For Full-time employees

To be waived or elected at time of hire:

Pascagoula-Gautier School District Employee Benefits

The options below must be waived or elected at the time of hire.

Available to full-time employees only (at least 20 hours per week)

AHS State and School Employees Health Insurance administered by BCBS of MS:

http://knowyourbenefits.dfa.state.ms.us/

Customer Service Number - 1-800-709-7881

Base coverage, with a $1,800 deductible is provided for all full-time employees. Select coverage, with a $1,000 deductible is available to a new employee at the cost of $38 per month. Dependent coverage is available under either plan; paid by the employee. Employees who have worked with the state and have been covered under this state insurance plan prior to January 1, 2006, (Legacy employees) will pay $20 per month for select coverage for themselves, plus the cost for their dependents (if elected). Employees who waive coverage will not be allowed to enroll until the next open enrollment period in October, unless the employee experiences a change in family status or loss of other coverage. Prescription Drug program available only when Select coverage is elected.

Unum Basic State Life Insurance

Millette Administrators - Vic Walsh, Administrator - 228-475-8687 Ext. 131

Term life insurance coverage with employee and employer paying half the premium each. Employee must enroll or waive upon hire. Benefit is 2x your annual salary with a minimum of $30,000 and a maximum of $100,000. Employees may enroll at anytime; however, if the employee does not choose this benefit within 31 days of hire date, evidence of insurability will be required. Active employee cost is $0.12 per $1000 per month. Accidental Death & Dismemberment benefits included for current eligible employees.

Unum Supplemental Life Insurance

Term life insurance, in addition to the Unum Basic Life Insurance, not to exceed $100,000. Dependent coverage is available. Employees may enroll at anytime; however, if the employee does not choose this benefit within 31 days of hire date, evidence of insurability will be required. Accidental Death & Dismemberment (AD&D) benefits included for active employees.

Public Employees Retirement System http://www.pers.state.ms.us/

1-800-444-7377

Contributing to the Public Employees Retirement System is mandatory for all eligible, current employees. Employee contribution is 7.25 % of Gross Reportable Earnings. As of July 1, 2009, employer contribution is 12.00% of Gross Reportable Earnings.

Mutual of Omaha Life Insurance

1-800-348-4489

Term life insurance, $10,000 policy for all eligible, current, full-time employees. Employees may enroll at anytime; however, if the employee does not choose this benefit within 31 days of hire date, evidence of insurability will be required. This premium is paid by the employer.

Electives - For Full-time employees

United Concordia Dental Insurance

1-800-332-0366

Employees may enroll within 31 days of hire date or during open enrollment in October. Monthly rates for employee only = $25.54, employee and spouse = $51.08, employee and child(ren) = $57.98 and family = $83.98.

Citizens Security Vision Insurance (Davis Vision)

1-800-843-7752

Employees may enroll within 31 days of hire date or during open enrollment in October. Monthly rates for employee only = $5.85, employee and spouse = $11.29, employee and child(ren) = $10.37, employee and family = $16.44.

Medical Reimbursement

Millette Administrators - Vic Walsh, Administrator - 228-475-8687 Ext. 131

125 Cafeteria plan; Medical savings plan. Enrollment available in October (Open Enrollment) only.

Dependent Reimbursement

Millette Administrators - Vic Walsh, Administrator - 228-475-8687 Ext. 131

125 Cafeteria plan; Daycare reimbursement. Enrollment available in October (Open Enrollment) only.

American Heritage Cancer Insurance

1-800-348-4489

Cancer Insurance Coverage. Employees may enroll at any time. Cost is dependent upon provisions of policy.

Deferred Compensation http://www.mdcplan.com

1-800-846-4551

A 457 tax savings retirement plan. Administered in conjunction with the Mississippi State Retirement System. Employees may enroll at any time.

United of Omaha Life Insurance

Millette Administrators - Vic Walsh, Administrator - 228-475-8687 Ext. 131

Term Life insurance coverage in addition to the Unum Basic, not to exceed $100.000. Dependent coverage is available.

Mutual of Omaha Disability Insurance

1-800-877-5176

Salary protection; Benefits are payable when you are unable to work due to a covered accident or illness. Employees may enroll at any time; however, if the employee does not choose this benefit within 31 days of hire date, evidence of insurability may be required. Rates dependent upon income.

I hereby acknowledge the receipt of the above statement of insurance options available to me. I understand it is my responsibility to elect or waive coverage in the manner and time frames prescribed.

______________________________________________ _________________________

Signature of Employee Date