Our providers will continue to be  PacificSource for medial, dental and vision and United Heritage for life, accidental death & dismemberment, and long-term disability. The $1500 Deductible plan is now a $2000 Deductible plan and the $2000 HSA plan is now a $2500 HSA plan. You will not need to complete any forms unless you are new or would like to change plans, add or delete dependents.

2020-2021 – INSURANCE BENEFITS

2020-2021 PREMIUM RATES

2020-2021 EMPLOYEE BENEFIT RESOURCE GUIDE – SUMMARY PLAN DESCRIPTIONS

2020-2021 GROUP HEALTH ENROLLMENT FORM AND WAIVER   

2020-2021 PLAN SELECTION FORM (Complete if you want to change plans only (no dependent changes)

VEBA Enrollment Form(Complete if choosing the $6000 deductible plan)
HSA Salary Reduction Arrangement (Complete if choosing the $2500 HDHP)

Health Savings Account Enrollment Form(Complete if choosing the $2500 HDHP)

2020-2021 Life and LTD ENROLLMENT FORM

2020-2021 Evidence of Insurability (Complete if applying for additional life insurance above and beyond group policy)

2020-2021 SHORT TERM DISABILITY ENROLLMENT FORM

Flexible Spending Account (FSA)

MASA – Medical Tranpsort Employee Enrolllment Application

FLEXIBLE SPENDING ACCOUNT

Flexible Spending Account

 

 

OTHER BENEFIT INFORMATION

PACIFICSOURCE PHARMACY NETWORK

FIND A DOCTOR

WHA (Benefit Service Team)

2020-2021 REQUIRED ANNUAL NOTICES

 

SBC – $6000 Deductible Plan

SBC – $2500 HDHP(HSA)

SBC – $2000 Deductible Plan

COBRA Notice

Medicare Creditable Coverage Notice

Medicare Non-Creditable Coverage Notice for $2500 HDHP

CHIPRA Notice

Women’s Health and Cancer Rights Notice

HIPAA Notification

Market Exchange Notice

Summary Plan Description

2020 403(b) Notice

 

403(b) PLAN
Click here for information specific to the District’s 403(b) Tax Sheltered Annuity Plan (TSA) including vendor lists and enrollment forms.  Carruth Compliance Consulting (CCC) provides compliance assurance and plan administration services to the District on a contractual basis. CCC serves as a clearing house for administration of the District’s Plan, providing employees with the information they need to take advantage of this tax deferred retirement savings plan.

Salary Reduction Agreement

Vendor List

 

QUESTIONS?

If you have any questions about employee benefits, please contact either 

payroll@fernridge.k12.or.us or

Quanah Bennett at 541-935-2253 x1202 or Leiisa Boytz at 541-935-2253 x1204 

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The FRSD is an Equal Opportunity/Affirmative Action/Veteran’t Preference employer.  The district does not discriminate on the basis of race, color, national origin, sex, sexual orientation, marital status, religion, disability, or age in its programs or activities.

FRSD Title IX Coodinator

Michelle Marshall (Principal EES)

541-935-8214 

 

 

 

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