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Staff Benefits Open Enrollment

St. Francis Area Schools Benefit Plan Year: 
July 1, 2020-June 30, 2021

This information is for all St. Francis Area Schools benefit-eligible employees (staff contracted for 1,020 or more hours per year)

Benefits Open Enrollment Period: 
May 4 through May 18 at 4:00 pm

IMPORTANT for 2020-21 Benefit Eligible Employees

• PEIP Medical: You only need to complete a PEIP enrollment form to make changes or to enroll in coverage (if not currently enrolled).  All current participants should review the 2020-21 plan benefits schedule, insurance carrier and primary care clinic information. Carrier, plan and primary care clinic is listed on your medical insurance ID card.
• Delta Dental: You only need to take action if there is a change.
• Flexible Spending Accounts: If participating, an enrollment form is required.

Forms can be picked up and/or dropped off in the vestibule at the District Office, 4115 Ambassador Boulevard NW, St. Francis MN 55070 as follows:

  • Wednesday, May 6, 1:00-4:00 pm
  • Thursday, May 7, 8:00 am-1:00 pm
  • Tuesday, May 12, 8:00 am-12:00 pm
  • Friday, May 15, 12:00-4:00 pm
  • Monday, May 18, 1:00-4:00 pm

Completed forms can also be submitted via email to: Benefits@isd15.org

Completed forms are due no later than 4:00 p.m. on Monday, May 18, 2020.

Questions?

Email Wendy.Carlberg@isd15.org

Forms & Information

To view all benefits, check out the St. Francis Area Schools
2020 Enrollment Guide 

NOTE: For fillable PDF forms, first download the form to your computer and open with Adobe Reader. This will allow you to fill in the blanks, save, print and email the form.

PEIP

For more information about PEIP, visit www.innovomn.com
or call 952-746-3101.

Pro-Tip: Calculator to Compare Medical Plans

(Employee Monthly Premium Cost x 12 months) + Maximum Plan Year Out-of-Pocket = Total Maximum Potential Cost Per Plan

Example:
Employee Example ($385.52/month premium x 12 months) = $4,626.24 + $2,000 max out-of-pocket max = $6,626.24 total maximum potential cost

Delta Dental
Flexible Spending Accounts

Flexible Spending Accounts (FSA) enrollment forms need to be completed every plan year if you wish to participate in medical or dependent care FSA. The medical FSA maximum is $2,650 per eligible employee per plan year; the dependent care FSA maximum is $5,000 per plan year.

Flexible Spending Accounts (FSA) Enrollment Form (TASC)

Includes Direct Deposit Authorization form if you have a banking account change or a new bank account. New FSA enrollees are required to complete the Direct Deposit Authorization form.

What is the maximum amount that I can FLEX per plan year
(July 1-June 30)?

  • Medical Flex = $2,650
  • Dependent Care Flex = $5,000

What are eligible medical expenses that I can be reimbursed from a flex account?

For Publication 504, visit www.irs.gov 

CIGNA Life Insurance

Employees who previously purchased less than $50,000 in supplemental term life have the option to purchase up to $50,000 with an application. Subject to approval from CIGNA.

Evidence of Insurability Application Form

CIGNA Long-Term Disability

Refer to Long-Term Disability for more information.