Employee Benefits Guide

2018-2019

Welcome

Welcome to the Jamestown Public Schools Benefit Program

Jamestown Public Schools strives to provide a balanced, comprehensive benefits program for their employees. The Jamestown Public Schools Employee Benefits program offers you core benefits, such as Medical, Vision, and Life insurance as well as voluntary and supplemental benefits that help maximize your coverage options.

If you have questions please contact your Human Resources Department.

Changes for 2018-2019

  • Added a $0 co-pay benefit on certain preventive medications (complete list available on the BCBS website under HSA Preventive Drug List)
  • All members will receive new ID cards.

Enrollment Instructions

All full-time employees working at least 30 hours per week of continuous employment are eligible for coverage on the first or the 16th day of the month following date of hire. If you terminate employment or change to a part-time status, your coverage will terminate on the last day of the month that the change/termination occurs.

Please note: It is important that you enroll in a timely manner. If you do not enroll within your first 30 days of employment, you will not be eligible to enroll without a qualifying life event until the next open enrollment period.

Open enrollment will end on August 29, 2018 and benefits will begin September 1, 2018.

Life Event Changes

The following events allow you to change your benefits outside the open enrollment period:

  • You get married, divorced, or legally separated
  • You add a dependent child through birth, adoption, or change in custody
  • Your spouse or dependent passes away
  • Your dependent loses coverage or gains other coverage
  • Your spouse loses or qualifies for coverage through his or her employer

If you have a change in status, you must notify Human Resources to complete the necessary change forms within 30 days of the change. You will need to present documentation, such as a birth, marriage or divorce decree.

Blue Cross Blue Shield of North Dakota Logo

BlueCross BlueShield of North Dakota

Benefit Details
Annual Deductible
Single/EE+Dependent/Family
$250/$375/$500
Out-of-Pocket Maximum
Single/EE+Dependent/Family
$2,500/$3,750/$5,000
Preventative Care Covered 100%
Office Visits $20 Primary/Specialist, then covered 90%
Emergency Room $100 copay, then covered 90%
Urgent Care $20 copay, then covered 90%
Inpatient Hospital Covered 90% AD
Outpatient Hospital Covered 90% AD
Chiropractic Visits $20 copay, then covered 90%
Mental Health
Outpatient
Inpatient
First 5 visits plan pays 100%, then covered 90% AD
Covered 90% AD

Prescriptions - Retail Order (covers up to a 100 day supply)  
Preventive care medication
(see BCBSND list)
Formulary
(applies to Out-of-Pocket Maximum)
Non-Formulary

$0 copay

$15 copay, then covered 80%

$15 copay, then covered 50%

Please refer to District Human Resources for premium rates

This is a brief summary of your benefit. Please refer to plan summary for more details.

BCBSND Summary of Benefits

BCBSND: Jamestown Public Schools ClassicBlue 500

Summary of Benefits and coverage: What this Plan Covers and What You Pay for Covered Services

Coverage Period:  9/1/19-8/31/20

Coverage for: Individual, Parent and Child, Parent and Children, Two Person, Family  |  Plan Type:  PPO

The Summary of Benefits and Coverage (SBC) information will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.  This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, go to the BCBSND website or call 1-844-363-8457. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at the healthcare.gov website or call 1-844-363-8457 to request a copy.
Important questions
answers
why this matters:
What is the overall deductible?
$500 individual / $750 parent and child / $750 parent and children / $1,000 two person / $1,000 family
Doesn't apply to preventive care or prescription drugs. Copays and coinsurance do not apply to the deductible.

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Are there services covered before you meet your deductible? Yes, Preventive care.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits.

Are there other deductibles for specific services? Yes. $500 for infertility services. There are no other specific deductibles. You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.
What is the out-of-pocket limit for this plan? $2,500 individual / $3,750 parent and child / $3,750 parent and children / $5,000 two person / $5,000 family

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-pocket limit? Premiums, nonformulary drug sanction, infertility services, balance-billed charges and health care this plan doesn't cover. Even though you pay these expenses, they don't count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Not Applicable. This plan does not use a provider network. You can receive covered services from any provider.
Do you need a referral to see a specialist? No You can see the specialist you choose without a referral.
All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
common
medical event
services you May need your cost limitations, exceptions, & other important information

 

 

If you visit a health care provider's office or clinic

Primary care visit to treat an injury or illness
$20 copay/visit; 10% coinsurance Deductible is waived.
$20 copay/visit; 10% coinsurance Deductible is waived.
Preventive care/screening/ Immunization
No Charge None

 

If you have a test

Diagnostic test (x-ray, blood work) 10% coinsurance None
Imaging (CT/PET scans, MRIs) 10% coinsurance None

 

 

 

 

 

 

If you need drugs to treat your illness or condition

More information about prescription drug coverage is available at the BCBSND website

Retail Pharmacy
Preventive Drug

 

Formulary

Nonformulary

0% coinsurance

$15 copay/ prescription; 20% coinsurance

$15 copay/ prescription; 50% sanction

 

Deductible is waived.

One copay for a 1-100 day supply.

Preferred Mail Order Pharmacy
Preventive Drug
 

 

Formulary

 

Nonformulary

 

0% coinsurance

 

$15 copay/ prescription; 20% coinsurance

$15 copay/ prescription; 50% sanction

 

Deductible is waived. Mail order prescriptions must be received from the preferred mail order pharmacy.

One copay for a 1-100 day supply. Mail order prescriptions must be received from the preferred mail order pharmacy.

Preferred Specialty Pharmacy
Formulary
 

Nonformulary

$15 copay/ prescription; 20% coinsurance

$15 copay/ prescription; 50% sanction

Specialty Drugs are subject to a dispensing limit of a 30-day supply. Specialty Drugs must be received from the preferred specialty pharmacy network.

common medical event services you may need your cost limitations, exceptions, & other important information

 

If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center) 10% coinsurance None
Physician/surgeon fees 10% coinsurance None

 

If you need immediate medical attention

Emergency room care $100 copay/visit; 10% coinsurance Deductible is waived.
Emergency medical transportation 20% coinsurance None
Urgent care $20 copay/visit; 10% coinsurance Deductible is waved.

 

If you have a hospital stay

Facility fee (e.g., hospital room) 10% coinsurance Precertification may be required.
Physician/surgeon fees 10% coinsurance None

If you need mental health or behavioral health services

Outpatient services 0%/10% coinsurance First five hours plan pays 100%
Inpatient services 10% coinsurance Precertification is required.

If you need substance abuse services

Outpatient services 0%/10% coinsurance First five visits plan pays 100%
Inpatient services 10% coinsurance Precertification is required.

 

If you are pregnant

Office visits 10% coinsurance Deductible is waived.
Childbirth/delivery professional services 10% coinsurance None
Childbirth/delivery facility services 10% coinsurance

None

 

 

 

If you need help recovering or have other special health needs

Home health care 20% coinsurance Precertification is required.
Rehabilitation services $15 copay/visit; 20% coinsurance Deductible is waived.
Habilitation services $15 copay/visit; 20% coinsurance Deductible is waived. Limited to 90 visits per benefit period.
Skilled nursing care 20% coinsurance Precertification is required.
Durable medical equipment 20% coinsurance Precertification may be required.
Hospice services 20% coinsurance Precertification is required.

 

If your child needs dental or eye care

Children's eye exam Not covered None
Children's glasses Not covered None
Children's dental check-up Not covered None

 

Excluded Services & Other Covered Services:

services your plan generally does not cover (check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Cosmetic Surgery
  • Long-Term./Custodial Nursing Home Care
  • Pediatric Dental and Vision Care
  • Routine Dental Services (Adult)
  • Routine Eye Care (Adult)
  • Routine Foot Care
  • Weight Loss Programs
Other covered services (Limitations may apply to these services. This isn't a complete list. Please see your plan document.)
  • Bariatric Surgery; lifetime maximum of 1 operative procedure
  • Chiropractic Care
  • Hearing Aids; $3,000 every 3 years for Members under age 18
  • Infertility Treatment; $20,000 lifetime maximum
  • Non-Emergency Care when Traveling Outside the U.S.
  • Private-Duty Nursing

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is:  Contact BCBSND at their website or 1-844-363-8457 or the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or on their website. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, Visit HealthCare.gov or call 1-800-318-2596.

Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: Blue Cross Blue Shield of North Dakota at 1-844-363-8457 or www.BCBSND.com, The Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.

Does this plan provide Minimum Essential Coverage? Yes.
If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.

Does this plan meet Minimum Value Standards? Yes.
If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.


To see examples of how this plan might cover costs for a sample medical situation, see the next section.

About these Coverage Examples:

Exclamation Warning Image

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the price your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Peg is Having a Baby

(9 months of in-network pre-natal care and a hospital delivery)


This EXAMPLE event includes services like:
Specialist office visits (prenatal care)
childbirth/Delivery Professional Services
Childbirth/Delivery Facility Services
Diagnostic tests (ultrasounds and blood work)
Specialist visit (anesthesia)

Total Example Cost  $12,800

In this example, Peg would pay:
Cost Sharing
Deductibles  $500
Copayments  $ 20
Coinsurance $1,200
What isn't covered
Limits or exclusions $60
The total Peg would pay is $1,780

Managing Joe's type 2 Diabetes

(a year of routine in-network care of a well-controlled condition)


This EXAMPLE event includes services like:
Primary care physician office visits (including disease education)
Diagnostic tests (blood work)
Prescription drugs
Durable medical equipment (glucose meter)

Total Example Cost  $7,400

In this example, Joe would pay:
Cost Sharing
Deductibles  $200
Copayments  $800
Coinsurance $1,200
What isn't covered
Limits or exclusions $60
The total Joe would pay is $2,260

Mia's Simple Fracture

(in-network emergency room visit and follow up care)


This EXAMPLE event includes services like:
Emergency room care (including medical supplies)
Diagnostic tests (x-ray)
Durable medical equipment (crutches)
Rehabilitation services (physical therapy)

Total Example Cost  $1,900

In this example, Mia would pay:
Cost Sharing
Deductibles  $500
Copayments  $200
Coinsurance $200
What isn't covered
Limits or exclusions $0
The total Joe would pay is $900

Note: these numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-844-363-8457.

*Note: This plan has other deductibles for specific services included in this coverage example. See "Are there other deductibles for specific services?" row above.

The plan would be responsible for the other costs of these EXAMPLE covered services.

BlueCross Blue Shield ND Logo

In accordance with federal regulations, Blue Cross Blue Shield of North Dakota is required to provide you the following disclosure:
Blue Cross Blue Shield of North Dakota complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross Blue Shield of North Dakota does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue Cross Blue Shield of North Dakota:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages

If you need these services, please call Member Services at 1-800-342-4718 (toll-free) or through the North Dakota Relay at 1-800-366-6888 or 711.

If you believe that Blue Cross Blue Shield of North Dakota has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Civil Rights Coordinator
4510 13th Ave S
Fargo, ND 58121
701-297-1638 or North Dakota Relay at 800-366-6888 or 711
701-282-1804 (fax)
CivilRightsCoordinator@bcbsnd.com (email) (Communication by unencrypted email presents a risk.)

You can file a grievance in person or by mail, fax, or email within 180 days of the date of the alleged discrimination. Grievance forms are available at http://www.bcbsnd.com/report or by calling 800-342-4718. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW.
Room 509F, HHH Building
Washington, DC 20201
800-368-1019 or 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Vision Benefits

VSP Logo

benefit description copay frequency
WellVision Exam
  • Focuses on your eyes and overall wellness
$20 Every 12 Months
Prescription Glasses   $20 See frame and lenses
Frame
  • $130 allowance for a wide selection of frames
  • $150 allowance for featured frame brands
  • $20% savings on the amount over your allowance
  • $70 Costco frame allowance
Included in Prescription Glasses Every 12 Months
Lenses
  • Single vision, lined bifocal, and lined trifocal lenses
    • Polycarbonate lenses for dependent children
Included in Prescription Glasses Every 12 Months
Lens Enhancements
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average savings of 20-25% on other lens enhancements
$55
$95-$105
$150-$175

Every 12 Months

Contacts (Instead of glasses)
  • $130 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
Up to $60

Every 12 Months

Benefit Description
Extra Savings
Glasses and Sunglasses
  • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details
  • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam.
Reinal Screening
  • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

Laser Vision Correction

  • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

coverage type monthly cost
Employee $12.51
EE + spouse or one child $20.00
EE + Children $20.41
Family $32.92

Premiums are based on a 9-month contribution schedule to cover a full 12-months of premiums

This is a brief summary of your benefit. Please refer to plan summary for more details.

UNUM LOgo

Basic Life and AD&D

Jamestown Public Schools provides basic life coverage as well as Accidental Death and Dismemberment coverage for all active, full-time employees working at least 20 hours per week.

Basic Life and AD&D Benefits  
Employee $25,000
Accidental Death (AD&D) $25,000
Accelerated Death Benefit If you are terminally ill, advance payout of 50% not to exceed $750,000
Age Reduction 50% of original amount at age 70
Conversion If your employment ends, you can apply for an individual policy without evidence of insurability within 31 days.
Monthly Premium Refer to District Human Resources

Employees who work less than 20 hours per week and paid over a nine (9) month period of time are eligible to participate in the plan. Employees will receive pro-rated benefits based on the number of hours worked and the balance of cost will be responsibility of the employee.


Voluntary LTD Coverage

Jamestown Public Schools provides Voluntary LTD coverage for all active employees working at least 30 hours per week whose regular job assignment extends beyond the school year.

Item LTD
Minimum Benefit Greater of $100 or 10% of gross disability payment
Benefits Begin After 90-day elimination period/30 day accumulation feature
Pre-Existing Condition 3 months prior/12 months insured
Coverage Basis/Maximum Benefit
Non-Certified Staff
Teachers
Administration
 
66.67% Up to $3,000 per month
66.67% Up to $4,200 per month
66.67% Up to $6,000 per month
Monthly Premium Refer to District Human Resources

Voluntary Life Insurance and AD&D

Voluntary Life Insurance is in addition to the basic life insurance. Voluntary Goup Life Insurance provides term life insurance at low rates. Current coverage includes financial protection in the event you, your spouse and/or one of your dependents die while covered under this benefit.

Item Voluntary Life benefits
Employee
Increments of $10,000 up to maximum of $500,000
Guaranteed Issue - up to $150,000
Spouse
Increments of $5,000 up to 100% of employee's life or $500,000
Guaranteed Issue - up to $25,000
Unmarried Dependent Children
Live birth to 6 months old - $1,000;
6 months up to age 26 - $10,000
Accelerated Death Benefit - Employee Only Equal to 50% of your basic and supplemental life amounts up to $750,000 for voluntary benefits
Age Reduction 65% of original amount at age 65 and 50% at age 70, and 30% at age 75

Portable (if elected prior to age 70)

If your employment ends, you can apply for an individual policy without evidence of insurability within 31 days. Coverage terminates at age 70

Monthly rates per $1,000 purchased

age cost for employee or spouse
15-24 $0.063
25-29 $0.072
30-34 $0.09
35-39 $0.117
40-44 $0.207
45-49 $0.351
50-54 $0.576
55-59 $0.90
60-64 $1.40
65-69 $2.52
70+ $4.518
   
Children $0.20 per $1,000

This is a brief summary of your benefit. Please refer to plan summary for more details.

Aflac Options

Aflac Short-Term Disability

(Policy Series A57600)
For many employees, a temporary loss of income could have long-term financial consequences. An Aflac Short-Term disability insurance policy provides a monthly benefit amount when the employee is disabled due to a covered accident or illness and unable to work. Having disability insurance can help provide a sense of security, knowing that if the unexpected should happen, the employee will still receive a monthly income.

Cancer Care

(Policy Series A78000)

Cancer is a serious disease that, unfortunately, many people can relate to. Today, the chances of surviving cancer are better than ever, but the financial impact of cancer can be devastating. An Aflac Cancer Care insurance policy can help employees and their families better cope financially-and emotionally-if a positive diagnosis of cancer ever occurs.

Critical Care Protection

Critical Care Protection helps provide comfort to individuals who are concerned with the financial liability a serious health even can leave behind and offers multiple coverage options to accommodate almost any budget. Unlike other critical illness insurance policies on the market, Critical Care Protection helps cover expenses from initial diagnosis through treatment and provides options for more robust heart coverage.

Aflac Hospital Advantage

(Policy Series A49000)
With a new health care landscape comes a new hospital confinement indemnity insurance policy, Aflac Hospital Advantage. Health care costs are on the rise for both employers and consumers and Aflac Hospital Advantage is there to help. It pays cash benefits that can be used to help with those out-of-pocket hospital expenses that may not be fully covered by major medical insurance.

Accident Indemnity Advantage

(Policy Series A35000)

Accidents are not planned and can happen at any moment. But when it happens, medical bills can start adding up fast. Help your customers be prepared: Aflac Accident Indemnity Advantage insurance policies pays cash benefits to help provide peace of mind during the different stages of care and recovery. Benefits can be used to help pay for emergency treatment, broken bones, lacerations, concussions, broken teeth, and ambulance transportation, as well as for treatment-related transportation and lodging. 

Also available:  Life insurance, dental insurance, and Wage works unreimbursed medical and dependent daycare benefits.

For more information on how Aflac can help protect your financial interests contact

Judy Butler Phone 701-952-4909 Email:  judith_butler@us.aflac.com

The Village Logo

Employee Assistance Program (EAP)

An Employee Assistance Program (EAP) offers short-term confidential counseling on all aspects of life at no cost to you. Employees and household members can confidentially address and resolve personal and work-related challenges including:

  • Relationship issues - Marriage counseling, family counseling, parent/child counseling, etc.
  • Emotional health issues - stress, anxiety, depression, grief, elder parent challenges
  • Drug and alcohol issues - assessments, evaluation and prevention education -this does not include treatment
  • Workplace issues - Sexual harassment, dealing with difficult people, handling conflict, changes, job stress
  • Crisis counseling - talk to a counselor 24/7
  • Wellness Education classes - Drug & Alcohol Education, Stress Management, Parenting, Couples Education
  • Legal issues - family law (divorce, wills, custody) and civil law (housing, harassment, motor vehicle) Receive free telephonic advice from a local lawyer and a 25% discount with the lawyer if additional assistance is required.
  • Financial Issues - Budget counseling, debt management, retirement planning, student loan planning or repayment-through the Village Financial Resource Center

The Village Financial Resource Center

The number of sessions available to a covered individual's household is equal to the number of household members times (x) four (4). As an example, a household with five (5) members would have access to a maximum of 20 sessions (5 members x 4/member = sessions) per 12 month period. Any number of those sessions can be used by any member of the household up to the total number. There is a minimum of 8 sessions per household.

Confidential assistance is available 24 hours a day, 7 days a week

It's easy to use. Call 1-800-627-8220 to schedule an appointment. 
Website:  www.villageEAP.com - Username: Jamestown Schools
 
This is a brief summary of your benefit. Please refer to plan summary for more details.

 

Important Notices

Federal regulations require Jamestown Public Schools to provide benefit eligible employees with the following notices:

Private Health Information

A portion o of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the protection of confidential health information. It applies to all health benefit plans. In short, the idea is to make sure that confidential health information that identifies (or could be used to identify) you is kept completely confidential and it will not be used or disclosed without your written authorization, except as described in the Plan's HIPAA Privacy Notice or as otherwise permitted by federal and state health information privacy laws. A copy of the Plan's Notice of Privacy Practices that describes the Plan's policies, practices and your rights with respect to your PHI under HIPAA is available from your medical plan provider. For more information regarding this Notice, please contact Human Resources or the medical plan directly.

Women's Health and Cancer Rights Act

Jamestown Public School's medical plan, as required by the Women's Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services.

This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For more information, contact your medical plan provider.

Individual Coverage Mandate

Federal law requires that you have health care coverage or you may be subject to an income tax penalty. You can enroll in the Jamestown Public School health plan, or you may want to consider visiting the healthcare.gov website for more information on health plans available through the Healthcare Marketplace in your area.

Premium assistance under Medicaid and Children's Health Insurance Program (CHIP)

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. 

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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 of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or go to their website to find out how to apply.  If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer's health plan is required to permit you and your dependents to enroll in the plan - as long as you and your dependents are eligible, but not already enrolled in the employer's plan. This is called a "special enrollment" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

North Dakota Medicaid
Phone: 1-800-755-2604

Contact Information

Provider phone number e-mail address/website
Medical
Blue Cross Blue Shield of ND
7-844-363-8457

https://www.bcbsnd.com/

FSA
Wage Works
1-800-950-0105

http://www.takecarewageworks.com/

Life Insurance/Voluntary
LTD
Unum
1-800-421-0344
Claims 1-800-858-6843
Refer to HR for all other questions

https://www.unum.com/

Vision
VSP
1-800-877-7195

https://www.vsp.com/

Dental & Voluntary
Worksite Benefits
Aflac
Aflac HQ
1-800-922-3522
Claims Fax
1-877-442-3522

https://www.aflac.com/

Aflac Local Representative
Judy Butler
Or
 
Local Admin - Cindy
Office: 701-952-4909
Cell: 701-320-4923
Fax: 701-952-4910
 
701-490-0121
Fax: 701-490-3208
or
 

 

We encourage you to read the entire enrollment guide before you enroll.

This benefit guide gives a brief description of what is in the official summary plan documents for these plans. The benefits that you receive are based upon the plan's official documents, not this guide or any other written or oral statement. If there is a conflict between this guide and the official plan document, the official plan documents will govern in all cases. Jamestown Public Schools reserves the right at any time to change or terminate these plans.