Human Resources - Benefits

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BENEFITS

The Benefits Department manages and coordinates benefit programs including health, dental, life, and long-term disability insurance for 1500 active employees and 1,100 retirees. We also administer the District's Section 125 Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA), COBRA compliance, FMLA designation, HIPAA compliance, EAP and ADA accommodations. In addition, we oversee OSHA recording requirements and are responsible for Tax Shelter Annuity (TSA) programs.

Benefits Phone No.: (218) 336-8723 Benefits Fax No.: (218) 336-8785

Blue Cross Blue Shield (BCBS) - Advantage High Plan: (866) 286-2948

Delta Dental of Minnesota - (800) 553-9536

Educators Benefit Consultants (EBC): (888) 507-6053

Employee Assistance Program: (866) 451-5465

Health Partners (HP) - Advantage High Plan: (800) 883-2177

Medica (Retirees Only): (800) 575-2300

Navitus - (Prescriptions Only): (866) 333-2757

Preferred One (P1) - Advantage High Plan (800) 997-1750

Listed below are website links, informational sheets and forms that might be helpful.

Helpful Links:

Educators Benefit Consultants, LLC

Duluth Teachers' Retirement Fund Association

Navitus - Prescription Website

Categories

2013-2014 RATE SHEET (1)

BENNY CARD (2)

COBRA INFORMATION (2)

DELTA DENTAL (5)

EMPLOYEE ASSISTANCE PROGRAM (EAP) (1)

FAMILY MEDICAL LEAVE ACT (FMLA) (6)

HEALTH REIMBURSEMENT ARRANGEMENT (HRA) (10)

HIPAA NOTICE OF PRIVACY PRACTICES (1)

LIFE & LTD INSURANCE (8)

NAVITUS PRESCRIPTION INFORMATION (1)

PARENTAL LEAVE CHECKLIST (1)

PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP) (7)

RETIREES 65+ (8)

RETIREES PRE-65 (8)

RETIREMENT CHECKLIST (1)

SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA) (13)

TAX SHELTER ANNUITIES (TSA) (6)

WORKER'S COMPENSATION (7)

List All (88)

Name ▲		Size	Date	Category
	2013 Medica Benefit Grid.pdf	29.52 Kb	01/02/13	RETIREES 65+
	2013-2014_Clinic_Listing_Duluth__Surround_Area.pdf	33.30 Kb	05/13/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	2013-2014_Clinic_Listing_Duluth__Surround_Area.pdf	33.30 Kb	05/13/13	RETIREES PRE-65
	2013-2014_PEIP_Benefits_Schedule.pdf	30.19 Kb	05/13/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	2013-2014_PEIP_Benefits_Schedule.pdf	30.19 Kb	05/13/13	RETIREES PRE-65
	2013_Open_Enrollment_Form.pdf	42.60 Kb	05/13/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	2013_Open_Enrollment_Form.pdf	42.60 Kb	05/13/13	RETIREES PRE-65
	403B Information Sheet.pdf	47.12 Kb	04/28/11	TAX SHELTER ANNUITIES (TSA)
	Accident Report Form.pdf	34.69 Kb	11/26/12	WORKER'S COMPENSATION
	Basic Delta Dental Plan Summary.pdf	83.77 Kb	04/28/11	DELTA DENTAL
	Benny Card Enrollment Form.pdf	144.38 Kb	04/28/11	BENNY CARD
	Benny Card FAQ.pdf	168.05 Kb	04/28/11	BENNY CARD
	Certificate of Coverage MN Life For DDWIAA, EEA Admin., & Non-Cert Business.pdf	145.42 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN Life For Directors.pdf	134.45 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN Life For Ed. MN Clerical, EEA Clerical, EEA Clerical, Food Service, Maint	141.42 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN Life For Education Directors.pdf	140.57 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN Life For Principals.pdf	141.00 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN Life For Superintendent.pdf	134.40 Kb	01/02/13	LIFE & LTD INSURANCE
	Certificate of Coverage MN LTD For All Benefit Eligible Employees.pdf	133.70 Kb	01/02/13	LIFE & LTD INSURANCE
	Change of Beneficiary Form 8-08.pdf	26.69 Kb	01/02/13	LIFE & LTD INSURANCE
	COBRA General Notice 2013.pdf	225.40 Kb	01/02/13	RETIREES 65+
	COBRA General Notice 2013.pdf	225.40 Kb	01/02/13	COBRA INFORMATION
	COBRA General Notice 2013.pdf	225.40 Kb	01/02/13	RETIREES PRE-65
	Delta Dental Enrollment Form.pdf	1.01 MB	04/28/11	DELTA DENTAL
	Delta Dental Maintenance/Change Form.pdf	852.58 Kb	04/28/11	DELTA DENTAL
	Delta Dental Plan Comparison 2013.pdf	44.53 Kb	01/02/13	RETIREES 65+
	Delta Dental Plan Comparison 2013.pdf	44.53 Kb	01/02/13	DELTA DENTAL
	Delta Dental Plan Comparison 2013.pdf	44.53 Kb	01/02/13	RETIREES PRE-65
	Direct Debit Form.pdf	182.43 Kb	08/21/12	RETIREES 65+
	EAP Brochure.pdf	2.53 MB	01/02/13	EMPLOYEE ASSISTANCE PROGRAM (EAP)
	EE WC Process Notification.pdf	344.22 Kb	11/27/12	WORKER'S COMPENSATION
	Employee Injury Reporting Instructions.pdf	340.60 Kb	11/27/12	WORKER'S COMPENSATION
	Employee Online Information 2013.pdf	21.74 Kb	01/02/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	FMLA_Rights__Responsibilities_Rev._02-13.pdf	258.93 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)
	FROI Letter To Employee 3.pdf	179.20 Kb	11/26/12	WORKER'S COMPENSATION
	HIPPA Notice 2013.pdf	148.10 Kb	01/02/13	HIPAA NOTICE OF PRIVACY PRACTICES
	HIPPA Notice 2013.pdf	148.10 Kb	01/02/13	RETIREES 65+
	HIPPA Notice 2013.pdf	148.10 Kb	01/02/13	RETIREES PRE-65
	HRA Beneficiary Designation Form.pdf	23.07 Kb	04/28/11	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Direct Deposit Form.pdf	128.70 Kb	08/24/12	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Eligible Expense Table As of 12-17-12.pdf	5.49 MB	01/02/13	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Investment Designation Form.pdf	77.23 Kb	01/02/13	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Investment Options & Fees.pdf	217.88 Kb	01/02/13	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Letter of Medical Necessity	45.92 Kb	08/24/12	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Plan Document Rev. 04-11.pdf	283.01 Kb	04/28/11	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Reimbursement Claim Form.pdf	60.14 Kb	04/28/11	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Request For Acceleration	6.12 Kb	04/28/11	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	HRA Suspension Election Form.pdf	15.46 Kb	08/24/12	HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
	If You Are Injured At Work Posting.pdf	273.40 Kb	11/26/12	WORKER'S COMPENSATION
	Important Information About COBRA Continuation.pdf	133.03 Kb	04/28/11	COBRA INFORMATION
	Inactive_Rates_2013.pdf	14.17 Kb	05/13/13	RETIREES 65+
	Inactive_Rates_2013.pdf	14.17 Kb	05/13/13	RETIREES PRE-65
	Letter Provider Explaining Temporary Transitional Work Availability 10-20-10.pdf	199.75 Kb	11/26/12	WORKER'S COMPENSATION
	Medica Extended Absence Brochure.pdf	319.56 Kb	08/21/12	RETIREES 65+
	Medica Silver Sneakers Brochure.pdf	252.89 Kb	08/21/12	RETIREES 65+
	Navitus_Benefit_Schedule.pdf	361.96 Kb	12/28/09	NAVITUS PRESCRIPTION INFORMATION
	Parental_Leave_Checklist.pdf	99.40 Kb	04/28/11	PARENTAL LEAVE CHECKLIST
	PEIP Change Form.pdf	111.69 Kb	04/28/11	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	PEIP_Summary_of_Benefits_2013-2014.pdf	1.24 MB	05/13/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	PEIP_Summary_of_Benefits_2013-2014.pdf	1.24 MB	05/13/13	RETIREES PRE-65
	Premier Delta Dental Plan Summary.pdf	83.26 Kb	04/28/11	DELTA DENTAL
	Rate_Sheet_Final.pdf	204.36 Kb	05/13/13	PUBLIC EMPLOYEES INSURANCE PROGRAM (PEIP)
	Rate_Sheet_Final.pdf	204.36 Kb	05/13/13	2013-2014 RATE SHEET
	RETIREMENT_CHECKLIST.pdf	46.44 Kb	10/16/12	RETIREMENT CHECKLIST
	Return To Work Capabilities Form Release.pdf	84.26 Kb	11/26/12	WORKER'S COMPENSATION
	Section 125 Flexible Spending Account (FSA) Change of Status Form.pdf	110.74 Kb	08/21/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Cobra Form.pdf	125.78 Kb	08/21/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Dependent Daycare Receipt.pdf	91.58 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Direct Deposit Form.pdf	139.78 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Employee Worksheet.pdf	155.07 Kb	04/28/11	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Important Plan Change.pdf	1.27 MB	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Information.pdf	4.86 MB	04/28/11	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) OTC Update 01-11.pdf	138.68 Kb	04/28/11	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Reimbursement Claim Form.pdf	159.18 Kb	04/28/11	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Flexible Spending Account (FSA) Summary Plan Document.pdf	268.33 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Plan Flexible Spending Account (FSA) Contact Change Information Form.pdf	90.23 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Plan Flexible Spending Account (FSA) Letter of Medical Necessity.pdf	29.33 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	Section 125 Plan Flexible Spending Account (FSA) Waiver Form.pdf	35.61 Kb	08/24/12	SECTION 125 FLEXIBLE SPENDING ACCOUNT (FSA)
	TSA Comparison Pricing-Plan Features.pdf	123.35 Kb	01/02/13	TAX SHELTER ANNUITIES (TSA)
	TSA EBC 3rd Party Contact Information 2013.pdf	26.24 Kb	10/24/12	TAX SHELTER ANNUITIES (TSA)
	TSA FAQ 403B.pdf	110.48 Kb	10/20/11	TAX SHELTER ANNUITIES (TSA)
	TSA Salary Reduction Agreement 2013.pdf	171.01 Kb	10/24/12	TAX SHELTER ANNUITIES (TSA)
	TSA_Company__Contacts_2013.pdf	87.28 Kb	01/30/13	TAX SHELTER ANNUITIES (TSA)
	WH-380-E.pdf	162.87 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)
	WH-380-F.pdf	134.48 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)
	WH-384_Rev._2-13.pdf	121.60 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)
	WH-385_Rev_02-13.pdf	129.43 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)
	wh385V_Rev._02-13.pdf	149.59 Kb	03/06/13	FAMILY MEDICAL LEAVE ACT (FMLA)