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2022Employee BenefitsYour 2022Minneapolis Public SchoolsEmployee Benefits at A Glance
WelcomeWelcome to the Minneapolis School District employee benefits program. It is our pleasure to provide you with acopy of the 2022 Employee Benefits Guide. Its purpose is to acquaint you with the benefits and health care plansoffered by the Minneapolis Public School District. We believe this guidebook will assist you in understanding andselecting the benefits most helpful in meeting your individual needs.You probably know that the District offers an extremely competitive and comprehensive benefits program forbenefit eligible employees. It does so to provide employees with additional support as they work towards helpingthe District achieve its mission and strategic priorities. District employee benefits include medical, dental, vision,life, and long-term disability insurance coverage, along with two retirement plans (one defined benefit and onevoluntary defined contribution plan), reimbursement accounts and health savings account options, wellness, andan employee assistance program. Additionally, the District has provisions for paid leave time (vacation and sick),family and medical leave, holidays, and other types of paid and unpaid leave.We encourage you to keep this guidebook along with your other benefits information, as you may want to refer toit periodically. This guidebook is also available on the Benefits Department website ve.html.You should know, however, that coverage or participation in most of the benefits outlined in this guidebook arenot automatic. It is extremely important that you familiarize yourself with the various options and enroll in thosethat best fit your needs. Many of the plans are effective for the entire calendar year. If you are a union employee,you may have certain benefits that are part of your collective bargaining agreement. Please refer to your laboragreement for guidance (available on the Human Resources Department website html ).As your need for certain employee benefits change, you will have opportunities to change your benefits choices once per year through annual enrollment in the fall or immediately at the time you experience a qualified work/lifeevent (i.e. marriage, birth/adoption of a child). Depending upon the event, you also may add or drop somebenefits. Please refer to the Eligibility and Enrollment section of this guidebook for more information.If you should have any questions, the Benefits Department is here to assist 2.668.0560612.668.05351250 West Broadway Avenue North, Minneapolis MN 55411
Table of Contents:Your Benefit Choices . 4Eligibility & Enrollment . 5Health Insurance . 10Plan Rates. 10Plan Options. 11Make the Most of Your Health Benefits. 14Rightway . 15Sanvello . 15Virtual Visits by UnitedHealthcare . 16Dental Insurance . 17Vision Insurance . 20Flexible Spending Accounts . 22Health Savings Account (HSA) . 25Employee Well-being Program . 27Employee Assistance Program (EAP) . 28Well@Work Clinic –Davis Center . 29Ancillary Benefits . 30Basic Life and AD&D Insurance . 30Supplemental Life and AD&D Insurance. 31Long-term Disability Insurance. 32Additional Sun Life Benefits . 33Long Term Care Insurance . 34Retirement Savings Plans . 35Defined Benefit Pension Plans . 36Minnesota 529 College Savings Plan . 36Legal Services . 37Family Medical Leave Act (FMLA). 38Continuation Coverage Rights Under COBRA . 41Notice of Privacy Practices . 43Notice Health Insurance Marketplace . 45Contact Information. . 46
2022 Benefits at a GlanceYour Benefit ChoicesMinneapolis Public Schools strives to provide a wide variety of benefits for our employees. Some benefits areprovided automatically at no cost while others are available if you choose them. Check the guide below to seewhich benefits you need to make a successful program designed just for you.Keep this booklet and all coverage materials easily accessible, so that you may refer to them if necessary.WHO PAYS THECOST?EFFECTIVE DATEHealth InsuranceMPS & EmployeeDate which plan is enrolledin onlineDental InsuranceMPS & EmployeeVision InsuranceEmployeeBENEFITCARRIEREmployee Assistance Programs(EAP)MPSGroup Term Life and AD&D Insurance1st of the month followingdate which plan is enrolledin online1st of the month followingdate which plan is enrolledin onlineDate employee becomes apermanent benefit eligibleemployeeMPSLong-term Disability InsuranceSupplemental Term Life InsuranceEmployeeLong Term CareEmployeeFlexible Spending Accounts (FSA)EmployeeHealth Savings Account (HSA)Employee403(b) Savings PlanMPS & Employee457 Savings PlanMPS & EmployeeDate coverage is approvedby carrierDate which plan is enrolledin onlineMPS & EmployeeDefined Benefit Pension PlansTeachers’ RetirementAssociationCompensated Time Off and HolidaysMPS & EmployeeMPSLegal AssistanceRefer to CBAEmployeeVitality – Wellness ProgramMPSWellBeats – On Demand FitnessMPSDate employee becomes apermanent benefit eligibleemployeeDate employee becomes apermanent benefit eligibleemployeeThis is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.4Rev. 01.01.2022
2022 Benefits at a GlanceEMPLOYEE ELIGIBILITYFor the purpose of benefits eligibility, employees are eligible to receive benefits as long as they are a permanentemployee working at least 20 hours per week or have an FTE of 0.5 or more.Employees covered by a union contract are entitled only to those benefits described in that labor agreement.Please refer to your union contract for details regarding your employee benefits.All employees are eligible to participate in the Deferred Compensation Program, however only permanent benefiteligible employees will receive the District match. Please refer to the Retirement Summary Plan Description fordetails.Temporary employees are ineligible for District-sponsored benefits.DEPENDENT ELIGIBILITYIf you are an eligible participant, you may also cover your eligible dependents under the health, dental, vision, andsupplemental life and AD&D plans. Employees will be required to verify eligibility by providing appropriatedocumentation to the Benefits Department at time of enrollment. Enrolling ineligible dependents into the District’sbenefits program is a violation of District policy and will be treated accordingly. Eligible dependents include your: Legally Married Spouse (see below for more information);Domestic Partner (see below for more information);Dependent Children to the age of 26 including;o an Enrollee’s natural or legally adopted child;o a child for whom the Enrollee or the Enrollee’s spouse is the legal guardian;o a child covered under a valid qualified medical support order (as the term is defined under Section609 of the Employer Retirement Income Security Act (ERISA) and its implementing regulations)which is enforceable against an Enrollee;o a stepchild of the Enrollee (that is, the child of the Enrollee’s spouse)o a grandchild of the Enrollee or an Enrollee’s spouse who is a newborn and resides with and isfinancially dependent on the covered grandparent. The grandchild must be either under 26 yearsof age or a disabled dependent;o an Enrollee’s dependent who is (a) incapable of self-sustaining employment by reason ofdevelopmental disability, mental illness or disorder, or physical disability; and (b) chieflydependent on the Enrollee for support and maintenance.Legally Married Spouse Coverage: A copy of your marriage license AND one form of dated (within six months)documentation establishing current marital status such as a joint household bill, joint bank/credit account, orjointly filed federal tax return.Domestic Partner Coverage (Eligible only if stated in union contract): A copy of a notarized affidavit ofdomestic partnership AND two forms of dated (within six months) documentation establishing current partnershipstatus such as: a joint household bill, joint bank/credit account, joint mortgage or lease, front page of both federaltax returns showing current common address (with blacked out financial information), assignment of durablepower of attorney, or designation as a beneficiary of life insurance or retirement plan.This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.5Rev. 01.01.2022
2022 Benefits at a GlanceENROLLMENT & CHANGESNew hires and newly benefit eligible employees must enroll within thirty (30) days of their employment start date.Employees who elect to insure their spouse, domestic partner (eligible only if stated in union contract) and/ordependents will be required to provide proof of eligibility. Benefits Department staff will verify eligibility status andassist with the process.Medical coverage will be effective on the date in which the employee enrolls online. Dental and Vision coveragewill be effective the first day of the following month from the date the employee enrolls online.For those employees who start in the month of August, their medical, dental and/or vision insurance coverage willbegin on September 1st, if enrollment is completed by August 31st. If enrolling on September 1st or later, medicalcoverage begins the day the employee enrolls online, and dental/vision insurance will begin the first day of thefollowing month.PAYROLL DEDUCTIONSDeductions for premiums are taken out of twelve (12) paychecks from January through June and then again outof eight (8) paychecks from September through December. Your deductions may differ slightly in the latter part ofthe year. Employees’ deductions for January through June also include the premiums for July and August. TheSeptember through December deductions only include four months of premiums.In accordance with state and federal regulations, health benefit premiums paid towards domestic partner benefitswill be deducted on a post-tax basis.EMPLOYEE SELF SERVICEYou can perform a variety of inquiries and make changes online, such as: View and update address and phone numberView and update emergency contact informationView pay statementView benefit electionsCheck your earnings historyView and change your W-4 electionsView and change your deferred compensation deductionsYou can access the Neptune ESS system from the District website by going to www.mpls.k12.mn.us and click onStaff Login. You will want to login using your username and password. If you forgot your password, or areexperiencing technical difficulties, please go to the ESS Help website at https://ehelpdesk.mpls.k12.mn.us/ or call612-668-0088.This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.6Rev. 01.01.2022
2022 Benefits at a GlanceNOTICE OF SPECIAL ENROLLMENT RIGHTSIf you are declining enrollment for yourself and/or your dependents (including your spouse) because of otherhealth insurance or group health plan coverage, you may be able to enroll yourself and your dependents in thisplan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towardsyour or your dependents’ other coverage). However, you must request enrollment within 30 days after you oryour dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). ThisSpecial Enrollment opportunity is available only if you indicated (or otherwise as required) informationregarding you or your dependents’ other coverage on your initial enrollment form/waiver.In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, youmay be able to enroll yourself and your dependents. However, you must request enrollment within 30 days afterthe marriage, birth, adoption, or placement for adoption.*You do have up to 60 days to request enrollment after the loss of Medicaid coverage.QUALIFYING LIFE EVENTSThe elections that you make during your initial benefits eligibility period, or at the Annual Enrollment, will remain ineffect for the next 12 months. During that time, if your life or family status changes you will be permitted to reviseyour benefits coverage to accommodate your new situation (according to the recognized events below). You areable to make benefits changes by contacting the Benefits Department by email at Benefits@mpls.k12.mn.us orcall 612-668-0560.IRS regulations govern the circumstances through which you may make changes to your benefits, which benefitsyou can change, and which types of changes are permitted. All changes must be consistent with the qualified life eventChanges must be accompanied by supportive documentationIn most cases, you cannot change your benefit elections, but you may modify the level of coverage (In otherwords, you can add or delete dependents, enroll or dis-enroll yourself or dependents, but not switch carriersor plans).Any changes in benefit levels must be completed within 30 days of the eventRecognized Qualifying Events: MarriageDeath of spouseDivorce/legal separation/annulmentSpouse gains or loses coverage from another eligible sourceBirth or adoption of childDeath of dependent childChange in dependent eligibilityThis is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.7Rev. 01.01.2022
2022 Benefits at a GlanceCHANGING YOUR BENEFITSAnnual EnrollmentEligible employees who wish to change their benefits during annual enrollment are allowed a window ofopportunity in the Fall of every calendar year. Benefit elections made during this period of annual enrollment areeffective on January 1 of the following year.Employees who wish to participate in health care or dependent care reimbursement account electionsMUST enroll through NEPTUNE ESS online EVERY YEAR. In accordance with IRS regulations, thoseelections must be made every year regardless of whether they change or not.Adding New Dependents Spouse or Stepchildren - you must submit the appropriate enrollment form within thirty (30) days of thedate of the marriage to the Benefits Department. Coverage for your spouse and/or stepchildren will start onthe first day of the month following the date of the marriage. Newborns and Children Placed for Adoption – you must submit the appropriate enrollment form withinthirty (30) days after the date of birth for newborn child or thirty (30) days of the date of placement for youradopted child. Coverage starts on the date of birth or date of placement. Disabled Children or Disabled Dependents – you must submit the appropriate enrollment form within thirty(30) days of the date of eligibility. Coverage starts on the date of eligibility.If the enrollment form is received after the application period, your spouse and/or dependent must wait until thenext annual enrollment to apply for coverage.Special Enrollment PeriodsSpecial enrollment periods are periods during which eligible employees and dependents may enroll under certaincircumstances after the initial thirty (30) days when they were first eligible. The following conditions must be met:1. Employee or dependent was covered under health insurance coverage at the time coverage waspreviously offered to the employee or dependent;2. The employee must complete any required written waiver of coverage and state in writing that, atsuch time, other health insurance coverage was reason for declining enrollment;3. The employee’s or dependent’s coverage is terminated because his/her continuation has beenexhausted, they are no longer eligible for the Plan due to a divorce, legal separation, death,termination of employment, reduction in hours, or District’s contributions toward coverage wereterminated; and4. The employee or dependent requested enrollment not later than thirty (30) days after the terminationof coverage or District’s contribution.This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.8Rev. 01.01.2022
2022 Benefits at a GlanceMEDICAID and the CHILDREN’S HEALTH PROGRAM (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from MPS,your state may have a premium assistance program that can help pay for coverage, using funds fromtheir Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’tbe eligible for these premium assistance programs but you may be able to buy individual insurancecoverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below,contact your State Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any ofyour dependents might be eligible for either of these programs, contact your State Medicaid or CHIPoffice or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, askyour state if it has a program that might help you pay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligibleunder MPS’s plan, MPS must allow you to enroll in the medical plan if you aren’t already enrolled. This iscalled a “special enrollment” opportunity, and you must request coverage within 60 days of beingdetermined eligible for premium assistance. If you have questions about enrolling in MPS’s Plan, contactthe Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).Below is contact information for state agencies that can help determine whether you are eligiblefor assistance paying your employer health plan te800-657-3739 http://www.dhs.state.mn.us/(Click on "Health Care” then “Medical Assistance”)800-362-3002 95.pdfYou can also obtain a copy of the full listing from the Department of Labor website or by clicking this linkto the Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP).For more information on special enrollment rights, you can contact either:U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/ebsa1-866-444-EBSA (3272)U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Ext. 61565This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.9Rev. 01.01.2022
2022 Benefits at a GlanceHealth InsuranceInsurance 46whyuhc.com/mps*Monthly medical plan costs are an average monthly cost over the full plan year.Notes:1. The District will not deduct medical contributions during the first pay period in January (January 14, 2022). Thedistrict will deduct for this skipped deduction date from the July 1, 2022 pay period.2. Benefit deductions are taken during the school year. Biweekly rates are subject to change if your start date is afterJanuary 1st.This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.10Rev. 01.01.2022
2022 Benefits at a GlancePlan 1You Pay In-NetworkTier 1Non-Tier 1Calendar Year DeductibleYou PayOut-of-NetworkThe in and out-of-network deductibles accumulateseparatelyDoes not include co-pay or coinsurance amounts 1,000 Single 2,000 Family 1,500 Single 3,000 FamilyCalendar Year Out-of-Pocket Maximum 2,750 Single 5,500 Family 4,750 Single 9,500 FamilyUnlimited 1,000,000(Combined Medical AND Pharmacy)Lifetime MaximumPreventative Health Care(routine physical, eye exam, well-child care, prenatal andNot coveredYou pay nothingpostnatal care, immunizations)Office Visits Primary care physician Specialist visit On-line care (Virtual Visits) 30 copay(Well-being participant) 50 copay(Non Well-being) 30 copay(Well-being participant) 50 copay(Non Well-being) 55 copay(Well-being participant) 75 copay(Non Well-being) 55 copay(Well-being participant) 75 copay(Non Well-being)No chargeNo chargeEmergency Care Urgent care Clinic50% after deductible50% after deductibleNot covered 30 copay (Well-being participant) 50 copay (Non Well-being) Hospital Emergency Room20% after deductible AmbulanceTests Diagnostic tests (X Ray, blood work)20% after deductibleNo chargeNo charge50% after deductible20% after ded.20% after ded.50% after deductibleInpatient Hospital Care20% after ded.20% after ded.50% after deductibleOutpatient Hospital Care20% after ded.20% after ded.50% after deductible 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 10 Co-pay 80 Co-pay 120 Co-pay 10 Co-pay 80 Co-pay 120 Co-pay Imaging (CT/PET scans, MRI)Prescription DrugsRetail Copayment for 31-day supply Generic from formulary Brand from formulary Medications not on formulary SpecialtyMail Order Copayment for 90-day supply Generic from formulary Brand from formulary Medications not on formularyThis is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.11Not coveredRev. 01.01.2022
2022 Benefits at a GlancePlan 2You Pay In-NetworkTier 1Non-Tier 1Calendar Year DeductibleYou PayOut-of-NetworkThe in and out-of-network deductibles accumulateseparatelyDoes not include co-pay or coinsurance amounts 2,000 Single 4,000 Family 3,000 Single 6,000 FamilyCalendar Year Out-of-Pocket Maximum 4,250 Single 8,500 Family 6,750 SingleUnlimited FamilyUnlimited 1,000,000You pay nothingNot covered(Combined Medical AND Pharmacy)Lifetime MaximumPreventative Health Care(routine physical, eye exam, well-child care, prenataland postnatal care, immunizations)Office Visits Primary care physician Specialist visit On-line care (Virtual Visits) 35 copay(Well-being participant) 55 copay(Non Well-being) 35 copay(Well-being participant) 55 copay(Non Well-being) 60 copay(Well-being participant) 80 copay(Non Well-being) 60 copay(Well-being participant) 80 copay(Non Well-being)No chargeNo chargeEmergency Care Urgent care Clinic Hospital Emergency Room AmbulanceTests Diagnostic tests (X Ray, blood work) Imaging (CT/PET scans, MRI)Inpatient Hospital CareOutpatient Hospital Care50% after deductible50% after deductibleNot covered 35 copay (Well-being participant) 55 copay (Non Well-being)20% after deductible20% after deductibleNo chargeNo charge50% after deductible20% after ded.20% after ded.50% after deductible20% after ded.20% after ded.20% after ded.20% after ded.50% after deductible 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 5 Co-pay 40 Co-pay 60 Co-pay20% up to 200 10 Co-pay 80 Co-pay 120 Co-pay 10 Co-pay 80 Co-pay 120 Co-pay50% after deductiblePrescription DrugsRetail Copayment for 31-day supply Generic from formulary Brand from formulary Medications not on formulary SpecialtyMail Order Copayment for 90-day supply Generic from formulary Brand from formulary Medications not on formularyThis is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.12Not coveredRev. 01.01.2022
2022 Benefits at a GlanceYou PayIn-NetworkPlan 3You PayOut-of-NetworkWell-being participant 1,400 Single 3,000 FamilyCalendar Year DeductibleThe in and out-of-network deductibles accumulate separatelyDoes not include co-pay or coinsurance amounts 2,600 Single 5,000 FamilyNon Well-being 1,650 Single 3,500 FamilyCalendar Year Out-of-Pocket Maximum(Combined Medical AND Pharmacy)Lifetime MaximumPreventative Health Care(routine physical, eye exam, well-child care, prenatal and postnatal care, 3,000 Single 6,000 Family 5,000 Single 10,000 FamilyUnlimited 1,000,000You pay nothingNot covered20% after deductible20% after deductible0% coinsurance, afterdeductible40% after deductible40% after deductibleNot coveredimmunizations)Office Visits Primary care physician Specialist visit On-line care (Virtual Visits)Emergency Care Urgent care clinic20% after deductible Hospital Emergency Room20% after deductible AmbulanceTests Diagnostic tests (X Ray, blood work)20% after deductible20% after deductible40% after deductible 20% after deductible40% after deductibleInpatient Hospital Care20% after deductible40% after deductibleOutpatient Hospital Care20% after deductible40% after deductiblePrescription DrugsRetail Copayment for 30-day supply Generic from formulary Brand from formulary Medications not on formulary Specialty20% after deductible20% after deductible20% after deductible20% up to 20040% after deductible20% after deductibleNot coveredImaging (CT/PET scans, MRI)Mail Order Copayment for 90-day supply Generic from formulary Brand from formulary Medications not on formulary*Plan 3 has a non-embedded deductible. Before benefits will pay, an individual or any member of your family must meet the entireamount of the deductible. For example, if you, your spouse and two kids are enrolled in Plan 3 with a non-embedded deductible,either you or the combination of you and your family members need to meet the entire 3,000 family deductible for the well being planor 3,500 family deductible for the non well being planned deductible before the plan will pay benefits.Please note: Based upon IRS guidance, MPS has determined that the clinic provides significant medical benefits (other than preventivecare) for our staff at no charge. Employees enrolled in Plan 3 will not be allowed access to the MPS clinic.This is a brief description only. It is not a Certificate of Coverage. Please see the Group Policy, which alonedetermines all rights, benefits and applicable Limitations and Exclusions.13Rev. 01.01.2022
2022 Benefits at a GlanceSELF-FUNDED MEDICALMedical coverage helps you and your family access routine and preventive healthcare at a reasonable cost and helps to protect you against the catastrophic costs ofmajor illnesses or injuries.The Minneapolis Public School Districts’ medical program is self-funded. This means that the District takes on allrisk for paying claims. UnitedHealthcare provides third-party administrative services, such as providing access to anetwork of providers and processing of claims.The District does not price the plan to make a profit. Employees also pay a portion of the cost through deductiblesand coinsurance. The District pays the remainder of the claims and administrative costs.Make the Most of Your Health BenefitsNavigating a new health plan can be co
Email: Benefits@mpls.k12.mn.us Phone: 612.668.0560 Fax: 612.668.0535 Mail: 1250 West Broadway Avenue North, Minneapolis MN 55411 . Benefits Department staff will verify eligibility status and assist with the process. Medical coverage will be effective on the date in which the employee enrolls online. Dental and Vision coverage
