Employee
Benefits
Medical Benefits
HEALTH PROTECTION
The District provides eligible employees with medical,
dental and vision coverage at no cost to the employee.
An employee's spouse and eligible dependents may be
enrolled initially or in the event of an IRS status
change for an additional premium. A medical reimbursement
program is provided through the District's Section
125 Cafeteria Plan (“Flex Plan”) for employees
who wish to pay out-of-pocket health expenses with
tax-free dollars.
(This information was reviewed 06/13/08)
MEDICAL PLAN OVERVIEW
Our medical plan is provided by Regence Blue Shield
of Idaho. The plan design encourages wellness by covering
annual wellness exams and the associated lab work in
full after a $20.00 co-payment. Outside the annual
wellness exam, primary care physician office visits
require a $20.00 co-payment, and specialist office
visits require a $40.00 co-payment. The office visit
co-payment is not subject to the $200.00 deductible.
Lab work and x-rays outside the annual wellness exam
are covered at 80% after the deductible has been met.
The plan pays 80% of most other eligible medical expenses
after payment of $200.00 deductible per person per
plan year ($600.00 deductible per family per plan year).
The plan year runs from September 1 through August
31. After the deductible has been met, there is a $1,250.00
out-of-pocket maximum per person per plan year ($2,500.00
per family per plan year). Hospitalization and all
other services are covered at 80% after the deductible
at St. Alphonsus Hospital, and 65% after the deductible
at any other hospital. Emergency room services are
covered at 80% after meeting the deductible, regardless
of which hospital renders the services. The plan offers
access to the full network of Regence Blue Shield's
participating providers. For customer service and claims,
call Regence Blue Shield at
1-800-632-2022.
Note: IRS dependent children may remain on your medical,
dental, and vision plan until the end of the month
in which they turn 25.
PRESCRIPTION DRUG BENEFIT
Through the ARGUS network pharmacies, all generic
prescriptions may be obtained for a $7.00 co-payment.
Employees obtaining brand name drug prescriptions on
the formulary list will pay 25% or $70.00, whichever
is less. Non-formulary brand name drugs will be 25%
or $120.00, whichever is less. If you choose to have
your prescription filled with a brand name drug when
a generic is available, you will pay $7.00 plus the
difference in cost between the brand name and generic
drug. If you obtain your prescription from a non-network
pharmacy, you will be charged the normal co-payment
plus 50% of the balance. For a list of participating
pharmacies, please contact Regence Blue Shield. Participating
providers and the drug formulary may be accessed at
Regence Blue Shield of Idaho's website www.id.regence.com.
Note: Employees should always confirm their medical
provider is currently participating with Regence Blue
Shield. Please be aware that some hospital-based physicians
with exclusive hospital contracts may not necessarily
participate with Regence Blue Shield. Employees obtaining
services at the hospital are generally not allowed
a choice of physician for Anesthesiology, Radiology,
Pathology and Emergency Room. Non-participating providers
will generally balance-bill employees for any charges
above the amount Regence has agreed to pay participating
providers. The Boise School District has negotiated
a special agreement with St. Alphonsus Hospital and
its hospital-based physician groups. Hospital-based
physicians at St. Alphonsus Hospital will not balance-bill
Boise School District employees.
MAMMOGRAPHY BENEFIT
Mammography screening through BCDC (Saint Luke's Breast
Cancer Detection Center) is an important part of the
District's wellness program. Women age 40 and above,
or 35 and older with a high risk factor, are eligible
to participate. This benefit is also available to spouses
covered under the District's medical plan. All you
need to do is call BCDC (381-2055) and identify yourself
as a participant in the Boise School District's medical
plan. They will make an appointment for you anytime
during the year at one of their convenient locations.
When you go to your appointment, you pay $15.00 to
BCDC and the District will pay the balance of your
mammogram. Note: Employees may pay by check
or cash; if paying with cash, please bring the exact
amount of $15.00.
DENTAL PLAN - Dental
Coverage Information flyer
This incentive dental program is provided through
Delta Dental of Idaho. There is no annual deductible.
The maximum annual benefit per eligible patient is
$1,000.00. Most services are covered at 70% the first
benefit year. The benefit increases 10% each year,
provided you visit your dentist at least once each
calendar year. After the end of 3 years, covered services
will be paid at 100%. Certain services such as crowns,
jackets, bridges, and dentures are covered at 50% and
are not included in the incentive plan (new employees
must fulfill a 12 month waiting period before these
major restorative services are covered). For general
questions or claims, please call Delta
Dental at 489-3580 or (800) 356-7586.
Employees will receive a higher level of benefits
if they obtain their dental care through a Delta POS
(point-of-service) dentist. The maximum annual benefit
per eligible patient of a POS dentist is increased
to $1,500.00. Preventive care is covered at 100% the
first year. Other basic care is covered at 80% the
first year and increases by 10% each year if the insured
sees a POS dentist at least once per calendar year.
Crowns, bridges, dentures, etc. are covered at 55%
and there is no 12-month waiting period for these major
restorative services if provided by a POS dentist.
VISION CARE PLAN
Vision coverage is provided through Vision Service
Plan (VSP). Covered expenses include eye exams, eyewear
and contact lenses. Certain limitations apply to eyewear
and contact lenses. Please refer to the VSP brochure
for details. If you receive vision care services from
one of VSP's participating providers, services will
generally be provided at no out-of-pocket expense,
except for a $10.00 co-pay if the doctor prescribes
lenses and/or frames. In addition to the regular benefits,
you may obtain a second pair of glasses every 24 months
for a $20.00 co-payment. Only employees have
the second pair option. If you elect to receive
services from a non-participating provider, vision
expenses will be paid according to a schedule, which
may not fully cover your expenses. For general questions
or claims, please call VSP at
1 (800) 877-7195
MEDICAL REIMBURSEMENT PLAN
Flexible Benefits
Plan also known as Section 125 Cafeteria Plan
Through the Boise School District Flexible Benefits
Plan, eligible employees may be reimbursed for out-of-pocket
health expenses with tax-sheltered dollars from a flexible
spending account. This account is funded by pre-tax
deductions from the participating employee's paycheck.
Claimed expenses may include such items as deductibles,
co-payments and other expenses not covered by insurance
programs (i.e., orthodontia, excess chiropractic charges).
Employees may also be reimbursed for over-the-counter
medicines such as pain relievers, allergy medications,
cold medicines, etc. Each Flex Enrollment period, the
employee authorizes the dollar amount he/she would
like deducted from his/her salary to cover expenses
during the plan year, which runs from September 1 through
August 31. Once the election has been made, it may
not be changed during that plan year except for a change
in family status (i.e., birth or adoption of a child,
death of the employee's spouse or dependent, marriage
or divorce of the employee, termination or commencement
of employment of spouse). The employee will be reimbursed
for eligible expenses as they are incurred. Claim
forms may be obtained online. An employee must
carefully forecast the expenses he/she intends to claim,
since any unclaimed monies revert to the plan. The
maximum amount an employee may allocate into a Medical
Reimbursement Plan per plan year is $5,000.00. For
more information, email your questions to
.
DEPENDENT CARE REIMBURSEMENT
(Flexible Benefits Plan
also known as Section 125 Cafeteria Plan
This IRS-approved plan allows eligible employees to
reduce their salaries on a pre-tax basis to pay for
dependent care. In this way, an employee can pay for
these expenses with Income from which no Federal, State
or FlCA taxes have been deducted.
Each Flex Enrollment period, the employee authorizes
the dollar amount he/she would like deducted from his/her
salary to cover expenses during the plan year, which
runs from September 1 through August 31. Once the election
has been made, it may not be changed for that plan
year except for a change in family status (i.e., birth
or adoption of a child, death of the employee's spouse
or dependent, marriage or divorce of the employee,
termination or commencement of employment of spouse).
The maximum amount an employee may allocate into a
Dependent Care Reimbursement Plan per plan year is
$5,000.00. An employee must carefully estimate the
total expense
he/she will incur, as any unclaimed monies revert to
the plan. For more info, email your questions to
.
DISCLAIMER: In the event that the information
presented in this summary disagrees with or contradicts
the language in the current plan documents, the language
of the current plan documents will rule.
Employee Benefits
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8169 W. Victory Rd.
Boise, Idaho 83709
Office hours: 8:00 - 4:30
Phone ~ (208) 854-4074
Fax ~ (208) 854-4010
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Email:
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