INSURANCE:
OPEN ENROLLMENT: Our providers will continue to be PacificSource for medical, dental and vision and United Heritage for life, accidental death & dismemberment, and long-term disability.
Open enrollment period starts September 1st and ends September 30th. If you do not want to make any changes for 2024/2025, you do not need to do anything.
If you would like to change your plan election, please complete a plan change form. If you are new to insurance, please complete the new enrollment form. If your form is received in the Payroll Office by September 11, 2024, the new out-of-pocket/contribution amount will be deducted/contributed from your paycheck beginning September 20, 2024. If your form is received after September 11, 2024, the new out-of-pocket/contribution will be deducted/contributed from your paycheck beginning October 18, 2024 and will include an adjustment to correct your September payroll deduction/contribution.
If you have other group coverage and would like to waive coverage in the group plan offered by the District, you must complete a new enrollment form (specifying that you wish to waive or decline coverage) and return to the payroll office by September 11, 2024.
2024-2025 INSURANCE BENEFITS:
2024-2025 EMPLOYEE BENEFITS RESOURCE GUIDE – SUMMARY PLAN DESCRIPTIONS
2024-2025 LICENSED AND CLASSIFIED PREMIUM RATES
2024-2025 EARLY RETIREE BENEIFT RESOURCE GUIDE – SUMMARY PLAN DESCRIPTIONS
INSURANCE ENROLLMENT FORMS:
PACIFICSOURCE – Enrollment and/or Waiving Insurance
PACIFICSOURCE – Select a plan form
VEBA FORM (Complete if choose the $6000 plan)
HSA FORM (Complete if choosing the $2500 HDHP)
United Heritage LIFE and LTD – Enrollment Form
PACIFICSOURCE – Termination of dependent Coverage
VOLUNTARY INSURANCES:
Flexible Spending Account Guide (FSA)
Flexible Spending Account Enrollment Form (FSA Form)
Supplemental Life Insurance (In addition to Group Term Life Insurance)
Evidence of Insurability (Complete if applying for additional life insurance above and beyond group policy)
Short Term Disability – Enrollment Form
MASA – Medical Transport Employee Enrollment Application
OTHER BENEFIT INFORMATION:
Change My HSA contribution Form
HRA VEBA – Medical Care Expenses
PACIFICSOURCE PHARMACY NETWORK
REQUIRED ANNUAL NOTICES
Medicare Creditable Coverage Notice
Medicare Non-Creditable Coverage Notice for $2500 HDHP
Women’s Health and Cancer Rights Notice
2023-2024 INSURANCE BENEFITS:
2023-2024 EMPLOYEE BENEFITS RESOURCE GUIDE – SUMMARY PLAN DESCRIPTIONS
2023-2024 LICENSED and CLASSIFIED PREMIUM RATES
2023-2024 ADMINISTRATORS, D.O. GROUP and SUPERINTENDENT PREMIUM RATES
2023-2024 EARLY RETIREE BENEFIT RESOURCE GUIDE – SUMMARY PLAN DESCRIPTIONS
403(b) INFORMATION
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. Carruth Compliance main contact page.
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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