OUTLINE OF EMPLOYEE BENEFITS
I. HEALTH INSURANCE 
A. Eligible 1st of month following start date.
B. The school district pays for full-time employee and dependent coverage per the terms of the employee contract.
C. Major medical highlights:
Blue Cross/Blue Shield of Illinois
2 PPO Plans:
$500 deductible per person, maximum first 2 deductibles per family.
$1500 deductible per person, maximum first 2 deductibles per family.
2 HMO Plans:
Enhanced benefits
HMO1 – larger network of providers; BA HMO – smaller network of providers
Coverage = PPO, in-network 80%20%; out-of-network 60%/40% both to a maximum out of pocket of $1000 (after $500 Deductible) and $2000 (after $1500 deductible), maximum first 2 per family.
Wellness benefits paid at 100%
$30 co-pay for physician office visit; $50 co-pay for specialist office visit.
Prescription card coverage = 80%/20% of first $1000. $20 minimum and $100 maximum co- pay.
Mail Order prescription services available. $15 for 3 month supply of generic drugs, $25 for 3 month supply of formulary drugs and $45 for 3 month supply of non-formulary drugs.
Premiums usually change effective January 1st of each year.
D. Additional Blue Cross Information
E. Benefit Forms
II. DENTAL INSURANCE 
A. Delta Dental, eligible 1st of month following start date.
B. The school district pays for full-time employee and dependent coverage per the terms of the employee contract for health insurance.
C. Major dental highlights:
Preventive care:
100% coverage.
No deductible
Annual deductible:
$50 per person (3 person family maximum).
$1500 calendar annual maximum per person
Other services:
50% to 80% per terms of schedule
Some services require waiting period
$1500 lifetime maximum per person under age 19 for orthodontia
D. Delta Dental Additional Information
E. Delta Dental Forms
III. VISION INSURANCE
A. EyeMed, eligible 1st of month following start date.
B. The school district pays for full-time employee and dependent coverage per the terms of the employee contract for health insurance.
C. Major vision highlights:
· Eye exam once every 12 months ($10 in network)
· Lenses and frames or contact lenses once every 12 months ($25 in network)
· Discounts offered if out of network
IV. LIFE INSURANCE
A. Mutual of Omaha, full-time employee eligible 1st of month following start date.
B. The school district pays for full-time employee coverage per the terms of the employee contract.
C. Additional optional life insurance available for employee, or employee and spouse, or employee and dependent children at a reasonable cost to the employee subject to application approval.
D. Life insurance included in the TRS or IMRF benefits also.
E. Additional Mutual of Omaha Information
F. District Paid Life Insurance Benefits by Employee Type
G. Employee Paid Voluntary Life Insurance
V.
LONG TERM DISABILITY
A. Included in the employee TRS or IMRF benefits.
B. Mutual of Omaha, additional voluntary benefit available to all full-time employees subject to application approval.
C. Monthly benefit is per schedule, depending on disability.
D. Benefit begins per schedule, depending on disability.
E. Employee Paid Long Term Disability Insurance
VI
. PAID SICK, VACATION, HOLIDAY AND PERSONAL TIME
A. Per terms of employment contract
B. Extended Medical Leave
C. Request for Medical Accomodations Form
VII. FLEX PLANS 
A. PayFlex, full-time employee eligible on effective date of health insurance for medical/dental/vision reimbursement.
Eligible upon start date for dependent care reimbursement. Plan year is October 1st through September 30th.
B. Pre-tax payroll deductions for medical expense reimbursement and dependent care expenses.
C. Additional PayFlex Information
D. Claim Form
VIII. PAYROLL
A. Direct deposit available. Most banks offer free services (checking, etc.) for your direct deposit.
B. Pay dates are the 15th and last day of the month or the last business/school day before the pay date.
C. Changes to payroll must be received by the 1st of the month to appear on the 15th paycheck, and by the 15th of the month to appear on the end of month paycheck.
| DeKalb C.U.S.D. 428 |
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| Insurance Payroll Deductions |
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| Effective January 1, 2013 |
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$500 Deductible |
$1500 Deductible |
HMO 1 |
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BA HMO |
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| HEALTH INSURANCE |
2012-2013 Benefit |
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Individual |
Family |
Individual |
Family |
Individual |
Family |
Individual |
Family |
Individual |
Family |
| Teachers |
95% ($10,000 max.) |
$6,000 |
$ 17.86 |
$ 285.90 |
$ 16.19 |
$ 235.68 |
$ 15.11 |
$ 203.38 |
$ 13.60 |
$ 158.05 |
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| Secretaries |
90% ($10,000 max.) |
70% ($10,500 max.) |
$ 35.73 |
$ 160.77 |
$ 32.38 |
$ 145.70 |
$ 30.23 |
$ 136.01 |
$ 27.20 |
$ 122.41 |
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| Assistants |
90% ($10,000 max.) |
0% |
$ 35.73 |
$ 535.90 |
$ 32.38 |
$ 485.68 |
$ 30.23 |
$ 453.38 |
$ 27.20 |
$ 408.05 |
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| Cooks & Custodians |
100% |
0% |
$ - |
$ 535.90 |
$ - |
$ 485.68 |
$ - |
$ 453.38 |
$ - |
$ 408.05 |
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| Asst. Superintendents |
100% ($12,778 max.) |
95% ($13,850 max.) |
$ - |
$ 26.80 |
$ - |
$ 24.28 |
$ - |
$ 22.67 |
$ - |
$ 20.40 |
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| Other Certified |
100% ($12,778 max.) |
90% ($13,850 max.) |
$ - |
$ 53.59 |
$ - |
$ 48.57 |
$ - |
$ 45.34 |
$ - |
$ 40.80 |
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| Other Non-Certified |
95% ($12,778 max.) |
90% ($13,850 max.) |
$ 17.86 |
$ 53.59 |
$ 16.19 |
$ 48.57 |
$ 15.11 |
$ 45.34 |
$ 13.60 |
$ 40.80 |
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| DENTAL |
EMPLOYEE |
EE/SPOUSE |
EE/CHILD |
EE/FAM. |
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VISION |
EMPLOYEE |
EE/SPOUSE |
EE/CHILD |
EE/FAM. |
| Teachers: |
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| w/ind. & fam. Health |
$ 0.79 |
$ 16.61 |
$ 15.58 |
$ 33.66 |
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$ 0.15 |
$ 2.84 |
$ 3.14 |
$ 5.94 |
| w/ind. Health or no Health |
$ 0.79 |
$ 0.79 |
$ 0.79 |
$ 0.79 |
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$ 0.15 |
$ 0.15 |
$ 0.15 |
$ 0.15 |
| Hired before 8/15/06 & |
$ 15.82 |
$ 31.64 |
$ 30.61 |
$ 48.69 |
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$ 2.99 |
$ 5.68 |
$ 5.98 |
$ 8.78 |
| no Health Insurance |
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| Secretaries |
$ 1.58 |
$ 6.33 |
$ 6.02 |
$ 11.44 |
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$ 0.30 |
$ 1.11 |
$ 1.20 |
$ 2.04 |
| Assistants |
$ 1.58 |
$ 17.40 |
$ 16.37 |
$ 34.45 |
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$ 0.30 |
$ 2.99 |
$ 3.29 |
$ 6.09 |
| Cooks & Custodians |
$ - |
$ 15.82 |
$ 14.79 |
$ 32.87 |
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$ - |
$ 2.69 |
$ 2.99 |
$ 5.79 |
| Asst. Superintendents |
$ - |
$ 0.79 |
$ 0.74 |
$ 1.64 |
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$ - |
$ 0.13 |
$ 0.15 |
$ 0.29 |
| Other Certified |
$ - |
$ 1.58 |
$ 1.48 |
$ 3.29 |
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$ - |
$ 0.27 |
$ 0.30 |
$ 0.58 |
| Other Non-Certified |
$ 0.79 |
$ 2.37 |
$ 2.27 |
$ 4.08 |
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$ 0.15 |
$ 0.42 |
$ 0.45 |
$ 0.73 |
IX. NORTHERN ILLINOIS UNIVERSITY TUITION WAIVERS
A. Per terms of employment contract.
B. Prior approval required from building principal.
C. Receipts and grades required.
X. EMPLOYEE ASSISTANCE PROGRAM 
A. Preventative health and well-being workshops and seminars for employees and families.
B. 24 hour help line 1-800-292-2780
C. Short term counseling (up to 8 free counseling sessions per year).
D. Referral services for long term assistance.
E. Additional EAP Information
XI. TAX SHELTERED ANNUITIES (403B)
A. Payroll deductions are available.
B. All accounts will be administered by planwithease.com.
C. This benefit is not subject to any enrollment deadlines and can be applied for at any time.
D. Enrollment Form
E. Approved Vendors
XII. YMCA
A. 20% discount available for district employees and families
B. Payroll deduction also available
C. This benefit is not subject to any enrollment deadlines and can be applied for at any time.
XIII. TRS – Teacher Retirement System
A. State pension, disability and death benefit for all certified employees.
B. TRS Forms
XIV. IMRF – Illinois Municipal Retirement Fund
A. State pension, disability and death benefit for all certified employees
B. IMRF Forms
XV. Workman's Compensation Provisions for Assitance if you are Injured on the Job
A. Workman's Compensation Forms
Questions?? – Contact Jacque Mazanowski at (815) 754-2370 or e-mail: jacquelyn.mazanowski@dist428.org