Insurance

Our plan year for teachers runs Sept 1 – Aug 31. Deductibles for High Deductible plan follow this schedule and will reset on Sept 1, 2017. We pay our share of the premium for insurance with 20 pays ending on June 14, 2017. Everyone is paid and covered thru Aug 31, 2018 even if you leave Westport for whatever reason.

The BOE will deposit either $1000 single or $2000 family into our HSA accounts. 50% on Sept 1, 2017 & 50% on Mar 1, 2018.

WEA insurance rates  |  How to Survive a High-Deductible Health Plan from Consumer Reports

Cigna Information for the WEA

Use the online tool to find if your doctor is included in CIGNA: Download the Directions
click here enter doctor’s name and town/zip..  select…  Open Access Plus ONLY

Provider: CIGNA
Group Number:
Customer Service: (800) 244-6224
Provider Website: www.cigna.com set up an account for yourself to find all coverage info & get personal info
download instructions /   Instructions to Update Cigna info /   HIPPA Release form

Find the current rates for insurance for Westport Teachers:

What is the first step if I have a problem?

Contact CIGNA either toll free at 800-244-6224 or through their website at www.mycigna.com, advise the representative at CIGNA your position and explain your problem, remember to get the representative name.

What if CIGNA’s response is inaccurate or I do not feel helped?

Contact Eileen Ahern in the Westport TSO Business office by email and explain your problem. Make sure to cc Dr. Landon and Nancy Harris when you send the email. Include the WEA cabinet in the email so we can be made aware of the problem: Karen DeFelice and John Horrigan.

To change your insurance:

If you are requesting to cancel your medical plan coverage prior to September 1st, you will need a life changing event to cancel your active employee medical plan. For your reference a list of life changing events are listed below.
1) Marriage
2) Birth or adoption of child
3) Divorce
4) Death of spouse or child
5) Loss of health insurance plans

To cancel your medical plan due to a life changing event, you will need to submit your completed health insurance enrollment forms with documentation of your life changing event to my attention at the TSO Room 300, no later than thirty one days from your life changing event. Your request to cancel your medical plan will be processed the first of the month following your life changing event.

During the Open Enrollment Period, you may cancel your medical plan enrollment only and your dental plan will continue for the 2013/2014 school year.

If you need health insurance enrollment forms to cancel your medical plan due to life changing event, please send me a return email message so I may send you the necessary health insurance forms.   per Eileen Ahern  May 2013


Our Contract Language: 2016-2019  (pg 9)

ARTICLE XVI

MEDICAL INSURANCE

  1. A program of benefits shall be provided on a contributory basis to each eligible employee and their eligible dependents. Health benefits shall be in the form of a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA).  The deductible for such HDHP shall be $2000 for individuals and $4000 for families.  The Board will contribute 50% of the deductible for active employees participating in the HDHP.  Any employee ineligible for the HDHP may participate in a Health Reimbursement Arrangement (HRA) with the same terms as the HDHP.  Board funding to the HRA shall include a rollover feature allowing any unused HRA deductible funds to be rolled over up to the amount legally allowed.

The Board’s deposit toward the HDHP deductible will be made in two equal installments on September 1st and March 1st.

There will be no cost for preventative care.  Once the HDHP deductible is met, benefits will be covered at 100% for in-network.  Out-of-network services will be subject to an 80%/20% co-insurance after the deductible is met with an out-of-pocket maximum of $4,000/$8,000 (including satisfying the deductible).  The out-of-pocket maximum will be cross accumulative between in-network, out-of-network and prescription drug cost.  The Board will pay for all full-time employees eighty-one percent (81%) of the costs of all premiums and the employee shall pay nineteen percent (19%) of such costs. Effective September 1, 2017, the Board will pay for all full-time employees eighty percent (80%) of the cost of all premiums and the employee shall pay twenty percent (20%) of such costs. Effective September 1, 2018, the Board will pay for all full-time employees seventy-nine percent (79%) of the cost of all premiums and the employee shall pay twenty-one percent (21%) of such costs.  To establish HDHP rates the parties will retain a mutually acceptable insurance consultant, and the parties shall split the cost.  Contributions will be based upon the cost of coverage elected by the teacher, i.e. individual, individual plus one, family (the employee premium share contributions shall be computed on the basis of actual expenditures in the prior year).  Employee premium share contributions shall be made pursuant to an I.R.C. Section 125 Plan (pre-tax contribution) implemented by the Board.

The Board will pay for part-time employees, seventy percent (70%) of the cost of all premiums and the employee shall pay thirty percent (30%) of such cost. Contributions will be based upon the cost of coverage elected by the teacher, i.e. individual, individual plus one, family (the employee premium share contributions shall be computed on the basis of actual expenditures in the prior year). Employee premium share contributions shall be made pursuant to an I.R.C. Section 125 Plan (pre-tax contribution) implemented by the Board.”

Prescription benefits under the HDHP shall be provided through a prescription benefits manager (PBM), designated by the Board through a formulary established by the Board.  The co-payments for the HDHP plan will apply after the deductible is met up to an additional out-of-pocket maximum of $1000/$2000.  The co-payments shall be $10.00 for generic, $30.00 for preferred brand, and $45.00 for non-preferred brand, with mail order of two and one-half (2.5) times these retail co-payments for a ninety day supply.  A participant shall pay the difference between the brand name drug cost and the generic drug cost when a generic is available and the individual elects to take the brand name drug without a physician’s specification, “Dispense As Written” (“DAW”) provided for medical reasons.  A summary of the benefits of these plans shall be set forth for informational purposes in Appendix D, provided that the actual benefit shall be determined in accordance with the insurance contract(s).

The Board will also provide life insurance for each eligible employee in an amount equal to one and one-half (1.5) times annual salary rounded upward to the next highest thousand.  Upon resignation or retirement, unit members will be offered the opportunity to convert life insurance previously available under the Board group plan to an individual policy at their own expense, carrier permitting.  Upon retirement from the Westport Public Schools, each retiree shall receive from the Board an explanation of benefits booklet, which shall describe the retiree’s option for benefits and continuing benefits, (e.g. life insurance, medical and dental insurance).  The Board shall notify retirees in writing of any changes to those benefits, and the Board and the Association may provide information to retirees about the advantages of participation in the TRB insurance plan for teachers eligible to participate in Medicare A and B.

This Agreement shall be in full force and effect from July 1, 2016 through and including June 30, 2019, subject to reopener negotiations to commence at any time on or after January 1, 2017 over the provisions of Article XVI and in accordance with statute upon the written request of the Board if the cost of insurance plans offered herein are expected to result in the triggering of an excise tax under Internal Revenue Code Section 4980I and/or if there is any material amendment to the applicable provisions of the Affordable Care Act.  Reopener negotiations shall be limited to health insurance plan design and funding, premium cost share and/or introduction of an additional optional health insurance plan.

The parties agree that any negotiations pursuant to the reopener above shall include an investigation into the feasibility of obtaining group hospitalization, medical, pharmacy and surgical insurance coverage through the Connecticut State Employees’ Health Care Plan (state employee plan) under Public Act No. 15-93.  The parties agree to promptly provide the State of Connecticut Comptroller’s office and Health Care Cost Containment Committee with all information they may require to determine if the WEA bargaining unit may join the state employee plan as a stand-alone group.

B. Dental benefits shall reimburse preventive expenses at 100% co-insurance. A $50.00 annual deductible ($150 family maximum) is applied to general and major services.  General services shall be reimbursed at an eighty percent (80%) co-insurance and major services at fifty percent (50%) co-insurance.  This benefit is subject to a $2,500 calendar year maximum per covered individual.

C.  Insurance Carriers

The Board of Education at its sole discretion may change the identity of carriers or administrators contracted to provide or to administer medical, prescription drug, dental, vision and/or life insurance in whole or in part.  Prior to changing vendors under this section, the Board shall notify the President of the Association at least thirty (30) days in advance of the nature of the proposed change and the reasons therefore.

During the next ensuing thirty (30) day period, the parties shall meet and the reasons for the proposed change shall be more fully explained.  Any changes in the identity of the carriers or administrators contracted to provide or to administer medical, prescription drug, dental, vision and/or life insurance benefits in whole or in part must provide substantially equal coverage, benefits and service to the members of the bargaining unit and their dependents at no additional cost, and any claims then or thereafter that this is not the case may be the subject of a grievance under the controlling grievance procedures.  If, during the thirty (30) day period set forth above, the parties cannot agree that this is the case, either the Board or the Association may invoke arbitration as provided under this Agreement for the purpose of determining whether the proposed change or changes will, in fact, provide equal benefits, at no additional cost to covered employees or their dependents.  Network equivalence shall not be a factor in considering substantial equivalence in coverage, benefits and service, provided that there is no disruption of physicians of greater than fifteen percent (by visit).  A change in formulary shall be considered equivalent if at least 90 of the 100 drugs most commonly used by Westport teachers shall be included in the formulary.  Any arbitration under this clause will be final and binding as provided by the contract, preferably before an arbitrator experienced in insurance matters.