FT. ZUMWALT SCHOOL DISTRICT
All materials for open enrollment will be available online and sent via email. Please take a
moment to login to TalentED to confirm receipt of the Benefit Packet. You can also visit the
District’s website www.fz.k12.mo.us > ‘Departments’ > ‘Benefits’ to view the information.
Here’s to a great school year!
*OPEN ENROLLMENT ENDS AUGUST 25, 2022*
INSIDE THIS PACKET:
Update of Benefits 1
Medical & ZumCare 2
Dental & Vision 3
Life Insurance, Short Term Disability, & EAP 4
Cafeteria Section 125 & 403(b)/457 5
Medicare Overview 6
Your First 22-23 Paycheck 6
Insurance Rates – monthly and per check amounts 7
Medicare D Creditable Coverage 8
Cafeteria Plan - Dependent Insurance Deductions Information 9-10
Flexible Spending Account Information 11
Short Term Disability F.A.Q. 12
ALL FORMS ARE DUE BY Thursday, AUGUST 25, 2022
Due to payroll deadlines, there can be no exceptions!
The Federal Mandated Summary of Benefits Coverage (SBC)
is available at www.fz.k12.mo.us > ‘Departments’ > ‘Benefits’
2022-23
BENEFITS
2022-23 1
Benefit Update for 2022-23
Fort Zumwalt School District will continue to provide all eligible full-time employees with medical, dental, vision, and life
insurance at no cost to the employee.
MEDICAL INSURANCE: Fort Zumwalt will not make any changes to our medical insurance coverage, however, after a
5-year hold on premiums, there will be an increase for the 22-23 plan year. ZumCare continues to be a great option for
routine or minor medical care for our staff; Dr. Brown-Foote and Sue (Nurse Practitioner) continue to help serve our staff.
Please keep your current medical ID card. The Federal mandated Summary of Benefits and Coverage (SBC) is
located on the web at www.fz.k12.mo.us. Click on Departments > Benefits > Summary of Benefits (under the ‘Additional
Information’ link).
DENTAL INSURANCE: Our coverage and benefit costs through United Concordia will also remain the same for this
plan year. You will keep your current dental ID card.
VISION INSURANCE: Our current vision carrier will remain with Vision Benefits of America (VBA) and no changes will
be made to our coverage or premiums. While VBA doesn’t require an ID card, they now have a printable version online
if you would like to have one.
ANY PREMIUM COST CHANGES ARE RELFECTED ON OCTOBER’S FIRST CHECK.
PLEASE CHECK YOUR 10-14-22 PAY CHECK FOR ANY DESCREPANCIES!
MEDICAL FLEX SPENDING ACCOUNT: Remember your remaining MFSA balance (if applicable), up to a maximum
of $500, will be rolled over to the upcoming plan year to utilize for the entire year, October 1 – Sept 30. However, you
must re-enroll in the MFSA each year; previous elections do not rollover.
PREGNANCIES: If you have questions regarding coverage for a new baby, please contact the Benefits office prior to
your delivery date. You should decide before the birth which insurance plan will cover the baby. Our coverage does
NOT offer 31 days of free coverage. The baby is covered under the mother’s medical insurance, as an individual, for
48 or 96 hours after birth. This means the deductible applies to the child as well. The total cost could be $3,000; the
mother’s delivery up to $1,500 and baby’s hospital stay up to $1,500.
DEPENDENT AGE: It is your responsibility to notify the benefit’s office when your child is no longer eligible for coverage.
They must be removed from your coverage within 30 days. Fort Zumwalt will cover dependent children up to the end of
the month the child turns age 26 for all insurance plans. Please remember for dental and vision insurance, your child
MUST be your taxable dependent to be eligible for coverage. Children losing coverage will be offered COBRA.
MID-YEAR BENEFIT CHANGES: Changes for insurance can only be accepted as the result of a qualifying event (birth,
death, adoption, marriage, divorce, or loss/gain of spouse’s employment) during the plan year. The Benefits Department
must be notified within 30 days of the qualifying event date to add or drop members and/or dependents. Please
check with the benefits department before you enroll in any other plan(s) to determine eligibility. There are certain
guidelines that must be followed.
PSRS/PEERS: Contributions will remain the same as last year. The current contribution rates are 14.5% for PSRS,
9.67% for PSRS members in a support staff position, and 6.86% for PEERS. The retirement calculation is based upon
your salary, plus Board paid medical, dental, and vision insurance.
**Annual Open Enrollment is through August 25**
Employees may use the Open Enrollment period to change their current benefit elections. An open enrollment form must
be submitted for each change. Unless a change is submitted, all benefits will remain the same for medical, dental, vision,
and life insurance.
FORMS ARE ONLINE through TalentEd and are due by the close of business on August 25, 2022.
Due to payroll deadlines, there can be no exceptions.
New this year, benefit changes will be reflected on your October paychecks.
Watch your email for links to join the Web-ex discussions too!
2022-23 2
Aetna – Medical Insurance
The deductible for in-network services will remain at $1,500/individual for the October 1
st
– September 30
th
plan year
with co-insurance remaining at 0%. Remember, co-pays do not count towards the deductible and are paid all throughout
the plan year. After you have satisfied the deductible, the plan will pay in full for in-network services covered. The
maximum out-of-pocket will remain the same ($6,000), which the deductible, office visit copays, and pharmacy costs
count towards this larger limit. Should you satisfy the out-of-pocket amount in the plan year, you will no longer be
responsible for copays until our plan resets the following October 1.
In-network pharmacies include: CVS (has two 24 hour pharmacies), Costco, Sams, Dierbergs, Schnucks, Target, and
Walmart to fill your prescriptions. Our pharmacy coverage will remain a “5 Tier Drug Plan.” Tiers 1, 2, and 3 are at $10,
$30, and $55 copays respectfully, while Tier 4, is at 30% of the drug cost and Tier 5 is at 30% of the drug cost. You can
look up your prescriptions by creating your own login with Aetna.
Reminder – Prudent Rx – a Tier 4 and Tier 5 Specialty Medicine program will ELIMINATE your copay! Employees will
be contacted directly by Prudent Rx to enroll in this program which provides $0 co-pays for specialty medications! There
is no cost to enroll.
Our ‘Maintenance Choice’ program will continue. This requires employees to fill Tier 1 prescriptions at CVS unless you
opt-out by calling the number provided in Aetna’s communication to you. Aetna will contact you directly if this pertains
to you.
Rates will increase for the 22-23 Plan Year:
Benefit Premiums: Monthly Rates Per Check Rates
Employee Only (District paid) $730.00 District Paid
Employee’s Spouse $904.00 $452.00
Employee’s Child(ren) $710.00 $355.00
Employee’s Family $1,404.00 $702.00
In-Network Benefit Reminders:
• $1,500 Individual deductible / $4,500 Family deductible
• $25 Primary Care office co-pay – remember though, ZumCare is FREE
• $40 Specialist office co-pay
• $75 Urgent Care co-pays
• $250 Emergency room co-pay
• Co-insurance remains at 0% when in-network
• Maximum out of pocket limit: $6,000 (individual) / $12,000 (family)
o Includes the deductible, all office copays, and all pharmacy copays for the plan year
• Physical Therapy Visits: Covered 100% after the deductible has been met
• Chiropractor: maximum of 30 manipulation visits per plan year with a $20 co-pay each visit
Want four (4) monthly prescriptions FREE for the year? Consider the mail order 90-Day Rx option, which Aetna
offers. These options allow members to get three (3) months of a prescription for the cost of two (2)! The medication is
delivered to your home! Please talk with your doctor to see if this option is available for your prescriptions.
ZumCare – Health Clinic
ZumCare has been a huge success over the last four years! The clinic has the ability to provide basic services such as
routine well exams, vaccinations, flu shots, preventative and diagnostic lab work, x-rays, treatment for acute illnesses
(i.e. ear/sinus infections) or minor injuries. Using the clinic will eliminate your out of pocket costs for any service they can
provide. Remember, any dependents carried on our medical plan can also use the clinic.
ZumCare is open Monday – Saturday. To make an appointment, with Dr. Brown-Foote or Sue, you can call 636-978-1610
or use MyChart through BJC to schedule an appointment online. Remember, if you are a first-time patient you will need
to complete a few forms before being seen.
2022-23 3
United Concordia - Dental
Benefit Premiums: Monthly Rates
Employee Only (District paid) $35.68
+ One Dependent $39.20
+ Two or More Dependent $80.10
Our plan provides the “Preventive Incentive.” This incentive excludes the charges for Class 1 Diagnostic and Preventive
services (cleanings, exams, x-rays, etc.) from our $1,000 annual benefit, which allows more benefit dollars for Basic and
Major services. The Preventative Incentive adds approximately $200 or more in value to use on other covered dental
procedures.
The following benefits are still included with our PPO plan:
❖ Maximum benefit - $1,000 per person/plan year
❖ Diagnostic and Preventative – paid at 100% in-
network
❖ Basic services – paid at 80% in-network*
❖ Major services – paid at 60% in-network*
❖ Deductible - $25 per person (x3 per family)
*Dental insurance will pay the set percentages (80% or 60%) up to the yearly maximum of $1,000. Once you have utilized
the $1,000 benefit you will be responsible for the negotiated costs for the remainder of the plan year. For the best benefit
allowance, always use an in-network provider. The discounts you receive for services from a participating provider stretch
your $1,000 benefit a long way.
Orthodontic – This coverage remains at 50% up to maximum of $1,500 (dependents up to age 19); with a life time
maximum. If you are considering adding a dependent on for orthodontic coverage, please be aware if the child has dual
coverage the benefit from the other coordinating insurance company may be less. Reach out to the Benefits Department
to discuss this prior to enrollment to ensure you are getting the best benefit.
Vision Benefits of America (VBA)
The benefit premium costs will remain the same this year and we will maintain the exceptional value for the vision plan
too. There is no co-pay to have an annual eye exam. If you are asked to pay a $40 copay, your provider is billing Aetna
for services. Aetna is not your eye care provider and should only be used for medical issues (i.e. cataracts, etc.).
Be sure to always use in-network providers for your vision coverage to receive your truly free eye exam. If you use an
out of network provider, you may be ‘balance billed’ from what the provider bills and what VBA allows for payment. You
can find an in-network provider online through VBA’s website: www.vbaplans.com you do not need to create a login or
remember a special password for once!
Benefit Premiums: Monthly Rates
Employee Only (District paid) $7.58
Family $16.44
Benefits include:
✓ Eye exam & lenses every 12 months
✓ Scratch resistant coating
✓ Progressive (no-line) multi-focal lenses
✓ Solid and gradient lens tints
✓ $50 Wholesale frame options
✓ Polycarbonate lens material or Trivex lens
✓ Frames every 24 months
✓ UV protective coating
Note: Polarized lenses, Transition lenses, and the Anti-Glare Coating are NOT covered and
will need to be paid for by the member.
In lieu of glasses and frames, the member may choose the contact lens allowance of $160 to purchase their contact
material. As always, the contact lens fitting fee will be a separate charge you are responsible for paying. Providers are
allowed to charge different amounts for this fitting fee so it can vary from doctor to doctor. Remember, each year you
can only use the VBA benefit for one or the other (glasses or contacts). You cannot choose both benefits in the same
year.
2022-23 4
Sun Life of Canada
All full-time employees are provided $50,000 life insurance at no cost to the employee. There will be no rate increase
from Sun Life for employee basic life, dependent life, and optional life; however, employees with optional life insurance
who reach a new age band will notice an increase in premiums (i.e., age 40, 45, 50, 55, etc.). If your Optional Life
insurance amount changes, the Benefit Department will notify you prior to open enrollment ending so you can review
your coverage and make any changes prior to August 25
th
.
Enrollment forms will be online for members wishing to increase optional life. Please contact the Benefit Department if
you wish to make any changes asap. You must contact the benefits department to apply for additional life
insurance. You will receive the online instructions to complete your EOI form to go through underwriting. The
Benefits Department will need your enrollment form (filled out through TalentED) to complete the Employer’s
portion of the EOI form online. Likewise, all dependents requesting coverage must complete an “Evidence of
Insurability” (EOI) form. If approved, Sun Life will notify the applicant and Fort Zumwalt. Be sure to watch your paycheck
after you receive the approval letter from Sun Life to make sure the deduction is in place.
BENEFICIARY FORMS: Life insurance beneficiary changes can be done at any time throughout the year. You are not
limited to open enrollment to make beneficiary changes. You can find the forms online through TalentED and can view
the completed forms at any time through TalentED for a peace of mind.
Short Term Disability
The Employee paid premium for Short Term Disability will continue on for the employees enrolled in the program.
Adjustments to the premiums will be sent directly to any staff member who is enrolled. The change in premiums is based
on the annual salary and the age bracket of the enrolled employee. The Benefits Department will update the amounts
accordingly on the first paycheck of October when the plan year renews and salaries have been confirmed.
If you are currently enrolled in the Short Term Disability program and wish to continue; there is no action needed on your
end. The premiums will be adjusted and will continue to be withheld from each paycheck accordingly.
Want to enroll in the Short Term Disability benefit? Please contact the Benefits Department and complete the
enrollment form and the ‘Health Questionnaire’ provided by the Disability company to be reviewed. The Benefits
Department will securely send your health questionnaire directly to the provider for you. The employee will then be
contacted if additional information is needed. Upon approval/denial a letter will be sent to the applicant and the District.
If approved, the premium amount will be entered and deducted from your paychecks.
Short Term Disability allows employees who are not able to work, due to their OWN medical reasons, up to 13 weeks of
income at 60% of their annual salary. The benefit is available all year long, regardless of the employee’s work schedule.
A FAQ has been included in this packet to help answer some of the most common questions.
Employee Assistance Program (EAP)
Fort Zumwalt has partnered with Kepro for a FREE Employee Assistance Program (EAP) that is available to all our full
time staff AND their families (spouse/children) living in the same house hold.
Employees are eligible for up to 5 free visits PER OCCURANCE, meaning you can get 5 visits for one need and 5 for
another. Example: Your spouse lost their job and you need financial help and your parent’s health is declining and you
need care advice; each situation would receive 5 visits so this would be 10 visits total!
2022-23 5
Section 125 Pre-Tax Benefit Election Forms
We have two (2) Pre-Tax Election Forms. The Cafeteria Plan Election Form is for pre-tax deductions for dependent
medical, dental, and/or vision insurance premiums. The Flexible Spending Account (FSA) Election Form is for
reimbursement on a pre-tax basis for eligible, but not limited to, medical services not covered by insurance and eligible
day care expenses.
1. Cafeteria Plan Election Information:
Enrollment in the Cafeteria Plan allows you to pay the premiums for dependent medical, dental, and/or vision coverage
on a pre-tax basis. The amount of your elected contributions will not be subject to income tax withholding. Participation
in the Plan will reduce the amount of overall taxes you are required to pay. The form is available through TalentED and
must be submitted with any open enrollment change prior to the open enrollment deadline.
2. Flexible Spending Account(s) (FSA) Information:
This benefit consists of “reimbursement” accounts also known as Flexible Spending Accounts. Participants elect a
certain dollar amount to be withheld from their check on a pre-tax basis. When eligible expenses are incurred, the
employee may use their FSA Debit card to pay for the service or submit an affidavit for reimbursement. Participation in
the FSA plan(s) requires enrollment every year. Please read the form for eligibility requirements. Deductions begin on
the LAST September pay check and are divided equally over 16 paychecks or until the elected amount is reached.
Expenses must occur between October 1, 2022, and September 30, 2023 to be eligible for reimbursement. Employees
should use caution in selecting the amounts as the FSA is a ‘use it or lose it program.’
*REMEMBER* Employees are able to roll over their remaining Medical FSA amount, up to $500, for the next plan
year. Any money remaining in the MFSA accounts above $500 at the end of the plan year will be forfeited.
Remaining funds in the MFSA that are under $500 will be available for the employee to use the following plan
year, even without re-electing the benefit during open enrollment.
If an employee terminates or retires, the eligible expense period ends at the end of the month in which your coverage
ends and (unless elected to continue under COBRA) isn’t the full plan year.
Limits on Flexible Spending Accounts:
▪ The Medical Flexible Spending limit is $2,850 (please read form for information on eligibility).
▪ Dependent Care (Day Care) Flexible Spending limits are $5,000 for a married couple (only one parent may claim
the deduction), OR $2,500 for an individual (check the enclosed information for eligibility).
403(b) and 457 Pre-Tax Retirement Plan
Fort Zumwalt offers both the 403(b) and the 457 plans for employees to defer income to reduce their federal
and state taxes. Employees are allowed to enroll in these plans anytime during the year; there is no set open
enrollment period. You can also increase or decrease the amount you defer throughout the year. As a
government employee, you may open both of these accounts and defer up to the allowed maximum by the
IRS each year. Employees also have the option to open an account and defer their sick leave reimbursement,
upon retirement, if those funds are not needed immediately.
Upon enrollment, employees will elect the per paycheck amount to be withheld and their desired investment
options between stocks and bonds. Both the 403(b) and the 457 are managed by our third-party administrator,
Ekon Benefits.
You can use these funds to purchase years of service with the state retirement systems (PSRS or PEERS)
or even take a loan if needed.
Please reach out to the Benefits Department if you would like the enrollment packet or to get more information.
2022-23 6
Medicare & You
If you carry the Fort Zumwalt medical insurance and are still working, your Fort Zumwalt plan is primary while Medicare
becomes secondary. Individuals must enroll in Medicare when they become Medicare eligible (age 65), especially Part
A (Hospital) since it is most likely free. However, as long as you are currently working and covered under Fort
Zumwalt’s medical plan, it will not be necessary for you to purchase Medicare Part B (Physician coverage) and/or
a Medicare Plan D (Prescription coverage).
When you retire or terminate, you will need to contact Medicare for enrollment periods; otherwise, a penalty will be
applied for any late enrollment(s). You will also need the CMS Request for Employment Information completed by the
Benefits Department to confirm your enrollment in the Fort Zumwalt plan while you were employed.
If you have questions, contact the Medicare/Social Security Office at 1-800-772-1213. Enclosed is the Medicare D Letter
of Creditable Coverage for 2021-22. If you are covered by our medical plan, you do not need to enroll in Medicare D
because you currently have creditable prescription coverage.
Your First Paycheck for 2022-23
PLEASE LOOK CHECK YOUR PAYSTUBS TO VERIFY ALL DEDUCTIONS!
Please, please, please take a look at your pay stub. A quick look can help us correct the problem on your next payroll
check. In order for your W-2 to print correctly, all corrections must be processed through your payroll check. So, please
double check your deductions and notify benefits or payroll as quickly as possible if any errors need to be fixed.
You can access your check stub through the web portal at http://hr.fz.k12.mo.us/portal/
Additional Reminders:
➢ Very Important – Any change you make for insurance during Open Enrollment will be on your OCTOBER 14
th
check. All changes in coverage take place on October 1st. Please verify for accuracy and notify us as soon as
possible if you note a discrepancy. Corrections must be made before the last check in October.
➢ If you are electing to participate in the Medical Flexible Spending Account (MFSA) or the Dependent Care Flexible
Spending Account (DCFS), these deductions will begin on your September 30 paycheck and continue for 16
payrolls; however, eligible expenses must occur between October 1, 2022 - September 30, 2023.
➢ Dependent insurance premiums deducted on a pre-tax basis, will have the word “CAFÉ” printed by the deduction.
➢ What is OASDI? – This deduction is your Social Security tax deduction.
➢ What does MEDI–NCRT or MEDI-CERT on my check mean? – This deduction is your Medicare tax deduction.
The Benefits Department is here to help!
Please don’t hesitate to call or email one of us.
Thank you!!
Eileen Bresnahan 636-474-8506 ebresnahan@fz.k12.mo.us
2022-23 7
FORT ZUMWALT SCHOOL DISTRICT
Effective October 1, 2022 - September 30, 2023
HEALTH INSURANCE
AETNA - CHOICE POS II
Per Check
Monthly
Employee Only
FREE = District Paid
$365.00
$730.00
Employee's Spouse
Employee Pays
$452.00
$904.00
Employee's Child/Children
Employee Pays
$355.00
$710.00
Employee's Family (Spouse & Children)
Employee Pays
$702.00
$1,404.00
DENTAL INSURANCE
UNITED CONCORDIA
Per Check
Monthly
Employee Only
FREE = District Paid
$17.84
$35.68
+1 Dependent (Child or Spouse)
Employee Pays
$19.60
$39.20
+2 or More Dependents (Spouse and/or Children)
Employee Pays
$40.05
$80.10
VISION INSURANCE
VISION BENEFITS OF AMERICA
Per Check
Monthly
Employee Only
FREE = District Paid
$3.79
$7.58
Employee's Family (Spouse and/or Children)
Employee Pays
$8.22
$16.44
LIFE INSURANCE
SUN LIFE OF CANADA
Per Check
Monthly
Employee Only (Coverage Amount: $50,000)
FREE = District Paid
$2.85
$5.70
Dependent Life Insurance
Employee Pays
$3.20
$6.40
(Coverage: Spouse $25,000)
(Coverage: Children - 14 days through 5 mos. - $1,250)
(Coverage: Children - 6 mos. to age 26 - $12,500)
Employee's Optional Life Insurance
See Age Chart Below
(Coverage Amount: Available in $10,000
increments up to $150,000)
Age: Under 30 Employee Pays
Per $10,000
$0.25
$0.50
30-39
Per $10,000
$0.25
$0.50
40-44
Per $10,000
$0.45
$0.90
45-49
Per $10,000
$0.75
$1.50
50-54
Per $10,000
$1.35
$2.70
55-59
Per $10,000
$2.15
$4.30
60-64
Per $10,000
$3.15
$6.30
65-69
Per $10,000
$5.00
$10.00
70-74
Per $10,000
$8.35
$16.70
2022-23 8
Important Notice from Fort Zumwalt School District About
Your Prescription Drug Coverage and Medicare
The Centers for Medicare and Medicaid Services (CMS) require that the following notice be issued to eligible Medicare recipients annually. This
notice only applies to Medicare eligible employees, dependents, retirees, and COBRA participants currently covered under our group medical
plans. Plan dates October 1, 2022 through September 30, 2023.
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Fort
Zumwalt School District and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare
prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help
to make decisions about your prescription drug coverage.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare
Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by
Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Fort Zumwalt School District has determined that the prescription drug coverage offered by Aetna is, on average for all plan participants, expected to
pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.
Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this
coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15
th
through
December 31
st
. Beneficiary’s leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug
plan.
You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug
coverage in your area.
If you do decide to enroll in a Medicare prescription drug plan and drop your Aetna prescription drug coverage, be aware that you
and your dependents may not be able to get this coverage back.
Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan.
AETNA Tier 1 - $10 Tier - 2 $30 Tier 3 - $55 Tier 4 - 30% Tier 5 – 30%
Anthem Plan D Tier 1 - $10 Tier - 2 $25 Tier 3 - $40
You should also know that if you drop or lose your coverage with Fort Zumwalt School District and don’t enroll in Medicare prescription drug coverage after
your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.
If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will
go up at least 1% per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium
will always be at least 19% higher than what many other people pay. You will have to pay this higher premium as long as you have Medicare prescription
drug coverage. In addition, you may have to wait until the following November to enroll.
For more information about this notice or your current prescription drug coverage…
Contact our office for further information at 636-272-6620, x 18506. NOTE: You will receive this notice annually and at other times in the future such as
before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Fort Zumwalt School District changes. You also
may request a copy.
For more information about your options under Medicare prescription drug coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the
handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about
Medicare prescription drug plans:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for
personalized help,
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is
available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be
required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.
Document Issued: August 1, 2022
Effective Date of Plan: October 1, 2022 - September 30, 2023
Name of Entity/Sender: Fort Zumwalt School District, 555 E. Terra Lane, O’Fallon, MO 63366, 636-272-6620
Contact--Position/Office: Eileen Bresnahan, Benefits Coordinator
2022-23 9
CAFETERIA PLAN
For Pre-Tax Health Insurance Payroll Deductions
Please complete the election form through TalentEd along with your Open Enrollment Change form.
THIS PAGE IS FOR INFORMATION ONLY.
Your elections are binding and ordinarily may not be revoked or changed until the next Open Enrollment. Mid-year election
changes are permitted only upon certain "Qualified Changes in Status," which are described in the Summary Plan
Description. Your elections will apply until: 1) You leave employment with Ft. Zumwalt School District, or 2) You lose
eligibility to participate according to Plan terms, or 3) You revoke these elections or submit new elections in writing during
a future enrollment period, or 4) The Plan is terminated by the sponsoring Employer.
Your elections will remain in effect for future years until a new election form supersedes this enrollment election.
(1)
For Pre-Tax Health Insurance Payroll Deductions:
➢ New Employee Electing Pre-Tax Deductions for dependent insurance premiums.
➢ Current Employee Electing Pre-Tax Deductions for changed dependent coverage during the Open
Enrollment period. (1)
➢ Current Employee Electing Pre-Tax Deductions for changed dependent coverage based on a “Qualified
Change in Status.”
You must be eligible under the employer sponsored insurance plan as specified in the DOP Handbook to receive
this benefit. Your elections will take effect on the first day of your eligibility for group insurance or on the first day
of the Plan Year (if made during Open Enrollment).
Contributions for dependent health insurance will be withheld from your payroll in a pre-tax manner. Your
contributions are as determined by the District and are based on the coverage in which your dependent(s) are
enrolled. This form is not for enrollment for dependent coverage under the District’s health insurance plan; this
form enables you to pay the premiums for dependent coverage on a pre-tax basis.
Consider your elections carefully. Your elective contributions will be reduced from your gross payroll and will not
be subject to income tax or FICA withholding. Participation in the Plan will reduce FICA contributions made on
your behalf.
Insurance Waivers:
If you are declining enrollment for yourself or your dependents (including your spouse) in the Fort Zumwalt School
District Health Plan because of other health coverage, you may in the future be able to enroll yourself or your
dependents in this plan, provided that you request enrollment within 30 days after your coverage ends. In
addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may
be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the
marriage, birth, adoption, or placement for adoption. To be eligible for the enrollment rights described above, the
Fort Zumwalt School District Plan requires you to state in writing that the reason you declined enrollment is
because you or your dependents have coverage under another group health plan or other health insurance
coverage. Therefore, if you do not check the box below indicating that the reason for declining enrollment is
coverage under another health plan, you may not be eligible for the special enrollment rights. In addition, you
may enroll during a future enrollment period. Open enrollment occurs in August for plan years beginning in
October.
➢ I elect to waive Group Health Insurance because I have other insurance coverage.
➢ I elect to waive dental insurance.
➢ I elect to waive vision insurance.
2022-23 10
FORT ZUMWALT SCHOOL DISTRICT
CAFETERIA AND FLEXIBLE SPENDING ACCOUNT PLAN INFORMATION
The Cafeteria Plan is a voluntary fringe benefit plan sponsored by the District. The Plan may save you money because it allows
you to pay for certain expenses tax-free.
You participate in the Plan by having your salary reduced by the amounts you elect in order to pay for the benefits you elect, as
described below. The amount of your salary reductions is not subject to income tax or FICA withholding, and the benefits you receive
under the Plan are tax-free as well.
Dependent Medical Insurance Contributions.
The Plan allows you to pay on a pre-tax basis your contributions for District
sponsored health, dental and disability coverage for dependents. To participate, select on the Enrollment Form which coverage you
want to pay through the Plan.
Medical Flexible Spending Arrangement (Medical FSA).
The Medical FSA provides an opportunity for you to pay your
out-of-pocket family medical expenses tax-free. Eligible expenses include your health plan deductibles and expenditures for medical
care that are not paid by insurance. Expenses associated with general health promotion, over the counter medications, cosmetic
procedures and individually paid insurance premiums are not eligible.
To participate in the Medical FSA you must insert the amount of coverage you elect on the Enrollment Form, up to the limit
set out on the Enrollment Form. That amount will be deducted in equal amounts from each paycheck and credited to your account. To
benefit from the Medical FSA, you submit eligible expenses incurred during the plan year. Any unused amount at the end of the plan
year, up to $500, will be rolled over to the following plan year.
The amount you elect should be based on your best estimate of your uninsured medical expenses for the upcoming plan year.
Any unreimbursed balance at the end of each year will be forfeited. Your annual Medical FSA amount of coverage, less expenses already
reimbursed for the year, is available throughout the plan year to reimburse eligible expenses.
Dependent Care Flexible Spending Arrangement (Dependent Care FSA).
The Dependent Care FSA provides an
opportunity for you to pay your work-related dependent care expenses tax-free. Eligible expenses include expenses of caring for your
children under age 13, and expenses of caring for older children and adult dependents if care is required due to medical considerations.
The dependent receiving care must be your dependent for federal income tax reporting purposes and must reside with you.
You may utilize a dependent care facility, pre-school or a private provider. The provider may be related to you, but may not also be your
dependent. If you use a provider other than a tax-exempt organization, please note that you must obtain the provider’s social security
number or EIN. This information must be disclosed annually on your federal income tax return.
To participate in the Dependent Care FSA you must insert the amount of coverage you elect on the Enrollment Form. You may
elect up to $5,000 of coverage annually ($2,500 if you are married and file an individual (rather than joint) federal income tax return).
The amount you elect will be deducted in equal amounts from each paycheck and credited to your account. To benefit from the
Dependent Care FSA, you submit eligible expenses incurred during the plan year and are reimbursed for those expenses from your
account.
The amount you elect should be based on your best estimate of your dependent care expenses for the upcoming plan year. Any
unreimbursed balance at the end of each year will be forfeited. At any given time during the plan year, you may receive reimbursement
only from the balance in your Dependent Care FSA at that time.
Please note: FSA amounts may only be used to reimburse expenses incurred in the current plan year, and, in the case of
the Medical FSA, any remaining amount up to $500 will carry over to the following plan year to be used. Consider your FSA
elections carefully – they may not be changed or revoked until the end of the plan year except under qualifying circumstances.
Dependent Care FSA Account balances may not be carried forward to the next plan year. Unreimbursed balances are forfeited.
STLD01-810604-2
Fort Zumwalt School District
Flexible Benefits Plan Information
Adopted October 1, 2006
2022-23 11
FLEXIBLE SPENDING ACCOUNTS (FSA)
Annual Enrollment Required
Please go to TalentEd to complete your enrollment form.
THIS PAGE IS FOR INFORMATION ONLY.
Company used for Flexible Spending Accounts: On-Line Benefits a.k.a. OLB
Email: olbsys@sbcglobal.net
Phone: 314-664-2103
Please read the eligibility and enrollment rules carefully before enrolling in these plans. Per regulations and Plan terms,
once you enroll, you cannot change an enrollment election before the end of the Plan Year unless you have a qualifying
status change. In addition, if your eligible expenses are less than your annual contribution at the end of the plan year’s
extend grace period, you will lose any money remaining in your account.
Medical Flexible Spending Arrangement (MFSA) - Requires 1 year tenure
Must be employed with the District prior to October 1, 2021.
✓ Must work at least 30 hours per week.
✓ Maximum amount allowed - $2,850
The MFSA may be used to reimburse your eligible medical expenses that are not paid by insurance. Many health,
dental and vision care expenses qualify for reimbursement. Qualifying expenses are as described in IRC Section 213
and must be for specific and medically necessary health care/treatment. Note that expenses associated with cosmetic
health procedures and general health promotion (such as diet and exercise), and premiums that you pay for individual
health insurance or coverage sponsored by other employers ARE NOT ELIGIBLE.
Dependent Care Flexible Spending (DCFS) - Requires 1 year tenure
Must be employed with the District prior to October 1, 2021.
✓ Must work at least 30 hours per week
✓ Dependent child/children must be under age 13, unless there is a medical necessity
✓ Maximum amount is $5,000 (2,500 if you are married but file an individual, rather than joint federal income tax return.)
The DCFS may be used to reimburse dependent care expenses (i.e. day care, before/after school care, preschool
tuition, etc.) that are necessary due to your employment with Ft. Zumwalt School District. Each person receiving care
must be your dependent for income tax purposes and must reside with you.
Reimbursement for FSA:
There are a few options for reimbursed from your FSA Account.
Medical FSA:
- Purchase the FSA Debit Card (one-time fee $15) and the card will be ‘loaded’ with your funds at the beginning of
each year you elect to contribute. You must keep your receipts in case the IRS audits you.
- You can complete an affidavit and send in your receipts for reimbursements. OLB can either send you the funds
via direct deposit or via check.
Dependent Care FSA:
- You will be reimbursed from OLB either via direct deposit or via check. You will complete an affidavit with the
information about the child receiving care and the provider’s information or submit your day care provider itemized
receipt. You must keep your information in case the IRS audits you.
2022-23 12
Short Term Disability FAQ
Why would I apply and pay for Short Term Disability (STD)?
You will receive 60% of your base salary up to a maximum weekly benefit of $1,500. Base salary does NOT include
Extra Pay/Duty.
How long can I be approved for?
You can receive up to 13 weeks of paid time under STD if approved per disability.
Is there a waiting period before I can receive pay from the Short Term Disability company?
Yes, there is a 14 calendar day (two weeks, approx. 10 business days) waiting period that you have to be continually
disabled before you can be approved. You can apply for the disability pay as soon as you become disabled (and we
recommend you do this) to then gain approval before the end of your waiting period or as soon as possible.
How does my own accrued sick, personal, and vacation time play into how I am paid?
ALL of your accrued SICK time MUST be USED prior to being paid STD from the insurance company. You do NOT
have to use your personal time nor your vacation time (if applicable). You will be required to use your own time during
the waiting period through its exhaustion before receiving other compensation.
I’m an employee that doesn’t have a lot of time built up (new hires or staff who have used their time),
how does the waiting period affect me?
Any SICK time you do have remaining MUST be used during the initial waiting period. You may borrow from the sick
bank (if applicable) or use your personal and/or vacation to help pay you during this time. Otherwise you will be on dock.
Once you have met the 14-day waiting period and are approved for STD you will receive pay directly from the insurance
company throughout the approved time.
What about pre-existing conditions? Do they apply?
As a new hire, you are guaranteed enrollment without any medical questions asked. However, should you not enroll
initially, you can enroll during a future annual enrollment, but you WILL be required to go through a medical
questionnaire with the insurance company to be approved or denied enrollment. Keep in mind that some common
underlying conditions may hinder you from being approved by the outside insurance company for coverage.
I’m rather healthy now, should I still enroll?
It’s your call. Common ‘pre-existing’ conditions could keep you from being eligible later. Ex: pregnancy, high blood
pressure, high cholesterol, diabetes, etc. Even if these conditions are ‘under control’ you can still be denied enrollment.
You never know when the unexpected will happen and this benefit provides another level of protection for your income.
When should I apply for Short Term Disability?
We recommend to have the paperwork completed by you and your doctor as soon as possible after your disability
starts. While you must use all your SICK time first, we can note that and have the outside insurance company prepare
the approval ahead of time so there is less of a gap in when your pay ends with FZSD and when it starts with the other
insurance company.
What is the difference between Short Term Disability and if I’m eligible for FMLA?
Short Term Disability is a benefit that can pay you for your time away from work when you are disabled. FMLA is a
leave that protects your position and your District paid benefits. They will run concurrently. Think of it as one (FMLA)
protects you while the other (Short Term Disability) pays you.
What if I do not qualify for FMLA; can I still receive Short Term Disability?
Yes, if approved for Short Term Disability you will still receive pay from the insurance company. You would typically take
a leave of absence from FZSD and your District paid benefits will end.
Does Short Term Disability effect my years of service with PSRS/PEERS retirement system?
Yes, any time an employee is on DOCK (not receiving pay from FZ) they will not be paying into their PSRS/PEERS. At
the end of the school year, it will be your responsibility to inquire about this ‘missed’ time with PSRS/PEERS; should you
choose.
