Staff Information

The Family Medical Leave Act entitles eligible employees of covered employers to take unpaid, job protected leave for specified family and medical reasons with continuation of group health coverage under the same terms and conditions as if the employee had not taken leave.

Requests for FMLA may be submitted to beckmel@sdmfschools.org, or via interoffice mail to Melissa Beck, HR Manager-Benefits.

Employee Request for FMLA

If an employee is not eligible under FMLA, or are requesting time off that is not qualified under FMLA, they must submit their request to the Human Resource Department for approval.

Please complete and submit the request to beckmel@sdmfschools.org, of via interoffice mail to Melissa Beck, HR Manager-Benefits.

Employee Request for Leave - Non-FMLA

The District Partners with UMR, a third party administrator, who provides the network options and claims administration for members for the District.

2018 Summary Plan Description - Active Employees

2018 Summary of Benefits and Coverage - Active Employees

There are many resources available to assist members with their healthcare needs. Most importantly, make sure you register online at www.umr.com to access all the online services!

• UMR Cost Estimator
• Disease Management
• Preventive Care
• 10 Tips to Save on Healthcare
• How to Read your Explanation of Benefits

The School District of Menomonee Fall's health plan offers Prescription Drug coverage through Express Scripts, a third party Pharmacy Benefit Manager.

Manage your Prescription Drug needs online at https://www.express-scripts.com/

Express Scripts Customer Service: 888-848-4452

As prescription medication costs continue to increase, you may be searching for ways to lower your costs at the pharmacy. As a member, you have the ability to cost compare across pharmacies by using this link. Other resources are below.

• $4 Walmart Drug List (get your meds for $4!)
• Walgreens 90 day fill - If your prescription is on the list, you can get a 90 day supply at Walgreens and save some dollars
• Mail Order - If your prescription is not available through the Walgreens 90 day fill, you can save dollars by enrolling into mail order

• Dollars can be used for out of pocket medical, dental and vision expenses
• Tax deductible off of gross income
• Interest earnings grow tax-defered
• NEVER taxed when used for qualified medical expenses
• Rolls over year after year - no "use it or lose it"
• Portable - it is your money - it goes with you wherever you go

• Direct deposits may be made directly into the HSA account that you set up
• Pre-tax deductions may be set up through payroll
  • HSA Deduction Form - Please complete this form and return it to the Payroll Office with confirmation of your HSA account

A Flexible Spending Account allows employees to elect to have monies taken out of their payroll check on a pre-tax basis in order to pay for out of pocket medical, dental and vision expenses that are qualified expenses.

The annual maximum amount an employee can elect is $2,650 based on a calendar tax year. This is a use it or lose it benefit, therefore, if you do not incur claims within the plan year of your election, you will forfeit all but $500 of the remaining monies.

A Dependent Care Account allows employees to elect to have monies taken out of their payroll check on a pre-tax basis in order to pay for dependent daycare needs.

The annual maximum amount an employee can elect is $5,000 based on a calendar tax year. This is a use it or lose it benefit, therefore, if you do not incur the expenses within the plan year of your election, you will forfeit any monies leftover.

Claims must be filed directly with Diversified Benefit Services. You are able to file a claim online, via fax, mail or their mobile app.

Funds from a flexible spending account are accessible up front. Dependent care expenses, are only dispersed as the funds are credited to your account.

Click Here for more information on these options.

The District provides life coverage to all eligible administrators and professional/technical staff in the amount of 2x the annual base salary to a maximum of $400,000.

Certificate of Coverage

The District provides life coverage to all other eligible employees in the amount of 1x the annual base salary to a maximum of $200,000.

Certificate of Coverage

If an employee is eligible for the District provided life coverage, they may also choose to enroll themselves or their family members in additional voluntary life coverage. This coverage is subject to the terms of the carrier and may be subject to underwriting.

Supplemental Life Enrollment Form

Supplemental Life Rate Sheet

Long-Term disability benefits are provided by the District to eligible employees. The benefit kicks in on the 60th calendar day of being off of work and pays 66 2/3 of the monthly gross income, not to exceed $7,000 per month.

Sick leave pay will cease effective the first day long-term benefits begin.

Certificate of Coverage - All Active Eligible Employees, except Superintendent

Certificate of Coverage - Superintendent

The District offers the option for eligible employees to enroll in a voluntary short-term disability plan. The short-term disability plan will begin on day 1 for an accident and day 7 for an illness and pay out the weekly benefit amount elected at time of enrollment.

Short-term disability will pay out in conjunction with sick leave pay.

Maternity benefits are considered as an illness and will therefore pay out after 7 days up to a maximum of 6 weeks for a regular birth and 8 weeks for a C-section.

If you did not enroll in the coverage initially, you may enroll at a later date by completing the Evidence of Insurability Form and forwarding this to the HR Office.

Certificate of Coverage

If you need to file a claim, the following forms must be completed by yourself and your treating provider. Please notify the HR office as well.

Employee's Statement

Attending Physician's Statement