Welcome to the
South Washington County Schools Benefits site!

Employees with last names beginning A-L
Karin Manning at
Employees with last names beginning M-Z
Kim Shirek at

2020 Plan Information

Health Insurance

PreferredOne (P1) administers our health insurance
PreferredOne website
Group Number: PCH10638
Network: Open Access 200

Call Center Hours: 7:00 a.m. - 7:00 p.m. CST, Monday – Friday
Twin Cities Area: 763.847.4477 or Outside Metro Area: 1.800.997.1750

We offer 3 plan options for employees to select from.
Summary of Benefit Coverage:
Open Access High Deductible with VEBA*
Open Access $25 Co-Pay
Open Access $15 Co-Pay

Certificate of Coverage
Open Access High Deductible with VEBA *
Open Access $25 Co-Pay
Open Access $15 Co-Pay

2020  Medical Plan Comparison

Click here to access the 2020 Health Insurance premiums.

Preventative dental benefit only
– There is a preventative dental benefit under all medical plans with PreferredOne, Please click here to access a list of in-network dental providers within a 50-mile radius of Cottage Grove MN.

PLEASE NOTE: these are preventative dental benefits only; please review our dental insurance section for further dental coverage options.

*VEBA (for employees enrolled in the Open Access High Deductible plan)
121 Benefits administers our VEBA/HRA
121 Benefits website
612.877.4321 or 1.800.300.1672

A VEBA is a tax-free Health Reimbursement Arrangement (HRA) that provides a source of funds to pay for the cost of health, dental and vision care expenses for you, your spouse and qualified dependents. VEBA is available to employees who enroll in the Open Access High Deductible Plan only.

Dental Insurance

Delta Dental administers our dental insurance
Delta Dental website
Customer Service Department: 651.406.5916

Delta Care (Single Network of Providers)
Delta Care Summary 
Delta Care Plan Booklet 

Delta Preferred (PPO and Premier Networks)
Delta Preferred Summary
Delta Preferred Plan Booklet 

Click here to access the 2020 Dental Insurance rates 

Vision Insurance

EyeMed Administers our vision insurance.

EyeMed Website
Customer Service Department: 866.939.3633

Your eye examination and caring for your eyes is important to your overall health. Eye examinations diagnose much more than the need for corrective lenses. An eye examination can uncover more than 30 systemic diseases including hypertension, arteriosclerosis, diabetes, and Graves Disease. This plan allows you to improve your health by saving you money on your eye care purchases.

Eligible District employees have two plans to choose from:
Eye Exam and Materials
Materials only*

*Remember that you receive an annual Eye Exam covered by PreferredOne if you are enrolled in South Washington County Schools' PreferredOne Health plan.

Life Events

You may make changes to your health and/or dental insurance, outside of an open enrollment period, if you experience a life event AND you complete a change or enrollment form within 30 days of the life event. Examples of IRS qualifying life events include:

Obtaining New Insurance Coverage

If you, or your dependents, have obtained new insurance coverage within the last 30 days, you can drop coverage. You must provide evidence of new coverage. Evidence of new insurance coverage must show the name(s) of the individuals who have new coverage AND the date the coverage began. Complete the change form(s), attach proof of new coverage, and submit your form and evidence to the Benefits Department at the DSC before the end of the 30 day grace period.

Involuntary Loss of Coverage

If you, or your dependents, have involuntarily lost coverage within the last 30 days, you can add eligible dependents to your plan (if you initially waived coverage, you can enroll in coverage). You must provide evidence of loss of coverage. Evidence may be a copy of the COBRA notice, HIPAA notice, or some other employer or insurer document that clearly shows the name(s) of the individuals who lost coverage AND the date the coverage ended.


If you become divorced and cover your spouse under your medical and/or dental plan, your spouse must be removed from coverage. This must be done within 30 days of your divorce finalization date. You will be required to provide the following documentation: health/dental insurance change forms, in addition to the first and last pages of your divorce decree. Your spouse will be removed from active coverage at the end of the month in which your divorce is final. COBRA continuation will be offered to ex-spouse.


You may change your insurance coverage from single to family coverage by adding your new spouse (and his/her eligible dependents) to your plan. You may add your new spouse (and his/her eligible dependents) to your current family coverage. Coverage for your new dependent(s) becomes effective on the date of marriage. Please complete forms prior to your marriage date and return completed forms to the Benefits Department at the DSC.

New Child (Birth or Adoption)

Coverage becomes effective on the date of birth or adoption. Complete forms on or after (but not more than 30 days after) the date of birth or adoption and return completed forms to the Benefits Department at the DSC.

Child Graduates from High School or College

This is not a life event. You can remove a child from your coverage if he/she has obtained their own coverage within the last 30 days (see Obtain New Coverage above), if the child turns 26, or during an open enrollment period.


Dental Insurance Enrollment form Complete this form if you do not have current dental insurance with the district 
Dental Insurance Change form Complete this form if you already have current dental insurance with the district
Health Insurance Enrollment/Change form 

Additional things you may want to consider updating if you've experience a life event:
Flexible Spending form – Health Care Account and/or Dependent Care Account. Must be returned within 30 days of birth or adoption 
Life Insurance Beneficiary Change form Group Name: South Washington County Schools Group No: 147018 
• W-4 Employee’s Withholding Allowance Certificate - Please work with your payroll specialist to make changes to your withholdings
• TRA or PERA Beneficiary form - Please work directly with TRA or PERA to make changes

Flexible Spending Account (FSA)

121 Benefits is the administer for our FSA
612.877.4321 or 1.800.300.1672
121 Benefits website

HealthCare FSA - The current Health Care FSA annual maximum is $2,750.
Dependent Care - The Dependent Day Care FSA annual contribution is $5,000 per family

Outside of your new hire period, you will need to wait for our annual open enrollment period or have a qualifying life event in order to change your enrollment status for FSA.

Please contact your benefit specialist with enrollment questions.

Leaves of Absence

If you will need to be on a leave of absence that will extend beyond 10 duty days for the same reason, please begin the leave of absence process with your human resources specialist. Your benefit specialist will receive status updates for your leave and will work with determining how your leave may impact your benefits.

If your leave is medical in nature, you may be eligible for FMLA and/or MN Parenting Leave.

Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act (FMLA) protects the benefits and position of an eligible employee during a paid or unpaid leave for up to 12 weeks in a 12 month period. A Family Medical Leave (FML) eligible employee is someone who has been employed for at least 12 months and has worked at least 1250 hours in the last 12 month period. It is recommended that you speak with your Benefit Specialist regarding your FML eligibility.

For more information please reference these two documents:

FMLA Help-sheet
FMLA Information

MN Parenting Leave Act (Care of Relatives)
Effective August 1, 2013, the State of Minnesota revised legislation pertaining to parenting leave. The statute now includes the ability to use available personal sick leave time of up to 160 hours in any 12-month period for absences due to an illness or injury to the employee’s adult child, spouse, sibling, parent, grandparent, or stepparent.

To qualify, you must have been working at least 12 consecutive months preceding the request and work at least half time. A doctor’s note must be included with the leave of absence request. Please note each leave request is reviewed individually and you will be notified as to your eligibility.

For more information, please reference the document below:

MN Parenting Leave Act (Care of Relatives) Information

Life Insurance & Long Term Disability (LTD)

Upon your hire to a benefit eligible position, you will have the opportunity to enroll in Life and Long Term Disability coverage. If you choose not to enroll at that time or wish to make changes to your level of coverage please know that you may only enroll through an Evidence of Insurability process, which may require medical underwriting.

If you are interested in completing this process, please contact your benefit specialist for the necessary paperwork.

Life and LTD Insurance, underwritten by The Standard

Tax Shelter Accounts (TSA)

School District Contacts:
Karin Manning (Employees with the last name A - L)  651.425.6278 or
Kim Shirek (Employees with the last name M - Z) 651.425.6263 or

Participation in a TSA is optional. A tax-sheltered account is a tax-deferred retirement investment plan such as the 403b and 457 plans offered through the District. The terms “403b” and “457” refer to sections of the IRS Code which define the rules by which “pre-tax” investments may be made through payroll deduction. These voluntary saving plans supplement the mandatory defined-benefit pension plan (such as TRA or PERA) to which you already belong. Together they will help you be prepared for a more comfortable and secure life after you retire.

Eligible employees, as outlined in Collective Bargaining Agreements or individual letters of assignment, are encouraged to participate in a TSA. To begin, review the List of Vendor Choices, below, and work with an agent (or on your own) to open an account.

Once your account is set-up complete the TSA Salary Reduction form and submit to Karin Manning (Employees with the last name A - L) or Kim Shirek (Employees with the last name M - Z)  at the District Service Center.

“NEW” As of May 1, 2020, South Washington County Schools will utilize EBC (Educators Benefit Consultants, LLC) as our TPA (third party administrator) for all 403b transaction paperwork (i.e., rollovers, transfers, exchanges, hardship withdrawals, loans, etc.)

IMPORTANT information to submit forms to EBC can be found here:

Regular 403b payroll deductions for our current/active employees will continue to be processed through the district. Please continue to send your Salary Reduction Agreement (SRA) forms for new enrollments and changes to your HR Benefit Specialist.  These forms can be found below. 

South Washington County Schools 403b Summary Plan Description
403b Plan Vendors and Contact Information
403b Vendor Fees
Salary Reduction Agreement Form for 457 and 403b Programs
Salary Reduction Agreement Form for 457 and 403b ROTH Programs
457 Plan Information

Forms & Resources

Please return any/all completed forms to your Benefits Specialist

Health Insurance

Insurance Premiums, based on employee group

2020 Medical - All Employee Groups
2020 Dental - All Employee Groups
Teachers (.8 - 1.0 FTE)
Teachers (.7 FTE)
Teachers (.6 FTE)
Teachers (.5 FTE)
Teachers (.4 FTE)
Teachers (.3 FTE)
Teachers (.2 FTE)
Teachers (.1 FTE)
• Independent Tier 1
• Independent Tier 2
Independent Tier 3
Independent Tier 4
Bus Drivers Bus Assistants
Bus Mechanics
Kids Club Supervisor
Nutrition Services
Office Professionals
ACA Eligible 


Delta Care Summary
• Delta Care Plan Booklet
Delta Preferred ( PPO & Premier Networks) Summary
Delta Preferred Booklet
Delta Dental Enrollment Form
Delta Dental Change Form
Delta Dental website


Eye Exam and Materials
Materials Only
Freedom Pass
Sunglasses Discount
EyeMed Q & A
Vision Plan Booklet - Exam+Materials 
Vision Plan Booklet - Materials only
Vision Plan Summary Plan Description (SPD)
• Vision Enrollment Form
EyeMed website

Flexible Spending Account (FSA)

Dependent Care Overview
Fact Sheet
Prepaid Benefit Card FAQ
Reimbursement Claim Form
121 Benefits website


Attestation Process
Prepaid Benefit Card FAQ
Quick Start Guide
Reimbursement Claim Form
What is a VEBA?
VEBA Overview
Understanding your VEBA
Understanding the 121 Benefits & BPAS Partnership
VEBA 10% holdback
121 Benefits website

Employee Notices

CHIP Notice
HIPAA Special Enrollment Notice
Medicare Creditable Coverage
Women’s Cancer Annual Notice


Employee Assistance Program (EAP) Brochure
Examples of How the EAP Can Help
Insurance after Retirement - All Others
Insurance after Retirement - Teachers
Marketplace Coverage
2020 Benefits Booklet