New Tools Available To Help Reconcile Your Claims
As employee reimbursements from DataPath begin to arrive, you may have questions such as: Who do I owe? How much do I owe? How do I know I've been fully reimbursed what is due to me?
VEHI has created new tools for employees to help them reconcile their medical claims. They have put together a step-by-step list of tasks employees can go through to help with this process:
In addition to this reconciliation guide, VEHI has also created screenshots from both BCBSVT and MyRSC. They have also created an excel template to get employees started with the process. These resources can be found at http://www.vehi.org/home/datapath/.
EWSD provides medical insurance to eligible workers through the Blue Cross Blue Shield VEHI plans. Below is a list of eligible employees:
- Teachers (0.50 FTE or greater)
- Full-time Support Staff (30+ hours/week)
- Full-time Administrators, Directors and other Non-Union Professional Staff
New hires/rehires can enroll on our plan as early as the first of the month following his/her first day of work as an eligible employee, provided a completed enrollment form is submitted prior to the effective date of coverage. There are no waiting periods for coverage. The completed enrollment form (found under forms below) and any corresponding paperwork must be received within 30 days of the date of hire or rehire. Enrollment forms received after 30 days will take effect on the next earliest open enrollment date.
Eligible employees may select single, Parent/Child(ren), 2-person (2-adult), or family coverage. Eligible dependents include the employee's:
- Children who are under the age of 26
- Spouse’s children who are under the age of 26
- Children that do not live with the employee but the employee is responsible for their medical coverage under a court order (A copy of the court order is required)
- “Incapacitated” dependent age 26 or older (see below)
- In certain cases, a child whom the employee has assumed legal guardianship
In order for a dependent to be considered “incapacitated", the dependent must meet the following criteria:
- They are incapable of self-support because of a physical or developmental disability, mental illness or mental retardation,
- The incapacitating disability must have begun while the dependent was still a child, and
- The dependent must be primarily dependent on the employee for support and maintenance.
In order to request coverage for an incapacitated dependent, BCBSVT requires the employee to complete a form and provide medical certification of the disability. The determination as to whether a dependent qualifies as "incapacitated" is made by BCBSVT. The status of an incapacitated dependent will be reviewed annually by BCBS.
Plan Options and Cost
EWSD offers four different helath insurance plan options to eligible employees. All plans are provided by Blue Cross Blue Shield of Vermont (BCBSVT) through the Vermont Education Health Initiative (VEHI). Below is a list of plans offered. A Health Reimbursement Arrangement (HRA) is provided for those who select the VEHI Gold CDHP Plan. Copies of the Summary of Benefits and Coverage (SBC) for each plan above, along with an HRA wrap SBC for the VEHI Gold CDHP Plan, can be found in the Medical Insurance Documents folder herein:
Health Reimbursement Arrangement (HRA)
All employees who elect the VEHI Gold CDHP plan may elect to participate in a Health Reimbursement Arrangement (“HRA”). An HRA is an IRS-approved, employer funded, tax-advantaged employer health benefit plan that reimburses employees for out-of-pocket medical expenses. An HRA is not health insurance. An HRA allows the District to make contributions to an employee’s account to reimburse the employee for eligible expenses. An HRA allows employees to pay for a wide arrange of medical expenses not covered by insurance.
Eligible expenses under the HRA plan include medical deductibles, co-insurance, copays, and out-of-pocket Rx costs after the employee covers the first dollar amount of medical expenses up to the following amounts:
Teachers, Administrators, Director and all Exempt Level Employees: Once the employee pays the first dollar out of pocket maximums as outlined below, the district will pay the remaining first dollar medical expenses not to exceed $2,100 (single) or $4,200 (2-person, parent/child(ren), or family).
- Single: The employee must pay the first $400 of the medical maximum out of pocket costs.
- Two-Person, Parent/Child(ren) and Family: The employee must pay the first $800 of the medical maximum out of pocket costs.
All Support Staff: Once the employee pays the first dollar out of pocket maximums as outlined below, the employee and the district will share the remaining first dollar medical expenses with the employee paying 10% of the remaining covered out of pocket costs, and the District paying 90% of the remaining covered out of pocket costs not to exceed $2,100 (single) or $4,200 (2-person, parent/child(ren), or family).
- Single: The employee must pay the first $150 of the medical maximum out of pocket costs.
- Two-Person, Parent/Child(ren) and Family: The employee must pay the first $300 of the medical maximum out of pocket costs.
In order to participate in the HRA Plan, you must select the VEHI Gold CDHP Plan and complete and submit the following to Human Resources by the enrollment deadline:
- VEHI Enrollment and Change Form (with your medical insurance enrollment)
- Employee Authorization for Direct Deposit, and
- mySourceCard Enrollment Agreement (optional)
For more information, please refer to the HRA Frequently Asked Questions document provided herein.
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How to Enroll
Download the VEHI Enrollment and Change Form below, enter your information, save the document with your modifications, and email your saved version electronically to Human Resources. You can also complete and print the form with your information and submit a paper copy with your signature to Human Resources. The "Download" icon is the one with the arrow pointing to a horizontal line: If you cannot find your form, check your computer's "Downloads" folder.
Section 125 Plan
EWSD has adopted the Section 125 Plan to enable our employees to pay for their share of health insurance premiums with dollars that do not get taxed. Without this plan, these premiums will be paid by payroll deduction with after-tax dollars.
That is, your federal, state and FICA (social security) taxes will be computed on your full taxable paycheck, the taxes deducted, and then the premiums are deducted.
This Plan allows you to not pay federal, state or FICA taxes on the dollars that are used to pay your share of group health insurance premiums. We will automatically implement this portion of the Plan to help you pay your share of group health insurance premiums effective with your first paycheck with a premium deduction. If you do not wish to take advantage of this opportunity, you should complete and sign the Election Not to Participate Form and return it to Human Resources.
This form is available through Human Resources.
Our group medical insurance open enrollment period is November 1 - November 30 each year for a January 1 effective date. During an open enrollment period, eligible employees may elect to:
- Enroll in one of our group BC/BS health insurance plans if s/he is not currently enrolled;
- Add eligible dependents who are not currently enrolled; or,
- Change from one BC/BS Plan to another.
If you wish to take advantage of an open enrollment, please contact Human Resources to request an enrollment form. Completed enrollment forms must be returned to Human Resources for processing by November 30th. Late enrollments will not be processed until the next available open enrollment date.
If you have declined health insurance enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the EWSD plan if you, or you and your dependents, lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days (see chart below) after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
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. However, you must request enrollment within 31 to 60 days (see chart below) after the marriage, birth, adoption, or placement for adoption.
To request special enrollment please contact Sandy Emery at firstname.lastname@example.org or call (802) 857-7048 at least two weeks prior to the enrollment deadlines specified below to allow time for processing.
Type of Event
Deadline for Receipt of Enrollment/Change Form*
Change Effective Date
Within 31 days following marriage
First of month following marriage/civil union
Within 32 to 60 days following marriage
First of month following date of receipt
Birth or adoption
Within 31 days following birth, adoption or placement for adoption (child is automatically covered for the first 31 days)
32nd day after the birth, adoption or placement for adoption
Birth or adoption
Within 32 to 60 days following birth, adoption or placement for adoption
First of month following receipt
Spouse/Civil Union Partner Loses Coverage
Within 31 days of the loss in coverage
Date of the loss in coverage
In order to process a membership change, the employee must complete and submit a Group Enrollment Change Form (found under forms below) and any additional required paperwork to Human Resources. The paperwork must be submitted at least two weeks prior to the enrollment deadlines outlined above in order to allow time for processing. Human Resources will forward the necessary paperwork to BCBS after processing the change on our records. Requests not received as indicated above will be processed with the next open enrollment period.
Removing an Ineligible Dependent
Employees may be responsible for the entire premium cost of the ineligible dependent’s coverage if the employee fails to complete and submit the required paperwork within the time frame indicated. Below is an outline of the timelines and requirements.
- Divorce/Legal Separation: The spouse must be removed from the policy the first of the month following the divorce/legal separation. To do so, a completed enrollment change form (along with a copy of the separation agreement filed in court for legal separations) must be received within 60 days after the divorce. If the form is received after 60 days, the spouse will be removed the first of the month following receipt of the form. The employee must provide us with the address of the spouse so that a COBRA Notification letter can be issued.
- Child Loses Eligibility: If a participating employee’s dependent loses eligibility for coverage, the dependent must be removed from coverage effective the first of the month following the change of status. To do this, the employee must complete and submit an enrollment change form. This form must be received within 30-days of the change in status. A child is considered no longer eligible for coverage if they turn age 26.
- Death of a Dependent: A participating employee must contact Human Resources within 30 days following the death of covered participating dependent. A completed enrollment change form must be received within 60 days of the death.
Continuation Option (COBRA)
Under federal law, employees and their covered dependents have the right to continue medical/dental coverage under the employer’s plan at their own expense for a limited period following termination of benefits under COBRA. The medical/dental plan benefits under COBRA are identical to those provided for employees of the district. Please see our COBRA webpage for more information.
Cash-in-lieu of Insurance
Eligible employees have the option of electing cash-in-lieu of medical insurance coverage under our group plan for the benefit year, which runs January 1 through December 31. (Please refer to your contract agreement to see if you qualify.)
Elections must be made on an annual basis, so those who elect the cash-in-lieu of insurance option for one benefit year must make a new election for the subsequent benefit year. Please refer to the cash-in-lieu of insurance webpage for more information.
Please refer to your collective bargaining agreement or individual employment contract for more information.
Questions? Contact Human Resources at (802) 857-7048 or write Sandy Emery at email@example.com.