Employee Insurance Benefit Eligibility  

The employee must work at least 80 hours per month during the school year and must be expected to work at least six months in the first year hired.  Benefited employees working less than 260 days and who receive approved District breaks (summer, November –December-January, spring break, and holidays), are considered to be in compliance with EGI eligibility requirements.  An eligible school district employee will be covered continuously until which time the employee is off work and is not receiving paid benefit time (i.e. annual leave, professional development leave, personal day of leave, sick leave, etc.)  There are specific guidelines (available upon request) regarding Family Medical Leave, Workman’s Comp, Long Term Disability and Military Leave benefits.

Newly insurance eligible employees may enroll (without any applicable waiting periods) in the following plans that are offered by EGI: health, preventive dental, optional dental, employee life, dependent life, vision, Short Term Disability (STD) and Long Term Disability (LTD).  At that time, the employee may enroll their eligible dependents (spouse and/or children) without any applicable waiting periods.  When the employee enrolls in a health plan, the preventive dental coverage must be added.  Please notify this office if your spouse has EGI insurance coverage (you and/or children are covered).  The family premiums are “Split” and the employee who is currently enrolled in the State’s plan will become the lead employee on the family plan.  If both enroll at the same time, the employees may choose which employee will be lead.

Late Enrollment - Must enroll during the Open Enrollment Period

The employee is considered a late enrollee if the employee elected not to enroll within thirty-one days when first became eligible to enroll.  That includes dependents.

The State of Wyoming Benefits Press (egi.wyo.gov) includes updates and changes made during the year.

It is IMPORTANT for you to review the different Summary of Benefits and Coverage information, the Health Insurance Marketplace Coverage information, all plan booklets and the summary of benefits videos on EGI’s website, egi.wyo.gov. 

When adding dependents, a copy of the marriage certificate for your spouse, and a copy of the birth certificate or adoption papers for each child MUST be presented within 31 days from eligibility date or enrollment will be considered null and void.  Also, MUST enter each eligible dependent’s Social Security Number on the enrollment application form.

Dependent children, ages 19 to 26, are allowed insurance coverage through the month they turn 26, as long as they do not have their own insurance coverage.  They do not have to be full-time students, they could file their own income taxes and they could be married. 

Option I = $900 Individual/$1,800 Family

Option II = $2,000 Individual/$4,000 Family   

Option III = $4,000 Individual/$8,000 Family

Option IV = High Deductible Health Plan (HDHP) = $1,650 Individual Deductible Plan or $3,300 Family Deductible Plan:

If the employee enrolls in this plan, the employee does not have to elect a Health Savings Bank Account (HSBA). This plan has federal guideline limitations (www.treasury.gov/hsa).  If the employee enrolls in this plan, the employee will remain in this plan unless he/she wishes to make a deductible plan option change during the Open Enrollment period.  The employee may choose to have a monthly payroll before tax deduction deposited into a HSBA (details are listed in the HSA booklet and on NCSD’s HSA election form).  The employee may elect to decrease or increase a contribution amount anytime during the calendar year, must not go over the federal limit allowed for that calendar year. The $3,300 Family Deductible must be met before claims are paid (see federal guidelines).   This plan DOES NOT have a prescription co-pay plan. 

Waiting Periods:

The employee must wait until the Open Enrollment period to make a deductible plan option change.

Pre-existing limitations are NO longer in effect, please refer to the JANUARY 2016 CIGNA Medical Booklet

$2,000 individual and $4,000 family Annual Out-of-Pocket Maximum for generic, preferred and specialty drugs

Local purchases: $10 Generic, $20 Brand Name, $50 Non-Preferred Brand Name = 30 Day Maximum

Mail order purchases: $15 Generic, $30 Brand Name, $75 Preferred Brand Name = 90 Day Maximum

Specialty purchases: 30% coinsurance- eligibility for $0 copay

CVS Caremark (1-844-283-3383, www.caremark.com) = 30 Day Maximum

CVS Caremark Mail Order Purchases (1-844-283-3383, www.caremark.com) = 90 Day Maximum

CVS Caremark Specialty Pharmacy Purchases (1-800-287-2767, www.cvsspecialty.com) = 30 Day Maximum

Benefits are based on the use of a Delta Dental provider

$50 Individual Deductible/$100 Family Deductible

Basic services are paid at 80% and major services are paid at 50%.

Maximum annual benefit per person is $2,000

Orthodontia services are not covered.

Waiting Periods: Optional Dental

There is a one year waiting period before the employee will be eligible to enroll in this plan if this plan was not chosen when first eligible.  If the employee enrolls after the one year waiting period, the coverage will become effective the following January 1st.  The employee and dependents may enroll prior to the one year waiting period if their dentist submits a letter stating the following:  “…the employees nor the dependents (if applicable) are in need of any dental care based on examination (if the dependent being added is under one year of age, he/she may be added without the above- mentioned letter)”.  Letter must include the name of each person on your plan and the date of the most recent exam (must be approved by EGI).  Also, an employee may enroll during a special enrollment period, if meets requirements at that time.

If the employee and/or dependents did not enroll when first eligible, there is a one year wait period.  After the one year wait period, if enrolling, the coverage will become effective the following January 1st. During the year, enrollment will be allowed within sixty days of loss of coverage from another plan. Coverage will begin the first of the month after enrollment.  Proof of loss must be provided at that time. 

If the employee did not enroll when first eligible, the employee must go through medical underwriting by contacting the Standard Company directly.  The employee may inquire about this benefit at any time.

PLEASE NOTE: NCSD has a Long Term Disability (LTD) Plan offered by New York Life.  NCSD pays the employees’ monthly premiums.  This plan benefit is for all benefited employees who work at least 30 hours per week.  Employees are automatically enrolled in this benefit plan when first eligible. 

If you enroll in the Basic Life benefit through Standard, you may also enroll in the Voluntary Life benefit as well through Standard: The employee can elect up to $250,000.00; when first eligible or with specific qualifying events. Election must be in increments of $10,000. If Employee Voluntary life is elected: the SPOUSE can elect up to $50,0000 when first eligible or with specific qualifying events. Election must be made in increments of $10,000. If Employee Voluntary life is elected, CHILD voluntary life can be elected in the set amount of $10,000. when newly eligible or with specific qualifying events. Premium changes with age. Benefit decreases at age 65 to 65% of election. Benefit decreases at at 70 to 50% of election. Benefit decreases at at 75 to 35% of election.

Waiting Periods:

If not elected when first eligible, at any time, the employee and/or spouse wishing to have life insurance coverage must complete an enrollment form.   A “Proof of Good Health” form will be provided by EGI after receipt of enrollment form.  The insurance carrier will make the final determination regarding insurability.  Children could be added without proof of good health, as long as the employee has life insurance coverage. 

Preventive services paid at 100%

Blood Screenings - (State of Wyoming Free Blood Screenings are listed online, wyominghealthfairs.com)

The employee and each dependent (spouse and/or children) covered by the State’s health insurance may take advantage of two (2) blood chemistry profiles per calendar year.  Other allowable screenings are reimbursable at 100% after filing. 

At that time, detailed information will be communicated to all employees in the Staff News sent to each employee’s email account and on NCSD’s website, natronaschools.org: Employee Resources>Employee Online>Benefits.  

Employees may elect to make the following changes:

• Drop employee and/or dependents (spouse and/or children) health and preventive dental coverage 

• Drop employee and/or dependents optional dental coverage (Employee must remain in the optional dental program for at least one year prior to dropping coverage.

In this case, employee must maintain preventive dental also.)

• Change health plan deductible option

• Add employee and/or dependents (spouse and/or children) health and preventive dental coverage (Employee may add optional dental plan if meet requirements at that time.)

Flexible Spending Accounts:

Premiums – Current option will continue unless employee elects to make a change during that time

Medical and/or Dependent Care Accounts - MUST BE RENEWED each year if wishes to continue to participate

Medical and/or Dependent Care Accounts - May enroll if not participating

Insurance premiums are deducted in advance.  If premiums are not deducted the month prior to coverage, the premiums will be doubled in the next pay period.  As per federal guidelines, Flexible Spending Medical and Dependent Care Accounts deductions will begin the same month these accounts become effective.

An employee’s elected health, dental and employee life insurance premiums (does not include dependent life premiums) are deducted each month on a before or after tax basis. 

Newly insurance eligible employees may enroll (without any applicable waiting periods) in the following plans that are offered by EGI: health, preventive dental, optional dental, employee life, dependent life, vision, Short Term Disability (STD) and Long Term Disability (LTD).  At that time, the employee may enroll their eligible dependents (spouse and/or children) without any applicable waiting periods.  When the employee enrolls in a health plan, the preventive dental coverage must be added.  Please notify this office if your spouse has EGI insurance coverage (you and/or children are covered).  The family premiums are “Split” and the employee who is currently enrolled in the State’s plan will become the lead employee on the family plan.  If both enroll at the same time, the employees may choose which employee will be lead.

NCSD will contribute approximately 82% of the insurance premium when the employee enrolls in the health, dental and employee life insurance plans.  If the employee elects to participate in the voluntary plans: dependent life, vision, STD, and LTD, the employee will be responsible for that premium cost.  The insurance rates, employer contributions and employee deductions, will be provided during the enrollment period.