FILE:  EGAC

 

EMPLOYEE HEALTH INSURANCE

 

 

The Plaquemines Parish School Board shall contract with a health care provider for medical insurance for eligible employees, retirees and/or spouses and/or dependents.  The School Board may contribute a portion of an employee’s or retiree’s health premium as determined by the School Board, of any medical insurance selected by the School Board.  The employee or retiree shall be responsible for paying any portion of their premium not paid by the School Board.  Adjustments in the amounts paid by the School Board may be made with any change in premiums on a yearly basis.

 

Full-time employees and retirees, together with spouses and/or dependents, are eligible to participate in medical insurance selected by the School Board.  Retirees are eligible only for the insurance that is current at the time of retirement.  Any employee who terminates his/her employment with the School Board prior to the fulfillment of his/her employment contract shall not be covered by the School Board’s medical insurance as of the date of termination.  However, any employee who terminates employment with the School Board may apply for continued medical insurance in accordance with regulations of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

 

VESTING SCHEDULE FOR RETIREES

 

  1. Employees who retired before January 1, 2022, shall continue to receive a 100% premium School Board contribution of the total premium for the retiree and his/her spouse and his/her dependents.

  2. Employees employed by the School Board before January 1, 2022, but not yet retired, shall receive a 100% School Board contribution of the total premium from the School Board for the individual and his/her spouse and his/her dependents.  Years of service vesting shall not be required.

  3. Employees hired on or after January 1, 2022 and those re-joining the School District on or after January 1, 2022, shall be subject to the following vesting schedule:

 

Year

Level

Years of Continuous Employment at Time of Retirement

Retiree % Total Premium

Paid

Board % Total Premium

Paid

-10

Less than 10 years of service

100%

0%

10-14.99

10-14.99 years of service

75%

25%

15-19.99

15-19.99 years of service

50%

50%

20-24.99

20-24.99 years of service

25%

75%

25 +

25 + years of service

0%

100%

 

  1. Employees hired on or after January 1, 2022 and those re-joining the School District on or after January 1, 2022:

 

  1. At the time of the employee’s retirement, spouses and/or dependents must be enrolled on the School Board’s medical insurance.

 

  1. Employees hired on or after January 1, 2022 and those re-joining the School District on or after January 1, 2022, upon retirement:

 

  1. Retires and his/her spouse must enroll in Medicare Parts A & B if eligible.

  2. Retirees and/or dependents not yet eligible must enroll in Medicare Parts A & B upon eligibility.

  3. Employees must contact the School Board’s health insurance administrator to ensure enrollment into the Medicare Advantage Program offered by Plaquemines Parish School Board.

 

  1. When a provider agrees to accept what Medicare allows as full payment, the School Board does not pay for any portion of any bill in excess of the Medicare allowable amount.

  2. Any employee who has already retired, can enroll during the annual open enrollment held each year.  However, Medicare does assess a penalty for each year an employee has not been on Medicare.  Coverage shall become effective on the first day of the month that the employee becomes eligible for Medicare.

 

CONTINUED COVERAGE FOR SURVIVING SPOUSE AND/OR DEPENDENTS

 

  1. Benefits under the plan for covered dependents of a deceased covered employee/retiree shall terminate on the last day of the month in which the employee/retiree’s death occurred, unless the surviving covered dependents elect to continue coverage.

  2. The surviving dependents of an employee/retiree may continue coverage until attainment of the termination age for children.

  3. Surviving spouse/dependents shall be entitled to receive the same participant employer premium contributions as employees/retirees.  Once a participating surviving employee/retiree is eligible for Medicare, he/she shall move to the retiree rate schedule for Medicare eligible participants.

  4. A surviving spouse and/or dependent cannot add new dependents to continued coverage other than for the birth or adoption of a descendent child of the deceased employee/retiree born or adopted after the employee’s/retiree’s death, or if coverage for the descendent child of the deceased is court ordered.

  5. Coverage for the surviving spouse shall continue until the earliest following event(s) occur:

 

  1. Failure to pay the applicable premium;
  2. Death of the retiree/employee

 

  1. Coverage for a surviving dependent child under this section shall continue until the earliest of the following events:

 

  1. Failure to pay the applicable premium;

  2. Attainment of his/her termination age of children;

  3. Death of the surviving dependent.

 

Not all expenses may be eligible and are dependent upon the School Board’s current plan.

 

Employees may request a Participation Schedule prior to retirement.  Employees shall review and confirm the accuracy of the participation schedule with their records and the School Board’s records and report any discrepancies.

 

New policy:  December 6, 2021

Revised:  July 11, 2022

 

 

Ref:    La. Rev. Stat. Ann. §§17:81, 17:1221, 17:1222, 17:1223, 42:821, 42:851

Board minutes, 12-6-21, 7-11-22

 

Plaquemines Parish School Board