Non-Represented Employees
Non-Represented Employees
The School District of Philadelphia offers Non-Represented employees Keystone and Personal Choice coverage, administered by Independence Blue Cross(IBC). If you begin full-time work by the 15th calendar day of the month, health coverage becomes effective on the 1st of the following month. If you begin after the 15th, coverage becomes effective on the 1st day of the next succeeding month. Information about Personal Choice IBX.com/SDP.
For downloadable medical forms, please see below.
Summary of Benefits:
- Personal Choice 20/30/70
- Modified Personal Choice 320
- Keystone HMO 15
- Prescription Summary
- NR Benefits and Retirement
Enrollment Requests:
When submitting applications for Enrollment please follow the below guidelines:
- SDP Health Application and Attestation Form
- This application is for all SDP provided health plans. Your prescription and vision are included on your medical ID card.
- Your dental coverage is provided by Cigna and you will received a separate ID card.
- Complete all sections in entirety.
- Please refer to General Documentation Required section for a list of documents that may need to accompany your completed application
- The completed application and documentation, if required, can be faxed in to the Benefits Office at (215) 400-4631 or emailed to benefits@philasd.org. Please call (215) 400-4630 to confirm receipt if submitting by fax.
PLAN OPTIONS
As a newly appointed employee, you may enroll in Keystone 15, Modified Personal Choice 320 or Personal Choice 20/30/70 plan. The Modified Personal Choice 320 plan has a deductible and co-insurance for certain in-network services. The Personal Choice 20/30/70 has no deductible or co-insurance for in-network services. You must select a primary care physician for the Keystone 15 plan and received referrals for certain services. Keystone 15 has no out of network benefits.
Prescription
Your prescription drug coverage is provided by Independence Blue Cross and membership information will be on your medical ID card. The select drug select drug $10/$15/$25 Prescription Summary has both a retail and a cost saving mail order option. There is no cost to you for this program.
Vision
Included with your medical and prescription plan is a Vision Program managed by Davis Vision. This covers frames and lenses. Benefits are maximized by using Davis Vision Providers. Paid-in-full benefits for eyeglasses with standard lenses are possible when you choose from a select grouping known as the Davis Collection of Frames. Benefits summaries are below based on if you are enrolled in the Keystone HMO or Personal Choice PPO coverage
To locate a participating provider, go to www.ibx.com and click on the ‘Find a Doctor’ feature. and select “Vision Provider”.
Dental Coverage
Effective January 1, 2020, Cigna Dental replaced United Concordia. More information is available at https://www.philasd.org/benefits/home/cigna-dental/.
This benefit is provided at no cost to you. With most plans, you pay a percentage of the cost for a procedure and your insurer pays a percentage. Using a network provider maximizes your benefit. How these percentages are determined depends on the types of dental services covered.
Members receive one ID card issued in the employee’s name. Our plan has an annual deductible and coverage maximum. The annual deductible is $25.00 for the individual and $75.00 for a family. The coverage maximum is $2,000.00 per plan year. There is also a Lifetime orthodontic maximum of $1,200.00 per person. Cleaning services are not subject to a deductible. Specific coverage is outlined in the summary of benefits on our Cigna Dental Page. You can maximize your benefits if you use participating providers. Or call Cigna at 800.564.7642 Get more information from this How to Find a Dentist flyer, or call 800.Cigna24.
Premium Co Share
You contribute a portion of the premium for your medical insurance. Premiums are based on the plan medical selected and the family members (tier) in which you enroll. Deductions are on a bi-weekly basis; the deductions occurs on every paycheck throughout the year. Deductions are made on a pre-tax basis. Rates are effective July 1, 2022 through June 30, 2023.
| Rates below are for Non Represented employees effective in the July 1, 2023 pay. | No new enrollments of same gender domestic partners as of 10/1/2019. All existing same gender domestic partners are grandfathered. | |||
|---|---|---|---|---|
| Tier Level | Keystone 15 | Personal Choice 20/30/70% | Modified Personal Choice 320 | Personal Choice 20/30/70% |
| 5 % premium for Non Represented employees. | 5 % premium for Non Represented employees. Closed 6/30/2014 . | 8% premium for Non Represented employees. | 13% premium for Non Represented employees. | |
| Single | $13.36 | $15.77 | $21.26 | $40.99 |
| Employee & Child | $18.70 | $22.08 | $29.80 | $57.39 |
| Employee & Children | $24.04 | $28.38 | $38.32 | $73.79 |
| Employee & Spouse or Life partner | $26.71 | $31.54 | $42.57 | $81.99 |
| Family | $40.07 | $47.30 | $63.86 | $122.99 |
| Employee & Spouse or Life partner with Surcharge | $66.71 | $71.54 | $82.57 | $121.99 |
| Family with Spouse or Life Partner Surcharge | $80.07 | $87.30 | $103.86 | $162.99 |
*Spousal surcharge: Employees covering a spouse or same sex domestic partner on their Medical coverage will be required to sign a Letter of Attestation on the reverse of the SDP-Health-Application and Attestation verifying his/her spouse or same-sex life partner does not qualify for other employer health coverage or a School District of Philadelphia employee in order to waive the $40 PER PAY premium surcharge. If your spouse/domestic partner qualifies for employer health coverage, you will be subject to the $40 spousal surcharge.
General Documents Required
If you are adding a dependent to your coverage, you must provide documentation. Refer to the chart below. In most instances, you will have to provide at least two documents per dependent. Residential address must match address of record of employee. Address changes are handled by the Payroll Department at (215) 400-4490 or payrollhelp@philasd.org.
| To cover a: | You must provide: |
| Spouse | Marriage Certificate AND ONE of the following:
*Current is less than 1 year old. |
| Same Gender Domestic Partner | NOTE: No new enrollments permitted after 10/1/2019. Existing enrollments are grandfathered. |
| Child under the age of 26 | Birth Certificate and social security number. Proof of dependency may be required. Acceptable proofs of dependency for children differ depending on the relationship between the child and the employee (and in some cases, the employee’s marital status). |
| Disabled child, age 26 or older | Birth Certificate, social security number and Certification by the insurance carrier as an individual with a disability. |
| Stepchild under the age of 26 | Marriage certificate indicating stepchild’s biological parent is married to the employee, birth certificate listing spouse as parent and divorce decree indicating spouse is primary care giver or a signed statement attesting to financial responsibility. |
Over 65?
This information on Medicare enrollment is intended to be a guide only. You are strongly encouraged to contact Medicare at 1-800-MEDICARE to get definitive information on when you should enroll.
If you or your spouse are Medicare eligible (usually age 65 and older), and are enrolled in our active medical coverage, generally you do not have to enroll in and pay the premium for Medicare Part B. You can enroll in Medicare Part B during a Special Election Period (SEP) following you or your spouse’s retirement.
Because the District is a Large Group Health Plan (LGHP), we cover more than 12,000 employees, our understanding is that for active employees and their dependents, unless they qualify for Medicare based on End Stage Renal Disease (ESRD) the District’s medical coverage is primary over Medicare so it would pay medical claims before Medicare. As such, you have the opportunity to delay enrolling and paying for Medicare Part B until the time you separate from active service from the District. At that time the Benefits Office can provide a CMS L-564 Employment Verification Form to document your loss of coverage. That should provide a Special Enrollment Period (SEP) window to enroll in Part B with no enrollment Penalty.
With respect to Part A, most employees/dependents are automatically eligible and enrolled at age 65 based on their own or their spouses work history and contributions to Medicare (FICA MED). Most people get Part A premium-free. If you didn’t enroll in Part A when you were first eligible, you can sign up when you start receiving Social Security or during the General Enrollment Period between January 1–March 31 each year. Your coverage will start July 1.
There are several helpful publications and references on the Medicare website that should provide clarification to your questions. You may be able to request printed copies.
Medicare and You
When can I sign up for Part A & Part B?
Wage Continuation
Wage Continuation is the School District of Philadelphia’s (SDP) salary continuation program. You may elect coverage to protect yourself from sustained salary loss due to an illness or non-work related injury that extends beyond your sick time.
Should you become ill and exhaust all accumulated sick leave, at the conclusion of a short waiting period (0-7 days), you will be compensated a daily amount consistent with 75 percent of your salary for up to 26 weeks, pursuant to SDP approval. Expectant mothers may use this benefit to continue their salary for 6-8 weeks from the date of birth of the baby.
In order to qualify for the continued salary benefit, you must be enrolled in the program prior to the injury or illness and your absence will be monitored by the Office of Employee Health Services.
*Enrollment in the Wage Continuation program does not guarantee eligibility of use. You must be approved by the Health Services Department for use of this program. Review the How Do I Use the Benefit? for more information
Who is eligible for this benefit?
This benefit is extended to all salaried or benefits eligible employees. Non Represented employees in a Director or above position are eligible for up to one year of 100% of salary sick leave and therefore are not eligible for Wage Continuation coverage.
When and how can I enroll?
New employees may elect coverage within 30 days of date of hire; however, you will not be eligible for the program until the first of the month following 90 days of qualified service, at which time your premium contributions will begin to be deducted from your pay.
- After your first 30 days of hire, you can enroll or disenroll during the Annual Open Enrollment. Open Enrollment period held May 1 to May 31 with an effective date of July 1 for cancellation and August 16 for new enrollment.
Before completing the form, we suggest that you review the deduction examples below. This benefit can be costly, depending on how many sick days you have in your bank. It is typically very costly for employees with small unused sick banks.
When does my coverage begin?
For new employees who enroll at the beginning of SDP service, coverage begins on the first of the month after 90 days from the hire date. At that time, Wage Continuation payroll contributions will begin.
Coverage for employees who apply during Open Enrollment will begin at the start of the new school year, August 16, after employees are advanced Personal Illness leave for the upcoming school year. This applies to 10 and 12 month employees.
What does the deduction look like on my paycheck and how much will I have to pay?
Premiums paid for the Wage Continuation program are non-refundable.
The cost of this indemnity program is dependent upon the amount of your unused sick leave and salary.
Contributions are evaluated at the time of enrollment and at the start of each school year. At that time, you will be placed in the appropriate plan, as detailed in the charts below. Each plan type has an associated premium and “corridor days”.
“Corridor days”, also known as annual waiting period, are the days that you are required to wait between the use of your last sick day and the when your Wage Continuation payments start. The waiting period that must be completed once each school year, and ranges from 0 to 7 work days.
What does it looks like on my paycheck?
Your paycheck includes two indicators of your enrollment in the program. Please refer to this Sample Pay Stub for an example.
There is a box labeled “H.I. PLAN” under the box that contains the “EMPLOYEE NAME”. Enrollment is indicated by a code that shows how many corridor days you have and the range of accumulated sick days which your enrollment was assessed. Here are examples of the code and what it means:
You can also view your Wage Continuation balance through the Employee Payroll Application portal by following the below instructions:
You can view your leave balance through the Employee Payroll Information application. Your School District of Philadelphia email name and password are used for access. If you do not know the name and password, call the Technology Help Desk at (215) 400-5555 for assistance. Please note that the balances shown are all subject to a post separation audit. Your paycheck references this.
From the School District of Philadelphia main website (http://www.philasd.org) go to the Employee Portal. In the Employee section, enter your email name and password. Your email user name should exclude the “@philasd.org” designation.
The other indicator of your enrollment is the deduction. There is a code in the DEDUCTIONS column. That code is “WAGE CON”.
How can I cancel participation?
You can cancel Wage Continuation coverage during the annual open enrollment from May 1 through May 31, effective July 1. You may only cancel coverage during the Open Enrollment period May 1 through May 31 for a July 1 effective date.
How do I use this benefit throughout the year?
*Enrollment in the Wage Continuation program does not guarantee eligibility of use. You must be approved by the Health Services Department for use of this program.
If you find yourself in a situation where you cannot return to work due to illness or injury (not work related), you must coordinate your absence with the Employee Health Services (EHS) department. Completing the following steps will ensure a smooth transition:
- For absences over 3 consecutive days, submit an Extended Illness Form SEH-3 to EHS.
- You will receive a letter from EHS scheduling an appointment for you to visit the SDP’s physician for review of your absence.
- You will continue to use all accrued (banked) sick days until you have none left.
- Upon approval of your continued absence, you will have a waiting period between your last sick day and when Wage Continuation payments begin. Waiting periods are listed above in the “How much will I have to pay”section and range between 0-7 work days, depending on which plan you are enrolled in.
- Wage Continuation payments continue until you are cleared to return to work. Payments may continue for up to 26 weeks.
You may contact Health Services at (215) 400-4660 or by e-mail at employeehealth@philasd.org Their office is located at 440 N. Broad Street, Rm 134, Philadelphia, PA 19130
How much do I have to pay?
Please review carefully.
Below are the bi-weekly rate charts and examples calculating premiums. Important: All premiums paid for the Wage Continuation program are non-refundable.
Refer to the chart below that explains the bi-weekly rate charged for participating in the Wage Continuation Program. The bi-weekly rate is per every $100 of salary.
Note: Premiums for employees are typically high if there are a limited number of unused sick days that are accumulated.
The “quick” way to find your bi-weekly premium is by doing the following calculation:
Formula: Biweekly Gross pay ÷ 100 × Rate from chart = Biweekly premium
Example $1,693.41 ÷ 100× $0.31 = $5.25
*Note that the purpose of this formula and calculation is to give an approximate value of the biweekly deduction. Actual biweekly deduction amounts may vary.
|
Unused Sick Leave |
H.I. |
Total Annual |
Premium per $100 of Salary paid by the Employee |
|
Less than 10 days |
HI 0-9 |
7 |
$2.95 |
|
10 but < 30 days |
HI 10-29 |
6 |
$2.10 |
|
30 but < 60 days |
HI 30-59 |
5 |
$0.31 |
|
60 but < 90 days |
HI 60-89 |
4 |
$0.00 |
|
90 but < 120 days |
HI 90-119 |
3 |
$0.00 |
|
120 but < 150 days |
HI 120-149 |
2 |
$0.00 |
|
150 but < 180 days |
HI 150-179 |
1 |
$0.00 |
|
Greater than 180 days |
HI 180+ |
0 |
$0.00 |
Here is an example of what to expect:
There are significant differences in the premium that you pay based on the number of unused personal illness (sick) days in your bank.
Based on an annual salary of $44,198 and a bi-weekly pay rate of $1,693.41:
- If you have 0-9.99 personal illness days in your bank, the bi-weekly deduction (each paycheck) would be $49.96 at the $2.95 rate. (i.e. $1,693.41÷100×2.95=49.96)
- If you have 10-29.99 personal illness days in your bank, the bi-weekly deduction would be $35.56 at the $2.10 rate. (i.e. $1,693.41÷100×2.1=35.56)
- If you have 30 or more personal illness days in your bank, the bi-weekly deduction would be $5.25 at the $0.31 rate. (i.e. $1,693.41÷100×0.31=5.25)
Life Insurance
BASIC TERM LIFE INSURANCE
As an SDP Non-Represented employee, you are entitled to a term life insurance policy. You are entitled to a basic $20,000 term life insurance policy in addition to a supplemental $25,000, for a total of $45,000, through Hartford Life Insurance Company at no cost to you. You are not required to undergo a medical examination if you enroll within the first 31 days of your employment. However, if after such time you wish to elect life insurance or increase your coverage amount, you are required to complete an Evidence of Insurability form which is reviewed by the insurance company and approval for coverage is not guaranteed. All life insurance coverage becomes effective on the first day of the following month after 30 days of active service with the SDP.
If you pass away during active service at the District, your beneficiary(ies) receive the full benefit, pending Hartford’s approval. If you have not designated a beneficiary(ies), the full benefit is assigned to your next of kin. Original, signed Beneficiary forms must be submitted in person or by mail.
All employees, who leave active service (retired or otherwise), have 31 days to convert all or part of the non-paid-up portion ($2,000 in the case of eligible retirees) of their active policies to a self-billing policy directly with the Hartford Life Insurance Company.
SUPPLEMENTAL TERM LIFE INSURANCE
In addition to the benefits we currently offer, you have the option to purchase additional term life insurance through convenient payroll deductions. Benefit Harbor, through The Hartford, is our Supplemental Term Life Insurance vendor. Policies are offered from a minimum of $10,000 up to $1 million for employees and eligible dependents. Coverage is on a guaranteed issue basis up to $150,000 without proof of good health within 30 days of hire. A professional advisor from Benefit Harbor is available to assist with the enrollment process. The advisors ensure that you have a complete understanding of coverage and various features available to you.
If you want to enroll, call Benefit Harbor at 1-888-391-3841 and a counselor will guide you through the enrollment process. The call center hours are Mondays through Thursdays from 9:00 AM to 6:00 PM, and Fridays from 9:00 AM to 5:00 PM. You also have an option to enroll online at: https://www.memberbenefitlogin.com/ees/psd.html
For downloadable life insurance forms, please visit our Life Insurance page.