All permanent employees who are .5 FTE and greater are eligible to enroll themselves and their dependents in the Natomas USD sponsored health benefit plans. Members of the Natomas Teachers Association may enroll in CalPERS Medical Health Plans. All other employees may enroll in Kaiser and Western Health Advantage (WHA) medical plans. All eligible employees may enroll in VSP and Delta Dental.
The following information is related to eligibility and standard operating procedures. For plan information, please see Certificated Employee Benefits for NTA plans and Non-Certificated Employee Benefits for all other plans.
NEW HIRES
New employees MUST sign the “Acknowledgement to enroll in Health and Welfare Benefits” form which states that employees have 30 days from their hire date to provide all required enrollment documentation. Once this 30 days has elapsed, employees must wait until the next open enrollment period to sign up for benefits unless a qualifying event occurs (See Qualifying Events below). If an employee is declining coverage, the “Acknowledgement to Enroll in Health and Welfare Benefits” form has an option to waive insurance immediately.
Required documents to enroll in coverage are:
- Benefits Selection Sheet for choice of plans
- Applicable Medical Enrollment Form (CalPERS, Kaiser, or WHA)
- Dental Enrollment Form
- Vision Enrollment Form
- Proof of dependents – marriage license, birth certificates for child(ren) or Federal Tax form showing dependent(s) name
Start date of Benefits
The day of the month an employee begins paid status determines the start date for benefits. These rules are governed by the District’s Section 125 Plan document. If paid status begins between the 1st and the 15th, benefits elected will begin on the first of the following month. If paid status begins between the 16th and the 31st, benefits elected will begin on the first of the second month. For example: If paid status begins on January 6th, benefits begin February 1st. If paid status begins January 21st, benefits begin March 1st.
Summer Deferred Benefits
For employees working less than 12 months, it is necessary to deduct a portion of the employee contribution amount to pay for the summer month premiums. If an employee works 11 months, one eleventh is deducted from each monthly paycheck to pay for the 12th month. If an employee works 10 months, two tenths is deducted from each monthly paycheck to pay for the 11th and 12th months.
Example for 11 month employee:
- The employee’s contribution each month is $150.
- The amount needed for the July employee contribution is $150.
- $150/11 months (August through June) = $13.64/month
- From August through June, the employee will have $150 (monthly contribution) + $13.64 (summer share) deducted to cover their medical premiums. Benefit contributions are NEVER deducted from deferred pay. Deferred pay is when you elected to receive your 11 NET paychecks over a 12 month period.
Example for 10 month employee:
- The employee’s contribution each month is $150.
- The amount needed for the June & July employee contribution is $150 x 2 months = $300.
- $300/10 months (August through May) = $30/month
- From August through May, the employee will have $150 (monthly contribution) + $30 (summer share) deducted to cover their medical premiums. Benefit contributions are NEVER deducted from deferred pay. Deferred pay is when you elected to receive your 10 NET paychecks over a 12 month period.
OPEN ENROLLMENT
The district plan year is January 1st through December 31st. The open enrollment period typically occurs in the Fall and employees will receive notice each year. The open enrollment period is the employee’s opportunity to review existing coverages and make changes to health plan participation for the upcoming plan year.
What employees need to do:
If an employee is making no changes, no action is needed.
If an employee is making changes (adding/deleting/changing plans), the employee should complete and submit the following to the Payroll/Benefits Department by the applicable deadline:
- Benefit Selection Sheet for choice of plans – Please note the Benefit Selection sheet should be complete for all plans regardless of changes. For example, if an employee is adding dental/vision but making no changes to medical, the selection sheet should indicate all 3 plans.
- Applicable medical/dental/vision enrollment forms for changes ONLY
If an employee chooses to waive medical benefits, the Benefit Selection Sheet must be completed by checking the box that states, “I am waiving my medical benefits” and submitted to Payroll/Benefits Department by the applicable deadline.
QUALIFYING EVENTS
Changes to health plans may only be made during open enrollment unless a qualifying event occurs. Qualifying events are:
- Change in marital status – Marriage, Death of spouse, Divorce or annulment, legal separation
- Change in dependents – Birth, adoption, death of dependent child
- Loss of Coverage – Employee loses other coverage (spouse’s health plan coverage terminates, or Medicare or Medicaid eligibility ends)
If a qualifying event occurs, the employee should complete and submit the following to the Payroll/Benefits Department:
- Benefits Selection Sheet for choice of plans
- Applicable medical enrollment form (CalPERS, Kaiser, or WHA)
- Dental Enrollment Form
- Vision Enrollment Form
- Proof of qualifying event
Documentation should be submitted no later than 30 days from when the qualifying event occurs.
LEAVES OF ABSENCES
Employees on approved leaves of absence without pay will have the option to continue health and welfare coverage (via COBRA) as specified by the NTA and CSEA agreements. This is contingent upon the insurance carrier’s agreement to provide such coverage.
For more information, see articles on COBRA and Leaves of Absence.
TERMINATION OF EMPLOYMENT
The end date for benefits is determined by the last day the employee is in paid status. These rules are governed by the District’s Section 125 Plan document. If paid status ends between the 1st and the 15th, benefits end on the last day of the month. If paid status ends between the 16th and the 31st, benefits end on the last day of the following month. For example: If paid status ends on January 6th, benefits end January 31st.. If paid status ends January 21st, benefits end February 28th.
For employees working less than 12 months (10 and 11 month employees), the employee contribution amounts withheld to pay premiums for summer months are refunded on the employee’s final paycheck.
For information on continuation of coverage, please see article on COBRA.
RETIREMENT BENEFITS
Eligibility for retiree benefits is determined by each respective collective bargaining agreement.
For more information, see article on Retirement Benefits.