This summary is designed to give you an outline of the health benefit programs. Contained in the summary are tips for you on using the plans.
Summary of Benefit Coverage Notices 9/1/2017
- Lincolnshire-Prairie View PPO 750 (pdf)
- Lincolnshire-Prairie View PPO 1200 (pdf)
- Lincolnshire-Prairie View PPO 2500 (pdf)
- Lincolnshire-Prairie View HDHP 1500 (pdf)
- SBC Uniform Glossary (pdf)
- Health Insurance Premiums, 9/01/16 (pdf)
- Health Insurance Premiums, 9/01/17 (pdf)
- Dental Insurance Premiums, 9/01/16 (pdf)
- Dental Insurance Premiums, 9/01/17 (pdf)
Express Scripts administers prescription benefits for all PPO Plans. Prescriptions can be purchased through your local pharmacy or through mail order. Prescription co-pays range from $10.00 - $50.00 depending on your prescription and/or plan. For more information regarding prescription coverage, visit the Express Scripts website at www.express-scripts.com or call (800) 627-9799.
Employee Medical Benefit Booklet
The Blue Cross/Blue Shield PPO Plan is offered to employees who are eligible for medical benefits. Please refer to the eligibility section of the booklet on page 7.
Health Care Benefit Program - PPO Plan
Option 750 - Deductible $750
Option 1200 - Deductible $1,200
Option 2500 – Deductible $2,500
Option HDHP 1500 with HSA- Deductible $1,500
Employee Dental Benefit Summary
MetLife PPO plan and Blue Cross Blue Shield HMO plans are offered to employees who are eligible for dental benefits. Eligibility is the same as for medical benefits.
- Dental Care PPO Benefit Program Detail (pdf)
- Dental Care HMO Benefit Program Detail (pdf) coming soon
Employee Life Insurance Policy Booklets
Basic term Life insurance is a District paid benefit for those employees who are scheduled to work a minimum of 17 1/2 hours per week. Supplemental Life and AD&D Insurance is also available to employees to purchase. The provider is Reliance Standard Life Insurance Company.
Employee Long Term Disability Insurance Booklet (Certified Staff Only)
LTD insurance provides income replacement for designated employee groups. In the event you become disabled from a non-work related injury or sickness, disability income benefits are provided as a source of income. This is a board paid benefit for eligible employees and is provided by Met Life Insurance.
- Flexible Spending Account (Section 125) (pdf)
- Flexible Benefits Plan - Summary Plan Description (pdf)
- District Tax Sheltered Annuity Information (pdf)
- Wellness Benefit (Certified Staff Only) (pdf)
- BCBS Medical Enrollment Form (pdf)
- Dental HMO Enrollment Form (pdf)
- Dental PPO Enrollment Form (pdf)
- Flex Enrollment Form (pdf)
- Basic Term & Voluntary Life and AD&D Insurance Enrollment Form (pdf)
- Evidence of Insurability (EOI) Form (pdf) – Must be completed if enrolling in Voluntary Life and AD&D Insurance
Contact Carey Murphy:
- (847) 295-4030, ext. 9312