documents" on the CHS enrollment website (available only during open enrollment).
- Add amount that the district doesn’t pay to the amount in the “YOU PAY PER MONTH” column. That will be the monthly contribution for a half-time teacher.
- Do this for each level of coverage for each plan, and then you should have all the right numbers to work with.
The 2017 plans have the same design as 2016, and the premiums were updated, so the calculator can be used again (for non-EM/E employees). Because of its level of complexity, we have not developed a calculator tool to help make decisions about the PEIP plans. The open enrollment presentations are available on the medical pages.
Non-EM/E: find the insurance estimator tool here.
The medical page includes a chart with the monthly and per-paycheck amounts for different hours. Find the number of hours you are assigned to work and look across the row for contributions.
I am eligible for Medicare Part D (prescription drug) but I am still employed and eligible for benefits through the district. Do I have to sign up for the Medicare prescription drug plan to avoid a penalty?
Here is some information from the Social Security website:
Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. You can wait to enroll in a Medicare Part D plan if you have other prescription drug coverage but, if you don’t have prescription coverage that is, on average, at least as good as Medicare prescription drug coverage, you will pay a penalty if you wait to join later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage. (from: http://www.socialsecurity.gov/pubs/EN-05-10043.pdf)
The bolded part shows why you don’t need B (or D) at this time. Your BlueCross BlueShield or PEIP coverage is "at least as good as" Medicare prescription drug coverage, so you will not pay a penalty later. You receive information about Medicare every year in your open enrollment materials (available under "Documents" in the CHS online enrollment system). Keep this in a safe place if you are approaching Medicare age.
The Social Security Administration wants to know more about my plan so that I can prove I won’t owe a penalty. Can you provide that to them?
If the SSA wants more information about your current plan, you can show them the plan documents you received during enrollment. Alternatively, you can call the number on the back of your insurance card for your carrier's customer service help in documentation.
Under Family Medical Leave Act (FMLA) you are eligible to keep your benefits for up to 12 weeks while out on a qualified leave.During this time the district contribution is continued and you are required only to pay your portion which would continue to be deducted from your pay. Once the 12 weeks are over, you will be informed of COBRA rights and may elect to go on COBRA and pay 100% of the premium cost or seek other coverage outside of the district .
You will need to contact Corporate Health Systems to enroll . Our contact there is Carmen Trettel: 952-939-0911 x139.
Please see the Human Resources page for more information about leaves of absence, including how your insurance is affected. You can also find information related to leaves of absence in your master agreement.
Under the Family Medical Leave Act (FMLA) you are eligible to keep your benefits for up to 12 weeks while out on an FMLA qualified leave. Not all medical or childcare leaves qualify for FMLA.
Yes. “Single” refers to insurance coverage for the employee only, not to marital status.
“Single + 1” is shorthand for “Employee + one tax dependent” (per master agreement), which means it has to be a legal spouse or child. So, unfortunately, your boyfriend or sister or couch-surfing friend or life partner cannot currently be covered under your policy. If you were to get married at any point during the year, your spouse could be added to your coverage within 30 days because that is a qualifying status change.
I don’t like the plan I chose. When is the soonest I can switch my health insurance plan from the plan I chose to a different plan?
You will not be able to switch again until the next open enrollment period (for next January 1), so you are committed to the plan you choose for one calendar year.According to IRS rules, because our insurance deductions are pretax, you cannot switch plans until open enrollment in the fall for January 1 of the following year. You could change the level of coverage (from family to single) or drop coverage if you have a qualifying status change, but you can’t switch plans except during open enrollment. Status changes would include marriage, divorce, change of employment for yourself or spouse, birth of a child, etc. If you have a qualifying status change you need to do the paperwork for Corporate Health Systems within 30 days of the change.
Teachers covered by PEIP have some added flexibility here. While you cannot change your plan or your network, you can change your primary clinic. If you move into a different cost tier by changing primary clinics, that will affect your benefits.
I don't think our group's contract is settled yet. Should I wait to complete my online enrollment, since the contributions might change?
If your contract is currently in negotiations, the District contributions last stated in the contract will remain in force until the new contract has been settled. District and employee contributions may change when the contract is settled, and that will be adjusted in your payroll deductions, just as your pay would be adjusted. You will not be given another opportunity to make benefit elections after your contract settles, so do not wait. Stick to the deadline.
- If you are non-EM/E and have your 2018 health insurance through BlueCross BlueShield, you can still be reimbursed through their Fitness Discounts program. Check their website for a list of participating health clubs.
- If you are EM/E and have your health insurance through PEIP, a fitness reimbursement program was added in 2015. The way you access that varies depending which network you choose. You can find the details of the fitness discount in this January 2015 newsletter provided by PEIP.
Certain hearing-related items are covered by medical insurance. In addition, Delta Dental members are eligible for a hearing discount program called HearPO. This discount program is not associated with your medical insurance, but instead with dental. Go to the dental insurance page for more information.
I can see what percentage my insurance pays for different procedures, but how do I know what the total cost is so I know what the amount could be?
The billing department at your clinic or doctor's office should be able to give you a rough estimate. If the procedure involves inpatient or outpatient hospital care, you can look it up on this website: http://www.mnhospitalpricecheck.org/
In the summer of 2012, you may have received a communication from Health Partners stating that due to recent changes in the Health Care Act, they would be providing a rebate to members via the District.
Edina Public Schools consulted with legal counsel to assess what options were available with the reimbursement. It was determined that either the rebate could be applied as a partial premium reduction for the upcoming year or in the form of a cash refund to employees. The School Board and administration opted to evenly distribute the HealthPartners rebate as a cash refund to all eligible employees.
The refund, which is only applicable to those staff members who were active participants in the HealthPartners health insurance plan as of December 31, 2011, was applied to eligible employees' September 30, 2012 paycheck. The amount was $43.10 (pre-tax). Note that current law requires this refund to be taxable. Those who were active participants in HealthPartners insurance in 2011 who were not current employees in September 2012 received a paper check by mail.No similar letter has been received in 2013 - 2017.
Payroll Deductions, District
Insurance WebsiteSara RiegelCompensation & Benefits SpecialistDistrict Office952-848-4905
Enrollment/Status Changes/EligibilityJanet Bear-RivardPlanSourceDirect: (612) 256-0842Fax: 1-616-243-5606ORTammy KnappPlanSourceDirect: (612) 256-0843Fax: (407) 386-8142
ReimbursementPlanSourceDirect: (612)256-0852Toll Free: (866)546-9134Fax: (407)386-8937
COBRA/RetireeJoAnne LynchPlanSourceDirect: (612) 256-0844Fax: (952) 939-0990