• Benefits for New and Expecting Mothers

    Congratulations! If you are thinking about having a baby or are already pregnant, this page will help you understand your rights and benefits. 

    Family and Medical Leave Act (FMLA)
    It is a job-protected leave regulated by the US Department of Labor. It provides certain employees with up to 12 weeks of unpaid leave per year. You can use family medical leave for several reasons, including the birth and care of a newborn child or adoption of a child. 

    Eligibility for Family and Medical Leave 
    To be eligible, you must have worked for PfISD at least 12 months and worked at least 1,250 hours over the past 12 months. 

    Mother and childLeave Days
    While out on leave, employees must use their accrued state and/or local sick days. Employees will only get paid for any accrued leave days. After the leave days run out, the pay will stop. 

    If you hold a certificate through SBEC, you may also be eligible for State Temporary Disability Leave. State Leave can be used for up to 180 calendar days. Unlike Family Medical Leave, State Leave cannot be used intermittently and can only be used for personal illness including parental leave.  

    If you are not eligible for State Leave (you don’t hold a certificate through SBEC), you can still apply for Local Temporary Disability Leave. This permits employees to be out up to 45 calendar days. To be eligible, you must have worked for PfISD at least 30 continuous days. Just like State Leave, it cannot be used intermittently and can only be used for personal illness including parental leave.  

    How to Request Leave
    Contact the Leave Office for paperwork. This paperwork may include a medical certification that you will give to your doctor. There will be a deadline to return these forms to the Leave Office.
    Once you’ve submitted all the requested paperwork, you will receive an email from the Leave Office with more instructions. Closer to your leave day, you will also receive a “pay estimate”. This will give you an estimate of how much you can expect to receive in payroll and the date when you’re expected to return. This is only an estimate. If your doctor releases you to work and you need to return sooner or if your doctor needs to keep you out of work for a longer period of time, please contact the Leave Office. 

     

    Disability Insurance (The Standard)
    Disability insurance acts as income protection if you are unable to work. This is a separate benefit and does not have anything to do with paid leave days. An employee on leave may receive pay for their accrued leave days and still receive their disability benefit. The disability benefit is paid directly to the employee and not through their payroll. If you are unsure if you have this benefit or need more information, contact the Benefits Department. When you go out on leave, make sure you also receive the claim form. This claim form is in three parts. One will be completed by the patient, the second form will be signed by the doctor, and the last will be completed by the Leave Dept. This claim form must be completed after the baby is born. Once the first two parts are completed, the employee can send them to the Leave Dept. at leave@pfisd.net and they will complete their portion and will send it to The Standard to process. PfISD does not know the processing time of claim forms. The employee can call The Standard to check on the status.

    Here’s a basic example of how The Standard LTD works when having a baby:
    An employee selected disability insurance during open enrollment. She selected the 0/3 waiting period with a benefit of $2,500 a month. Employee’s doctor orders her to be out of work for 8 weeks. Employee files a claim with The Standard. The Standard will process and send the employee the amount of her benefit – in this case, about $5,000. This amount is sent to the employee no matter if the employee has or does not have leave days with PfISD. PfISD does not review the claim form and does not decide on the benefit amount. This is handled by The Standard LTD insurance.


    Payment of Benefit Premiums
    While out on leave, your benefits stay active. If an employee is out on Family and Medical Leave, the district will continue to contribute towards the employee’s medical plan. When or if the employee runs out of accrued leave days and they are no longer receiving payroll checks, benefits premiums must be paid by the employee either by money order or online. If payment is not made, benefits may be terminated. It is important to always check your work email to read your messages. This is where you will receive communication regarding your leave, premium dues, and other relevant information.


    Hospital Indemnity with Cigna
    This supplemental insurance pays benefits if you are hospitalized. If you have this benefit, you may file a claim with Cigna for the number of days you were in the hospital. Depending on the plan you enrolled in, it may pay between $500-$1,500 a day (1 benefit every 365 days). For the rest of the days, you may receive between $100-200 a day for up to 30 days. 

    Vision with United Healthcare
    Women who are pregnant or breastfeeding may experience eye or vision changes. United Healthcare Vision includes expanded benefits for women who are pregnant or breastfeeding at no additional cost. If you notice changes to your vision during the plan year, you can get your eyes checked a second time and new glasses if your prescription changes (.5 diopter or more) at no additional premiums; standard copays may apply. 


    Helpful Resources from BlueCross BlueShield

    •   HD PLANpregnant person
      • PCP Visit - Initial office visit with OBGYN - Routine Prenatal Services, delivery and Postnatal Care - Non-routine prenatal services - Birthing Center - 70% after deductible
      • Breast pump (electric/manual) 100%
    •  LOW PLAN
      • PCP Visit & Initial office visit with OBGYN - $40 COPAY     
      • Routine Prenatal Services, delivery and postnatal care, non-routine prenatal services, birthing center - 70% after deductible
      • Breast pump (electric/manual) 100%   
    • HIGH PLAN     
      • PCP Visit & Initial office visit with OBGYN - $35 COPAY     
      • Routine Prenatal Services, delivery and postnatal care, non-routine prenatal services, birthing center - 80% after deductible
      • Breast pump (electric/manual) 100%         

     

    Helpful Resources from Healthcare Highways

    • HD PLAN
      • PCP Visit - Initial office visit with OBGYN - Routine Prenatal Services, delivery and Postnatal Care - Non-routine prenatal services - Birthing Center - 70% after deductible
      • Breast pump (electric/manual) 100%
    •  LOW PLAN
      • PCP Visit & Initial office visit with OBGYN - $20 COPAY     
      • Routine Prenatal Services, delivery and postnatal care, non-routine prenatal services, birthing center - 80% after deductible
      • Breast pump (electric/manual) 100%   

     Care Coordination HCH
     

     

     

     

     

     

     

     

     

     

     

     

     

    Qualifying Life Event
    If you need to add your new baby to your health insurance, contact the Benefits Department by email or phone call. benefits@pfisd.net 512.594.0026 You will complete H:\Qualifying events Information\2022 Qualifying event form.pdf and return along with a copy of the baby’s birth certificate or a copy of the hospital’s birth facts. Remember to enroll your new baby within 60 days of birth. After 60 days of birth, enrollment will need to wait until open enrollment. A qualifying event for birth will not allow the employee to add other children to any plan. 

    Contacts:
    Benefits & Leave 512-594-0026
    benefits@pfisd.net
    leave@pfisd.net 

    Cigna  1.800.754.3207

    The Standard   1.800.368.1135

    https://www.standard.com/