Machine -Readable Files as required by the Transparency in Coverage Rule
KHPE MRF URL<https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.ibx.com%2ftransparency-in-coverage%2f6305%3fkey%3dKx%2fL3B7ll4VSGa6t%2b4kfoWokFFTDMgtWFIuwb5odIjCvhiahvJXTUfWKLLr9qQtPs%2bUKUpk1CCyBaEME9tNd%2bg%3d%3d&c=E,1,QpiN6jpWyCxv8WVQ7XphcCl7nFrTJ_6Gg95Rj2zLFRnLq33huaurEQaw53gVu_Fd8aL0pDJBz_9jcmCGZC4O2jAbv13tSC3AgKip2DEuRDEhJlp3&typo=1>
QCC MRF URL<https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.ibx.com%2ftransparency-in-coverage%2f6305%3fkey%3dXrdGPU9Q1miA%2brdBraKBcK0SDXKTIuT29xmdcVcXz3PmWeqfFZufo%2fDDrINSI6gHlWNN%2bbnjUeDRU4hLNyaW&c=E,1,am2yoniXbToaKq19hutFODA8JwSf3FXW-jIr-flvxQeStxGHCmVuo2vzXG9s3uwF-mCgwl69_bSoHsYJLYKw7WqpCxRumLfSTmIn3eyF2tN4Uaw6&typo=1>Current Insurance Carriers:Health Insurance: Independence Blue CrossMember website https://www.ibx.com/Keystone POS Plan SummaryPersonal Choice 20/40/70 Plan SummaryPersonal Choice 10/20/70 Plan SummaryPersonal Choice HDHP Plan SummaryHealth Savings AccountPrescription Drug: FuturescriptsHealthy LifestylesDental:Vision:Certified Staff:: Vision Benefits of America Group 625Support Staff: Vision Benefits of America Group 626Confidential Secretary: Vision Benefits of America Group 626Change in Insurance Coverage:It is your responsibility to notify Human Resources if you have a life event that will alter your health insurance coverage. Examples are: marriage, divorce, birth or adoption of a child, child reaching age 19, or change in your spouse's employment resulting in the gain or loss or health care coverage. Our current coverages are: Single, Husband & Wife, Parent & Child, Parent & Children, Family.Voluntary Waiver of Employee Insurance (Opt-Out):Employees may waive District paid medical coverage: hospitalization/medical/surgical coverage and/or prescription drug and/or dental.Waiving coverage is effective at the first of the month following the date the waiver is received in the Office of Human Resources. Revoking a waiver cannot occur until July 1 following the open enrollment period, or some other date if the employee experiences a life event.Health, Prescription, and Dental Coverage Waiver: Opt Out FormOneAmerica® Employee Benefits:Employees are eligible to receive and/or buy short and long term disability coverage. Please consult your bargaining unit agreement for specific details.The following forms are available for printing:Short Term Disability:Life Insurance:
OneAmerica® Beneficiary Designation403B Annuity InformationPlease return completed forms to Sharon Russell in Human Resources.