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4J Benefits and Wellness Newsletter – November 2014 – Issue 278

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Prepared by Julie Wenzl • 541-790-7682 • November 3, 2014 • Issue Number 278


If you signed up for a Flexible Spending Account for unreimbursed health-related expenses for the October 1, 2014 – September 30, 2015, plan year, you should have received your Benny Cards from PacificSource Administrators (PSA) via US Mail. To activate your Benny card, your default PIN is the last 4 digits of your PSA ID number – this is the number that starts ZZMAN. If you cannot find your PSA ID number, you can call the local PSA customer service number for Benny Card activation assistance: 541-485-7488. That is also the number to call if you have not yet received your cards.

Remember to save receipts and verify that you are using your Benny Card according to the rules outlined in the letter that arrived with your cards.


The 4J Wellness Clinic is now a Synergy Network Moda Medical Home (MMH) provider. If you would like to choose the Clinic as your MMH, or change the MMH you elected during open enrollment, you may do so by calling Moda Health customer service at 1-866-923-0409. You can also send an e-mail to medical@modahealth.com.

Please note: the 4J Wellness Clinic is listed as a MMH under the name Cascade Health Solutions. In order for Moda to list the Clinic as your MMH, please indicate your choice as Cascade Health Solutions, 200 N. Monroe St., Eugene, OR 97402.


A Qualified Status Change (QSC) is a change in work or family status that allows limited mid-year changes to benefit plans. These changes are allowed outside of the annual open enrollment period, but most changes must be reported to 4J Human Resources within 31 days of the event (there are a few exceptions to the 31 day rule). Without a QSC, you cannot make changes to your OEBB enrollments outside of open enrollment.

Some common QSC events include:

  • A baby comes into your family. You must fill out Midyear Change Form within 60 days of your new family member’s arrival. If you do not meet this deadline, your new dependent will be ineligible for 4J insurance coverage until the next open enrollment period. Coverage for a newborn child is effective on the date of birth. Coverage for a newly adopted child is effective the date of the adoption decree or placement for adoption. In the case of adoption, you must submit a copy of the adoption agreement with your enrollment form.
  • You get married. Once your marriage has occurred, you must submit a Midyear Change Form within 31 days to add any newly acquired dependent(s) to your plan. You must also submit a copy of your marriage certificate. Coverage for any dependent(s) added will take effect the first of the month following the date of the event.
  • You have a domestic partner who qualifies for coverage under your plan. You must fill out the Midyear Change Form within 31 days of your domestic partnership to add any newly acquired dependent(s) to your plan. You must also submit a copy of your affidavit of domestic partnership. Coverage for any dependent(s) added will take effect the first of the month following the date of the event.
  • Divorce / Termination of Domestic Partnership. This makes your former spouse/ partner ineligible for our plan. Continuing to cover an ineligible person is insurance fraud, a federal offense. To remove a former spouse or domestic partner, a divorce decree or Statement of Termination of Domestic Partnership form must be submitted to Human Resources with the Midyear Change Form. Termination of coverage ends on the last day of the month that eligibility is lost.
  • Reduction in FTE. If a reduction of FTE results in an increase in monthly cost of 10% or more, limited changes to your enrollment may be allowed.

An increase in your FTE is not considered a QSC event. If your FTE increases, you are not allowed to make changes to your enrollments outside of open enrollment.

The Midyear Change form, the Affidavit of Domestic Partnership form, and the Termination of Domestic Partnership form are all available on the 4J benefits website: http://www.4j.lane.edu/hr/benefits/formsemployeebenefits/


All 4J employees are eligible to set up an account under the 403(b) Plan with any vendor who is on the District list of approved vendors. You can find a list of vendors here: http://www.ncompliance.com/guest_employervendors.aspx?EmployerID=12

4J Retirement Plan B eligible employees (hired into a licensed position on or after July 1, 1998) are eligible to receive a TSA contribution from 4J:

  • First year of eligibility – $50 / month
  • Third year of eligibility – $75 / month
  • Sixth year of eligibility – $100 / month
  • Tenth year of eligibility – $150 / month
  • Thirteenth year of eligibility – $175 / month

Under the 2013 – 2014 Collective Bargaining Agreement (CBA), Plan B employees who failed to set up a TSA account had contributions deposited into a default account on their behalf. The 2014 – 2017 CBA no longer includes the default provision. As of August 1, 2014, no additional contributions will be made into the default accounts. Instead, Plan B employees are now eligible for an increased contribution from 4J in their thirteenth year of eligibility.

Once your TSA account has been set up, the monthly District payment will be retroactive to the first month of eligibility, provided you have submitted a properly completed Salary Reduction Agreement for 403(b) Tax Sheltered Annuities (TSA) form within three months of your initial eligibility. Despite the form name, unless you complete the Voluntary Contribution section, your salary will not be reduced. You are not required to deposit any additional funds into your TSA to claim this 4J retirement benefit.

You can download the form by clicking on the Administrative and Certified Employees Salary Reduction Agreement on this webpage: http://www.ncompliance.com/guest_employersraspecial.aspx?EmployerID=12

If you choose to contribute to your TSA account above and beyond what the District deposits on your behalf, you must complete the Voluntary Contribution section of the Salary Reduction Agreement for 403(b) Tax Sheltered Annuities (TSA) form.

If you do not submit a completed and executed form selecting a TSA company within three months of your initial eligibility for the District TSA payment, you may complete the TSA enrollment form at a later date. In such a case, the District will make the monthly TSA contribution for you prospectively and will make a one-time retroactive contribution to your TSA account equivalent to three monthly TSA contributions.

4J Retirement Plan A eligible employees (hired into a licensed position prior to July 1, 1998) should also submit a Salary Reduction Agreement for 403(b) Tax Sheltered Annuities (TSA) form if they wish to set up a TSA account or increase the amount they are contributing to an existing account.


If you have dependents listed in the OEBB system, you should have received information from OEBB outlining the Dependent Eligibility Verification (DEV) process. You may choose to mail or fax the appropriate documentation to OEBB, or may opt to present your documentation in person to OEBB staff. OEBB staff members will be in the Ed Center Auditorium:

  • Tuesday, November 4 • 1:00 – 7:00 p.m.
  • Wednesday, November 5 • 9:00 a.m. – 2:00 p.m.
  • Thursday, November 6 • 1:00 – 7:00 p.m.

Members who choose to send documentation to OEBB will be asked to provide copies of documents only as all documents received by OEBB will be shredded at the conclusion of the review.  Documentation provided at the scheduled onsite review sessions will be reviewed, verified, and logged but will not be retained.

The deadline for providing your documentation to OEBB is November 30, 2014. If you have any questions about the DEV, please contact OEBB directly at 888-469-6322.


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