Insurance

Insurance FAQs

Q.  What is the calendar year deductible for health insurance?
A. $1,000 per individual, $2,000 per family, in network

Q.  What is the annual Out-of-pocket limit for health insurance?
A. $4,000 per individual, $8,000 per family, in network. (Includes deductible

Q.  How do I find out if my deductible or out-of-pocket has been met?
A. New members can visit umr.com or download the UMR app to create a HealthSafe ID. HealthSafe ID provides a secure way to log in to your accounts and access your information, quicky and easily. Once enrolled, you can view claims, access explanation of benefits (EOB’s), estimate procedure costs, look up in network providers, and access your digital ID card

Q.  Do all services require pre-certification with UMR?
A. No, only hospital admittances require a pre-cert.  Out-patient services do not

Q.  What pharmacies are in network? Are any pharmacies excluded?
A. You have access to a large network of pharmacies. You can register for access on www.TrueRx.com or via their mobile app and can view pharmacies, compare costs and sign up for mail order. Anyone over the age of 13 that wishes to access this information will need their own account with their own email.

For Specialty medications or any medications that retail over $350 for a 30 day supply, you will need to register at http://sharxplan.com/Moline-Coal/ Each family member that takes a high cost or specialty medication will need to enroll.

Q. What is TELEDOC and how do I access it?
A. Speak with a doctor – anytime, anywhere! Virtual visits allows you to consult a doctor for non-emergency situations by phone, mobile app or online video. Activate your account now so you can access this benefit when you need it!

1. Visit teledoc.com
2. Click “Get Started Now”.
3. Confirm benefits by providing some information about yourself
4. Select benefit provider and enter in your health plan ID
5. Create an account

Q.  Do we have dental insurance?
A. Yes, dental coverage is available through United Healthcare. You can sign up for an account to view benefits, look up providers and print an ID card through www.myuhc.com. You can use the same HealthSafeID, but you will need to register first through this site, even if you already have a HeathSafeID set up with UMR.

Q.  Do we have routine vision coverage?
A. Voluntary Vision coverage is available as a separate election through United Healthcare. Open enrollment occurs each year during the month of November with coverage beginning in January. If you are enrolled in the vision, you can access your account, look up providers and print an ID card by going to www.myuhcvision.com

Q.  How many counseling sessions are available through our Employee Assistance Program?
A. Three face to face counseling sessions each for staff and dependents. Please call Disability Resources at 866-899-1363 to schedule an appointment. Web based resources are also available at guidanceresources.com company ID DISRES

Q.  How much life insurance does the District provide for eligible staff?
A. $50,000 worth of term life for the member for the length of employment. Eligible staff may also purchase supplemental life and dependent life insurance at your own cost. IMRF staff may purchase life insurance through the NCPERS program.

Q.  Does the District provide Long Term Disability Insurance?
A. Yes, eligible staff have Long Term Disability Insurance provided by the District. You may also be eligible for Disability through your pension provider. For more information, contact the insurance office.

Q.  What is the “Spousal Rule”?
A. Eligible staff may cover their spouse under the health insurance, however, if the spouse is eligible for insurance through his/her employer, they must enroll in coverage with their employer as their primary coverage and can be covered as secondary under the District plan, as long as their other insurance is not a health savings account. The District offers only single and family rates for medical and dental insurance, there is not a separate rate to cover children only. 

Q.  When can I make changes in my insurance?
A. The open enrollment period, held each year during the month of November, is your only opportunity to enroll, change, or cancel most of your benefit elections, unless you have a qualifying life event during the year. Examples of qualifying life events include:

• Marriage

• Birth or adoption of a child

• Divorce

• Loss of other insurance coverage

If you experience one of these events and want to elect, change, or cancel your coverage, you must notify the Insurance Office within 30 days of the event. Otherwise, you must wait until the next open enrollment for a January 1 effective date. Contact the insurance office for the appropriate enrollment or change forms.

Q.  When do I need to have my wellness physical and tobacco form turned in?
A. Wellness physicals and tobacco forms must be completed and received in the insurance office between the dates of January 1 – December 1 of each calendar year if you are covered under the medical insurance. Please refer to the FAQ’s regarding physicals and tobacco certification forms for more information.

For any other questions regarding insurance related matters, contact 309-743-8115.

Frequently Asked Questions: Routine Physical Examinations

Q: Who is required to have an annual physical?
A: All Active Employees and Retirees (retirees under age 65) covered by the Moline-Coal Valley School District health plan and their covered spouses (if this is the spouse’s primary insurance carrier) are required to have annual physicals, however we recommend you do this on your own as part of living a healthy lifestyle. If you are a Retiree or a spouse of a covered Retiree and you are over the age of 65, this is not required. You do not have to submit physicals on dependent children.

Q: Why have an annual physical exam?
A: Health experts agree that it’s easier, less expensive and more effective to prevent illnesses like obesity, cardiovascular disease and diabetes rather than treat them. Simple lifestyle habits like eating healthy, exercising, avoiding tobacco and seeing your healthcare network provider each year can make a big difference in your health now – and in the future.

Q: Who can perform an Annual Wellness Visit?

• Physician (doctor of medicine or osteopathy)

• Physician assistant

• Nurse practitioner

• Clinical nurse specialist

• Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy)

Q: How much will the physical exam cost?
A: Wellness exams provided by a United Healthcare Choice PPO network provider are covered 100% by your insurance with no cost sharing. When scheduling your appointment, be sure to tell them you are scheduling for the purpose of your wellness exam. If you are charged an office visit copay, then the doctor’s office did not code your visit as preventive/wellness. Please note that if you are being treated for a condition in which you take regular medication (ie: high blood pressure, diabetes, high cholesterol) your doctor will most likely code as a medical visit. In this case, be sure they sign the form as you will be charge an office visit copay even though it’s a checkup. It’s all in how the doctor codes your visit. Your EOB will reflect a medical visit, not physical history, and therefore will not be accepted.

Q: Do I have to wait a full year between visits to have my next physical?
A: No, you do not have to wait, you can actually have multiple physicals a year as there are no maximum visits on wellness visits.

Please click here to download the latest Physical Exam Form.  This form is required to be completed and submitted to the Insurance Office annually. 

The District’s routine vision plan is administered by UnitedHealthcare. The vision plan is a voluntary plan paid for by the employee. A summary of the District’s vision insurance plan may be viewed by clicking this link (PDF).

Additional information can be found on the United Healthcare Vision Website (external link). 

Please visit the UMR website (external link) for more plan information, Explanation of Benefits, and the latest news from our insurance provider.  

What are the risks of using tobacco?

Did you know tobacco use is the single largest cause of preventable death and disease in the United States?

Cigarette smoking can increase the risk for many health problems including cancer, type 2 diabetes and coronary artery disease — and it causes an estimated 443,000 deaths each year.⁴  No tobacco product is safe. This includes cigarettes, cigars, hookah, e-cigarettes and smokeless tobacco products, like chewing tobacco. The nicotine in tobacco products is addictive.  

When used over a long period, tobacco-related chemicals, like tar and nicotine, may increase your risk of many health problems. There's a long list of serious health risks associated with smoking, and knowing these may help motivate you to quit.

Smoking may put you at a greater risk of:

• Developing certain cancers, including throat, mouth, esophagus, stomach, pancreas, kidney and lung cancers
• Developing lung problems such as chronic obstructive lung disease, emphysema, chronic bronchitis and asthma 
• Developing coronary artery disease which can lead to angina and heart attacks
• Having gum disease and tooth loss
• Having high blood pressure
• Developing type 2 diabetes 

What are the benefits of quitting smoking?

No matter how long you've smoked, there are a ton of benefits to quitting smoking. Quitting tobacco benefits may range from better heart and lung health to cutting cancer risks. It may also improve your reproductive health.

Need more reasons? The list of pros is quite impressive. You’ll also save money and help protect friends and family from being exposed to harmful secondhand smoke.  

Tobacco User Certification FAQ's            

Q: Who is required to complete the Tobacco User Certification form:

A: All Active Employees and All Retirees covered under the Moline-Coal Valley School District insurance plan, even is this plan is secondary for your dependent, must certify if they or their covered family member is a tobacco user on an annual basis. This includes all ages of dependents.

Q: If my spouse or child is a tobacco user, will I have to pay the higher premiums even though I do not use tobacco products?
A: Yes, if you cover them under your insurance policy though the District, you will have to pay the penalty based on family coverage. For those that carry single coverage, the surcharge is $100 per month, and for family coverage, the surcharge is $200 per month. Regardless of the number of tobacco users in your family, the fee is based on what coverage you carry.

Q: My dependent child does not live with me and I don’t know if they are a tobacco user, how do I answer if I don’t know?
A: Please answer this question to the best of your knowledge, but if you do find they are a tobacco user, please re-certify your form.

Q: What is considered Tobacco use under this certification?
A: Any tobacco product (including cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, e-cigarettes/vapes, and any other product containing tobacco) four or more times per week within the prior six-month period.

Q: I have quit smoking and using nicotine gum, am I considered a tobacco user?
A: No, as long as you are not using actual tobacco products, you are not a tobacco user. Nicotine gum, patches and medications are considered tobacco cessation medications and are covered under the United Healthcare tobacco cessation program.

Q: What if I lie on the form, or quit and start back up again?
A: The form we are having you complete to self-certify your tobacco use is considered a legal document. Dishonesty can result in premium back pay and/or possible job termination. Medical claims incurred as a result of a tobacco related illness may also be denied. If you or your covered family member were not using and are now, you need to certify a new form.

Q: How often do we recertify?

A: Tobacco certification forms are completed via google form annually between the dates of January 1 – December 1. You will only be able to complete the form one time to avoid multiple responses. If you need to recertify, you will need to contact the insurance office and let them know. If you do not complete the form, you will automatically receive the tobacco user surcharge based on the coverage you carry.

Click Here for a copy of the UnitedHealthcare dental summary