Director: E-mail: Phone: Fax:

Cheryl Matson cheryl.matsonjordan.k12.ut.us 801-567-8146 801-567-8070

Insurance Information for New Employees:

1. Your insurance packet will need to be picked up in the Human Resources Office.
2. You will receive insurance coverage if a completed Benefit Election form is received in the District Insurance Office within 30 days of your contract start date. If you miss this deadline, you will have to wait until the next Open Enrollment period to enroll in an insurance plan unless you have a qualifying event during the year.
3. Flexible spending election forms are also due in the District Insurance Office within 30 days of your contract start date.
4. For Certificated new hires (those individuals holding a teaching certificate or equivalent, interns, counselors, etc.),insurance plans will be effective the first day of the month after a 2-month waiting period has been satisfied as long as your enrollment form is completed and received in the District Insurance Office within 30 days of your contract start date. Your 2-month waiting period will start from the first day of the month after your contract start date.
5. For Classified new hires (secretaries, custodians, nutrition services workers, inspectors, maintenance workers, delivery drivers, bus drivers, other transportation workers, benefit eligible assistants, etc.) and Administrative new hires (directors, principals, assistant principals, consultants, etc.), insurance coverage will be effective the first day of the month after your Benefit Election form is received in the District Insurance Office as long as your enrollment form is completed and received in the District Insurance Office within 30 days of your contract start date.
6. A $32,000 life insurance and a long-term disability policy is offered to all benefit eligible employees at no cost to you. Even if it is your intent to waive medical insurance coverage, complete the Benefit Election form for these benefits.
7. Once enrolled in the medical, dental, vision, and cancer plans, you must remain on that plan for the benefit year unless you have a qualifying event. When you have a qualifying event you have 30 days to complete and return a new change form or you will have to wait until the next Open Enrollment period.
   • Divorce or legal separation (60 day notification);
   • Marriage, or change in number of dependents;
   • Change in employment status of employee, spouse, or dependent that causes loss of eligibility;
   • Dependent satisfies (or ceases to satisfy) eligibility requirements (60 day notification);
   • Change in coverage under another employer plan (including mandatory or optional change from your spouseÕs employer and change initiated by your spouse);
   • Loss of coverage from government or educational institution;
   • COBRA qualifying event (termination/reduction of hours, employee death, divorce/legal separation, ceasing to be a dependent);
   • Other changes resulting from a judgment, decree, or order; Medicare or Medicaid entitlement; or FMLA leave of absence.

Insurance Open Enrollment:

June and July, effective date of September 1
The following changes can be made during the open enrollment period:

1. Enroll in a new insurance plan
2. Change an existing service plan
3. Cancel an existing service plan
4. Complete a new flexible spending form
   (A new flexible spending election form must be turned in each year you wish to participate in this program per IRS guidelines.)
   

Note: Open enrollment forms and flexible spending elections will not be accepted during the months of August or September, unless you are a newly hired employee and your contract begins in August or September.

Please call Insurance Services, with any questions.

Document Name	Type
Premiums - High Deductible Plans 2010-11
Premiums - Traditional Plans 2010-11
Premiums - High Deductible Plans 2009-10
Premiums - Traditional Plans 2009-10
New Hire Benefit Election Form
Employee Benefit Change Form
Benefit Enrollment Guide 2010-11
Benefit Enrollment Guide 2009-10
(Policy) Accidental Death and Dismemberment - Active Employee
(Policy) Accidental Death and Dismemberment - Retiree After 9/1/03
(Policy) Accidental Death and Dismemberment - Retiree Prior to 9/1/03
(Policy) Life Insurance - Active Employee
(Policy) Life Insurance - Retiree After 9/1/03
(Policy) Life Insurance - Retiree Prior to 9/1/03
(Policy) Long Term Disability - Active Employees
Cigna Application - AD&D Conversion
Cigna Application - Life Insurance Continuation
Cigna Application - Life Insurance Conversion
Cigna Application - Dependent Child Insurance Continuation
PEHP Flexible Spending Enrollment Form
PEHP Flex Spending Reimbursement Form
Insurance Plans - Advantage, Summit, Preferred
Prescription COB Reimbursement
Prescription Mail Order
Jordan School District's Privacy Policy and Practice
Medicare Part D Creditable Coverage
Workers Compensation