CUSTOMER SERVICE NUMBERS

POWERPOINTS -

• PreferredOne Health Insurance (PDF-4/12/10)
• Delta Dental Insurance (PDF-4/10/10)
• Corporate Health Dependent Care Flexible Spending Account (PDF-4/13/10)
• Health Equity Health Savings Account (PDF-4/07/10)
• AlwaysCare Vision Program (4/26/2010)

2010-2011 INSURANCE INFORMATION & FORMS

• A. Health Insurance [PreferredOne]
• High Deductible Health Plan (HDHP) Rates
  • 2009-10 Rates (6/22/09)
  • 2010-11 Rates (3/10/10)
• Enrollment/Change
  • FORM-P1 Enrollment (4/06)
  • FORM-P1 Change (4/06)
• Plan Documents
  • Summary (4 pages) (4/13/2010)
• Certificate (68 pages) (7/29/09)
• Double Coverage (3/27/10)
• Minnesota Age 25 Mandate
• FORM-MN Age 25 Mandate (3/12/09)
• MEMO-MN Age 25 Mandate (3/12/09)
• Fitness Advantage Information and Enrollment Form (11/18/09)
• Fitness Advantage Approved Facilities (11/01/09)
• National Network -Beech Street Customer Service 1-800-937-2277 or 1-800- 877-1444
• PreferredOne phone: 763-847-4477 or 1-800-997-1750

• B. Health Savings Accounts [HealthEquity]
  • Eligibility
    • FORM-HSA Form (3/1/10), includes employee contribution changes and new hire eligibility
    • MEMO-Clarification re: Spouse's Medical Flex and HRA-like Account (6/4/08)
  • IRS Limits
    • 2009 IRS Health Savings Accounts Limits (7/31/08)
    • 2010 IRS Health Savings Accounts Limits (06/10/09)
• Hardship
  • HSA Hardship Form (6/1/10)
• Information
• IRS Publication 969 - HSAs
• IRS Publication 502 - Eligible Expenses
• List of Eligible HSA Expenses
• What is an HSA? (link to HealthEquity website)
• Frequently Asked Questions (link to HealthEquity website)
• Qualified Medical Expenses (link to HealthEquity website)
• Beneficiary Designation
  • FORM-HSA Beneficiary Designation for employees without wills or who want HSA to go to others than natural heirs
• Minnesota State Retirement System Health Care Savings Plan
  • FORM- MSRS HCSP Suspension Election (2010 update-1/20/10)
  • Contact: Joy Sperger, Retirement Services Specialist, Minnesota State Retirement System, e-mail- Joy.Sperger@state.mn.us, phone- 651-284-7840
• Health Equity, Inc. phone: 1-866-346-5800 (24/7)

• C. Dental Insurance [Delta Dental]

• D. Dependent Care Flex Spending Accounts [Corporate Health Systems]
• Enrollment Information (DC FSA)
  • Enrollment Letter (4/13/2010)
  • Benefit Guide (4/13/10)
  • On-line enrollment information (4/13/10)
• 2010-11 Reimbursement Schedule (4/13/10)
• FORM-Claim Form (4/13/10)
• FORM-Direct Deposit Authorization (4/13/10)
• FORM-Paper Enrollment (4/13/10)
• FORM-Paper Change (4/13/10)
• Plan Documents
• 2010-11 Plan Document (4/13/10)
• Medical Expense Flexible Spending Account - NOT AVAILABLE
  • replaced by Health Savings Accounts (HSAs) on July 1, 2008
• Corporate Health Systems phone: 952-939-0911 x14 (Patty Kivi)

• E. 403(B) - Tax Sheltered Annuity (TSA) [self-administered]
  • *FORM-403(B) Wage Deferral Authorization (updated 2/1/09)
  • *PDF IS A FILLABLE FORM.
  • Authorized Vendor List (8/1/08)
  • HR Communicates: 403(b) Info
    • Tip#2 (2/10/09) "DID THE NEW IRS 403(b) GO INTO EFFECT ON 1/1/09"
  • Tip#1 (12/4/08) "HOW WILL THE NEW IRS 403(b) REGULATIONS AFFECT ME?
• Plan Documents
  • Highlights (2 pages)
  • Summary (11 pages)
  • Adoption (22 pages)
  • Basic Plan Document (48 pages)
  • Amendment 12/31/09 (11 pages)
  • Amendment Summary 12/31/09 (1 page)
  • Universal Availability Notice 1/1/2010 (2 pages)
• Sharing Agreement Letter for Vendor (9/25/08)

• F. Life Insurance [ING ReliaStar Life Insurance Company]
  • Beneficiary Designation Change: Contact HR for form: 952-681-6440.
  • Effective July 1, 2010, all full and part-time employees will be covered for two times their annual salary.
    • 2010 ING Life Insurance Certificate

• G. Long-Term Disability (LTD) & Accidental Death & Dismemberment

  [ING ReliaStar Life Insurance Company]

  • Effective July 1, 2010, long-term disability will be provided by ING. 

2010 ING LTD Certificate 

• New:  3/12 Pre-existing Condition Exclusion for employees hired after 7/1/201:   ReliaStar will not pay monthly income bnefits 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 injry 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 advise; took prescribed drugs or had medications prescribed; experienced related or resulting symptons or aggravations which would be a reaonsable cause for an ordinarily prudent person to seek diagnosis, care or treatment from a doctor or health care facility. 

H.  Voluntary Vision [AlwaysCare]

Voluntary Vision Information Packet (3/26/10)

Voluntary Vision Enrollment Form (3/26/10)

Certificate of Coverage (06/14/20)

 

 I. MEDICARE Supplements for Retirees

Bloomington has an association with UCARE and MEDICA to offer a special option to our retired Bloomington staff who are looking for a MEDICARE supplement.   Please contact either company below if you want additional information or wish to enroll.

UCARE for Seniors - Call for more information 612-676-3557.

MEDICA - Call 952-992-2330 for information on the PEIP plan.

BENEFIT ELIGIBILITY TABLES (based on Hire Date) - APPENDIX A

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