The District 403(B) Plan, also known as tax-sheltered annuities (TSA), is self-administered. Use the form below for new enrollment or change of deduction. The form includes list of authorized vendors.
Questions on 403(B) accounts should be directed to Payroll:
- Jenny Evans: 952-681-6425
- Ali Blessing: 952-681-6431
- Sue Weber: 952-681-6429
- Plan Highlights
- 403(b) Plan Amendment
- Basic Plan Document
- 2020 Universal Availability Notice
- 415 Notice
- Required Minimum Distributions FAQ
Benefit Extras (Effective for the 2019-20 Plan Year)
- Customer Service
- Forms and online support: www.benefitextras.com
Enrollment Information: 2020-21
- 2020-21 Enrollment Letter
- 2020 Flexible Benefit Plan Highlights
- Flexible Benefit Plan Summary Description
- Benefit Extras Mobile App Instructions
- Dependent Care Program Guide
- Online Enrollment Instructions
Forms and Documents
Medical Expense Flexible Spending Accounts have been replaced by Health Savings Accounts (HSAs) and are no longer available.
612-672-2195 or 1-800-CALL-EAP
Employee Assistance Program
Bloomington Public Schools partners with Fairview to provide staff with an Employee Assistance Program (EAP). The program is available to all Bloomington Public Schools staff and their family members including spouses, parents, children, siblings, partners, etc. This benefit provides access to professional confidential counseling and/or assessment and referral services at no cost to staff. There is 24-hour telephone access to address urgent needs.
Counselors offer support and guidance for:
- Relationship, parenting and family concerns
- Work-related concerns and work-life balance
- Conflict management
- Change management
- Financial problems
- Leaves of absence and returning to work
- Save up to $20 a month at participating fitness facilities.
- Available at all fitness facilities in the PreferredOne Fitness Advantage Network.
Fitness Advantage Program Basics
- PreferredOne medical plan participation and fitness club membership is required.
- Work out 8 days or more in a calendar month and receive up to $20 toward your membership dues.
- Dependent Coverage: Employees with Employee-Plus-One or Family coverage may add one covered dependent (must be 18 years or older) and qualify for a total family monthly credit of up to $40.
- Participating fitness facilities track your visits through their normal business procedures and at the end of each month send PreferredOne the activity of all individuals enrolled in the Fitness Advantage Program.
- You are responsible for making sure your visits are electronically recorded.
- Qualifying credit will be applied to your fitness club membership account after verification processing.
- Processing typically takes 30-45 days.
- Informational Flyer
Enrolling in Fitness Advantage
- Download and complete the Fitness Advantage Program Member Enrollment Form. Eligible dependents must complete a separate enrollment form.
- Take it to your fitness facility for signature. Submitting the form to the fitness facility initiates the tracking of your visits.
- Keep a copy of the form for your records as the signed form verifies your enrollment in the program.
- Your fitness facility will submit the signed form to PreferredOne. If you want to make sure that this is done, you may also fax the signed form to PreferredOne at 763-847-4010.
- Begin working out! Multiple visits on the same day count as only one visit.
Active district employees who are considering retirement should schedule a pre-retirement conference with either PERA or TRA (see contact information below) based on your current position. Once you finalize your retirement date please submit a letter of resignation/retirement to Human Resources with a copy to your supervisor/principal. Information on continuing insurance benefits will be mailed to your home from Benefit Extras. Contact Mary Gorman at 952 681-6444 if you have any questions.
PERA offers retirement group counseling sessions periodically through the metro area. Contact PERA for more information or to schedule an appointment. 651-296-7460.
MN State Retirement System (MSRS) Post Retirement Health Care Savings Plan (HCSP)
- Customer Service: 651-296-2761 or 1/800-657-5757
Public Employees Retirement Association (PERA)
- Customer Service: 651-296-7460 or 1/800-652-9026
Teacher Retirement Association (TRA)
- Customer Service: 651-296-2409 or 1/800-657-3669
The Value of Your Pension
Do you know that you have a pension?
Check out this Pension video to see how the pension works, where contributions are invested and how you are saving for retirement.
Minnesota Deferred Compensation Plan (MNDCPLAN) 457 Accounts
Additional retirement accounts, called 457s, are available through the Minnesota State Retirement System (MSRS). Deposits are subject to FICA and Medicare withholdings, but are tax-deferred for Federal and State taxes. Visit the MSRS Deferred Compensation website for information and forms to set up your account.
- Customer Service: 651-296-2761 or 1-800-657-5757
Medicare Supplements & Medicare D Creditable Coverage Notification - See Below
The district offers an annual open enrollment period in late spring which allows staff to enroll or make changes to their benefits without a qualifying life event per IRS regulations.
2020-21 Open Enrollment is scheduled for April 15 - 30, 2020.
A qualifying life event includes a change in marital status, number of dependents, employment status, residence or coverage. Staff may also make changes to their coverage if their spouse is experiencing an open enrollment period in their place of employment. The deadline for making changes is 30 days from the qualifying life event or qualifying date.
Eligibility for employment benefits is determined by collective bargaining contracts or district policy.
Changes or new enrollments during open enrollment take effect at the beginning of the plan year, July 1.
2020-21 Open Enrollment Information
- 2020 Benefits Enrollment Guide
- 2020-21 health insurance rates, deductibles and HSA contributions
- 2020-21 summary of benefits and coverage
- 2020-21 glossary of health coverage and medical terms
- Health insurance enrollment form
- Health insurance change form
- HSA eligibility form - required for new health insurance enrollments
- 2020 retiree/COBRA letter
Dental, vision and accident information and forms are listed under their respective sections.
ING Compass Accident Insurance with Wellness Rider
Accident insurance is portable. This means that if you terminate your employment with the district (resignation or retirement) you can convert the insurance to an individual plan. Please contact Mary Gorman (email@example.com) in Human Resources for more information on this process.
Rates and Summary
- Accident Plan Brochure with Rates
- Wellness Screening Test Examples
- Accident Benefit Payout Examples
- Certificate of Coverage - Teachers - Certificate #B14195
- Certificate of Coverage - All Others - Certificate #B14196
Enrollment and Change Forms
How to Submit an Accident Claim or Wellness Benefit Claim
ING Compass Critical Illness Insurance
All part-time and full-time employees are automatically covered by Critical Illness Insurance through ING. This benefit, recommended by the Labor Management Committee and approved by the School Board, is being paid through our self-insured medical insurance fund. This plan provides a one-time tax-free lump-sum benefit of $2000 payable upon diagnosis of pre-defined critical illnesses – cancer, heart attack, coronary artery bypass, stroke, kidney failure, major organ failure, paralysis or coma. If you experience one of these diagnosis, you will receive a check sent directly to your home, which can be used to help pay deductibles, prescriptions or whatever you wish.
The $1.09 semi-monthly premium ($26.16 annually) is treated as income for tax and social security purposes. You will see "Taxable Critical" a non-wage item of $1.09 each pay period. You may opt out of this benefit by contacting Mary Gorman in Human Resources at 952-681-6444.
Critical Illness is portable. This means that if you terminate your employment with the district (resignation or retirement) you can convert the insurance to an individual plan. Please contact Mary Gorman in HR if you want information on this benefit.
How to Submit a Critical Illness Claim
- Each claim will require three forms - one from the employee, one from the doctor and an employer form from the District.
- To request claim forms, please contact Mary Gorman in HR (952-681-6444) or email firstname.lastname@example.org.
- Once all forms are completed, they should be submitted to:
PO Box 320
Minneapolis MN 55440
A claim check will be mailed to your home address upon approval of your claim.
- Customer Service: 1-800-553-9536
Rates and Summary
Enrollment and Change Forms
- Comprehensive Benefit Summary
- Preventive Benefit Summary
- Comprehensive Plan Document
- Preventive Plan Document
Free Delta Dental Hearing Program
Delta Dental of Minnesota has joined forces with HearPO to offer a hearing discount program. All employees of Bloomington Public Schools who are enrolled in Delta Dental have access to this discount program at no cost to you or the district. Discounts are available on diagnostic testing, hearing aids and batteries. Hearing Program information.
- Customer Service: 763-847-4477 or 1-800-997-1750
- PreferredOne website
- To find a provider, log on to www.preferredone.com and check the "open access 200" option.
- Customer Service (for students away at school or for members when traveling): 1-800-678-7427
- Customer Service (for members who live permanently out of the P1 network): 1-866-241-7427
High Deductible Health Plan (HDHP) Rates
- 2019-20 Medical Insurance Rates including deductibles and HSA
- 2020-21 Medical Insurance Rates including deductibles and HSA
- 2019-20 Benefit Summary
- 2020-21 Benefit Summary
- Glossary of Health Coverage and Terms
- 2018 Summary Plan Description Restated
- Preventive Care Services Schedule
Double Coverage - District Contribution Exclusion
Employees who have health or hospitalization insurance coverage under another plan may participate in the district health insurance, but they will receive no district contribution toward the monthly premium. This does not include employees who receive Medicare, or Tri‐Care or Veterans Affairs (VA) benefits, or exceptions granted by the Executive Director of Human Resources. The exclusion includes all employment contracts and plans.
Federal Age 26 Mandate
Federal Health Care Reform allows the insurance coverage of a dependent to age 26 regardless of whether the child is married, a student or a dependent.
PreferredOne Member Discounts
PreferredOne has partnered with a variety of health and wellness focused organizations to provide discount programs and services helping you to save money on the road to better health. Login to your member account for more information.
Care Advantage Information
Preferred One Care Advantage offers programs and services to help you reach your health goals from wellness to routine medical and illness care to chronic conditions including:
- Specialty Back Pain
- Healthy Mom and Baby
- Quit For Life tobacco cessation
- Case Management Services
For more information call PreferredOne at 1-800-940-5049, ext. 3456.
Preferred One offers options for online care, specifically MD Live for 24/7 access to health providers anytime, anywhere.
PreferredOne Communication Update - Member Website & EOBs
As of June 1, 2018, PreferredOne is mailing explanations of benefits (EOBs) directly to enrolled dependents ages 13 and older at their home addresses or other addresses of record. The subscribers, through whom any dependents are enrolled in health coverage, will no longer receive their dependents' EOBs via mail and will no longer have access to them through the PreferredOne website. Subscribers can request permission from dependent(s) to receive and view dependents' EOBs and other health information.
PreferredOne continues to enhance its website functionality, including its process for the distribution of EOBs for enrolled dependents ages 13 and older. With these improvements, EOBs and other health coverage and claim and pharmacy information is available directly to dependents ages 13 and older.
- Customer Service: 1-866-346-5800 (24/7)
- HSA Form - includes employee contribution changes and new hire eligibility
- Clarification Memo re: Spouse's Medical Flex and HRA-like Account
2020 IRS HSA Limits, Deductibles and District Contribution Levels - Remember to include the district contribution when calculating your maximum personal HSA contribution.
HSA Member Guide
HSA Beneficiary Designation
Although a beneficiary is not required on your HSA account, it is a good idea to designate a beneficiary designated so the funds may be easily accessed by your beneficiary if necessary. You can designate primary and contingent beneficiaries by logging into your HSA account.
If you are enrolled in the District health insurance through PreferredOne, you are automatically enrolled in the District-sponsored Healthy Savings Program. The Healthy Savings Program is a way to save on fresh produce, in addition to weekly Healthy Savings discounts and in-store promotions or coupons at participating stores.
For more information, visit www.MyHealthySavings.com.
The district provides coverage through Travelers Casualty and Surety Company of America for eligible costs if your identity is stolen. Coverage is provided at no charge to all full and part-time district employees and their immediate family members.
- Employees are automatically enrolled.
- Eligible costs may include attorney fees, long distance telephone charges, lost wages, etc.
- To file a claim, call 800-842-8496
Hartford Life and Accident Insurance Company
- Eligibility: All full-time and part-time employees, starting on the first day of the month after hire
- Amount: two times salary (effective July 1, 2010), spouse and children through age 26 are insured for $2,000.
- Please contact Mary Gorman in Human Resources for more information: email@example.com or 952-681-6444
Beneficiary Designation Change
Contact HR for form: 952-681-6444
PERA members who wish to purchase additional life insurance
PERA members who are actively at work are eligible to purchase additional term life insurance through NCPERS.
This brochure details the coverage available, cost and enrollment information.
You may enroll for this coverage only during the annual open enrollment period from Oct. 1-31. Complete the enrollment form and return it to Mary Gorman in Human Resources by October 31. If you are currently enrolled in this benefit, you do not need to do anything to continue participation.
If you have additional questions, please call Health Smart Benefit Solutions at 1-800-525-8056 or firstname.lastname@example.org.
Hartford Life and Accident Insurance Company
- Includes Accidental Death & Dismemberment
- LTD is a benefit for all full-time employees. Enrollment is automatic and the premium is paid by the district.
- LTD has a 90 day wait period before benefits are payable. If approved, LTD will provide 66 2/3% of your annual salary.
- For questions or to file a claim, contact Mary Gorman at 952 681-6444.
Pre-existing Condition Exclusion
For employees hired after July 1, 2010.
- Hartford Life and Accident Insurance Company will not pay monthly income benefits if your disability is due to a pre-existing condition and you become disabled during the first 12 months your insurance is in effect.
- Pre-existing condition is defined as a sickness or accidental injury for which, during the 3 months immediately before the effective date of your insurance you did one or more of these: received medical treatment, care, services or advice; took prescribed drugs or had medications prescribed; experienced related or resulting symptoms or aggravations which would be a reasonable cause for an ordinarily prudent person to seek diagnosis, care or treatment from a doctor or health care facility.
If you are planning to retire or have retired from Bloomington Schools, check out District Group Insurance in Retirement for information on continuing insurance coverage in retirement.
Medicare supplement for retired Bloomington staff is available through UCARE.
- 2019 Benefit Grid and Costs
- 2020 Benefit Grid and Costs
- Classic Choice Dental Option
- Customer Service: 612-676-3557
Medicare D Creditable Coverage Notification
The prescription drug coverage offered by PreferredOne is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
- Customer Service: 1-866-9eyemed (1-866-939-3633)
Rates and Summary
Enrollment and Change Form
Staff members who have a work-related injury should follow these steps:
- Report all injuries, even minor ones that may or may not require medical attention, to your supervisor the same day. Your supervisor will immediately contact Kristine Berg in HR at 952 681-6440 to report the injury.
- Complete an "employee accident investigation report" within 24 hours of your injury. Forms are available from your school secretary or nurse.
- If you need to see a doctor, Risk Administration Services (RAS), our worker's comp provider, prefers that you seek medical attention at:
U.S. HealthWorks (formerly Airport Clinic)
7550 34th Avenue S.
Minneapolis, MN 55420
Hours: Mon-Fri 8 a.m. - 5 p.m.
You are not required to go to this clinic, but may seek medical attention where you choose, especially after work hours. Be sure to tell the provider this is a work-related injury.
If you have questions, please contact Kristine Berg at email@example.com.