Staff Benefits Open Enrollment
St. Francis Area Schools Benefit Plan Year:
July 1, 2021-June 30, 2022
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 1-17
All forms must be submitted by May 17 at 4:00 pm
IMPORTANT for 2021-22 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), change carriers, change plans or cancel coverage. Submit inter-school mail to Wendy Carlberg, District Office or email firstname.lastname@example.org.
All current participants should review their plan summary, primary care clinic( (www.innovomn.com) and insurance carrier selection.
Primary Care clinic changes much be made directly with the carrier by calling the customer service number on their ID cards.
• 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
Monday-Friday | 7:30 a.m.-4:00 p.m.
Completed forms can also be submitted via email to: Benefits@isd15.org.
Forms & Information
To view all benefits, check out the St. Francis Area Schools
2021 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.
Medical Insurance will continue to be available with Public Employees Insurance Program (PEIP). Three Medical plan options are offered with single or family coverage increasing 6.9% on all plans. For more information about PEIP, visit www.innovomn.com or call 952-746-3101.
- Innovo Benefits Administration Step-by-Step Enrollment Instructions and 2021-22 PEIP Summaries
- PEIP 2021-22 Rates
- PEIP Summary Powerpoint
- PEIP Change Form
- PEIP Enrollment Form
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
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
Dental Insurance has no change in rates or carrier (Delta).
- The maximum per covered individual will increase from $1,000 to $1,250 per plan year.
- The deductible has been removed for Delta Premier Network and for out of network.
- Major restorative services coverage increased benefit from 60% to 80% with the PPO network.
- Cleanings and fluoride treatments changed from every six months to twice per year.
- Delta Dental Enrollment Form
- Delta Dental Change Form
- Delta Dental Plan Summary
- Delta Dental Rates 2021-22
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 maximum is $5,000 per plan year.
- Flexible Spending Accounts (FSA) Enrollment Form (TASC)
- Direct Deposit Form
- Dependent Care Reimbursement Form
- Medical Reimbursement Form
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?
VOYA Life Insurance
The life insurance carrier will be VOYA. Basic life insurance rates will decrease 16%.
VOYA Long-Term Disability
The long term disability insurance carrier will be VOYA. Rates will decrease by 7%.