Business Office

403(b) Notices & Forms

403(b) UNIVERSAL AVAILABILITY NOTICE

Updated 5/12/2021

You have the opportunity to save for retirement by participating in the Mt Blue Regional School District’s 403(b) plan (“Plan”). A 403 (b) plan is a retirement plan for certain employees of public schools, tax-exempt organizations and ministers. Contributions are mad under a Salary Reduction Agreement (SRA) with your employer. This agreement allows your employer to withhold money from your paycheck to be contributed directly into a 403 (b) account for your benefit. Usually, you do not pay income tax on these contributions until you withdraw them from the account. We recommend that all employees view a brief, 3-minute video presentation explaining what a 403(b) plan is, and how to contribute.

If there are any questions, you may contact The OMNI Group at 877-544-6664.

How Can I Participate?

Prior to contributing, you must open an account with an investment provider participating in the Plan, a list of which is available below. You can participate in the Plan with pre-tax contributions by completing and submitting a Salary Reduction Agreement (“SRA”) online at the OMNI 403b website, or by submitting a completed SRA form, which can be found on the same website, to The OMNI Group either by facsimile to (585) 672-6194 or by mail at 1099 Jay St., Bldg F, Rochester, NY, 14611 (“OMNI”).

How Much Can I Contribute Annually?

You may contribute up to $19,500 in 2021; this amount is subject to change annually. If you have at least 15 years of service with your employer or you are at least 50 years old, you may also be able to make additional catch-up contributions. For appropriate limits for your particular circumstances, please contact OMNI’s Customer Care Center at 1-877-544-6664.

What If I Already Have An Account?

If you are already contributing to the Plan, and you want to change your contribution amount or service provider, simply complete and submit a new SRA. See directions above for on-line and paper submission options.

What If I Do Not Want To Contribute?

If you do not want to take advantage of this program, simply submit an SRA with the option “I do not wish to participate at this time” selected. See directions above for on-line and paper submission options.

How can I get more information?

You can access further information at the OMNI 403b website or by viewing the 3-minute video presentation.

The following Vendors are authorized to receive contributions and contract exchanges between vendors under the Mt Blue Regional School District 403(b) Plan:

Name of Vendor	Contact Person	Phone Number
Ameriprise Financial Services	General Number	(800) 862-7919
Franklin Templeton	Aaron Knapp	(207) 778-9779
Franklin Templeton	Jared Ranger	(207) 778-9779
Great American Insurance Group	General Number	(800) 438-3398 ext 17197
Horace Mann Companies	Troy True	(207) 645-4779
Metlife	General Number	(800) 638-5433
Midland National Life Insurance	Bob or Ann Yorks	(207) 779-0505
North American Life Insurance	Bob or Ann Yorks	(207) 779-0505

Dental Insurance

Northeast Delta Dental Change/Enrollment form for open enrollment must be completed and submitted to the business office by July 31, 2021. The effective date of the change is September 1, 2021. If there is an event such as marriage, divorce, losing another coverage, the change form can be completed at the time of such event. The cost to the employee has not increased. It remains at:

$20.83 per pay for the employee and one additional family member;
$44.59 per pay for the employee and two or more additional family members.
There is no cost to the employee for a single subscriber plan.

Outline of Benefits

RSU #9 dba Mt. Blue Regional School District
Group Number: 0638-5253

Contract Year for Benefits - September 1 through August 31

Eligibility Period - Determined by the Employer

Waiting Period: None

Eligible Persons - Subject to the "Eligibility" provision above, employees and their dependents may be enrolled. Your employer pays the cost for eligible employees. Employees are responsible for the cost of their enrolled dependents. If enrolling dependents, all dependents must be enrolled for the term of the Agreement. A newborn child is automatically covered for the first thirty-one (31) days following birth. Coverage will continue if the child is formally enrolled within the first thirty-one days following birth or the child may be enrolled thereafter at any open enrollment or as of the first day of the month following the month of the child's second birthday.

Benefit Coverages and Percentages Paid by Northeast Delta Dental -

Diagnostic & Preventive: 100%
Basic Restorative: 80%
Major Restorative - including implant services: 50%

Benefit percentages shown are based upon the actual charge submitted up to the Maximum Allowable Charge for participating dentists, or Delta Dental's allowance for Non-Participating dentists.

Maximum Benefit - The maximum amount which your plan will pay is $1000 per person per Contract Year for Diagnostic & Preventive, Basic and Major benefits.

Deductible - There is no deductible

View the Outline of Coverage

Health Insurance

Notice of May, 2021 Open Enrollment

Open enrollment for health insurance is during the month of May. The effective date of the change is dependent upon your contract renewal date. July 1 is the effective date for administrators, support staff, and school lunch workers. September 1 is the effective date for teachers and any other September 1 contracts. Applications for change for the July or September 2021 contract year must be completed and returned to the business office by May 21st.

The following benefit information was provided by MEA Benefits Trust in a Rate Notice dated April 1, 2021.

Benefit changes for the 2021-2022 benefit year, effective July 1, 2021:

MEA Choice Plus Plan:
- The annual copayment maximum will increase from $6,950 per individual to $7,450 per individual.
- The LiveHealth Online network has added Virtual Sleep Medicine Clinics, including sleep medicine specialist and home sleep testing.
MEA Standard Plan:
- The annual copayment maximum will increase from $6,950 per individual to $7,350 per individual.
- The LiveHealth Online network has added Virtual Sleep Medicine Clinics, including sleep medicine specialist and home sleep testing.
- Acupuncture services up to 20 visits per calendar year.
MEA Standard 500 Plan:
- The annual copayment maximum will increase from $5,650 per individual to $6,050 per individual.
- The LiveHealth Online network has added Virtual Sleep Medicine Clinics, including sleep medicine specialist and home sleep testing.
- Acupuncture services up to 20 visits per calendar year.
MEA Standard 1000 Plan:
- The annual copayment maximum will increase from $5,150 per individual to $5,550 per individual.
- The LiveHealth Online network has added Virtual Sleep Medicine Clinics, including sleep medicine specialist and home sleep testing.
- Acupuncture services up to 20 visits per calendar year.

Below is a document with 7/1/21 - 6/30/22 monthly rates. The employer's and employee's percentage of the plan vary depending on the RSU 9 employee group. Please note that these employer's and employee's percentage are subject to completion of contract negotiations for some groups. Additional benefit information and comparative information is available on MEA Benefit Trust's website and on Anthem's MEABT site.

After reviewing the information on this page, if you would like to make any changes to your coverage, download and save the Anthem Application/change form to your computer, complete the form, re-save and email to Kristi Leavitt at the Business Office.

Monthly Rates	7/1/2021	Administrators		Support Staff		Teacher		At Will		School Lunch Grandfathered		School Lunch hired after June, 1993
	Rate	Employer	Employee	Employer	Employee	Employer	Employee	Employer	Employee	Employer	Employee	Employer	Employee
		79.5%	20.5%	76.5%	23.5%	79.50%	20.50%	75%	25%	85%	15%	95% single	5% single
Choice Plus
Employee	728.29	578.99	149.30	557.14	171.15	578.99	149.30	546.22	182.07	619.05	109.24	691.88	36.41
Employee/Spouse	1,641.44	1,304.94	336.50	1,255.70	385.74	1,304.94	336.50	1,231.08	410.36	1,395.22	246.22	691.88	949.56
Employee/Family	1,997.85	1,588.29	409.56	1,528.36	469.49	1,588.29	409.56	1,498.39	499.46	1,698.17	299.68	691.88	1,305.97
Employee/Child(ren)	1,288.92	1,024.69	264.23	986.02	302.90	1,024.69	264.23	966.69	322.23	1,095.58	193.34	691.88	597.04
Employee (Grandfathered 7/1/15)				582.63	145.66
Standard
Employee	786.46	625.24	161.22	557.14	229.32	578.99	207.47	589.85	196.61	668.49	117.97	747.14	39.32
Employee/Spouse	1,772.75	1,409.34	363.41	1,255.70	517.05	1,304.94	467.81	1,329.56	443.19	1,506.84	265.91	747.14	1,025.61
Employee/Family	2,157.68	1,715.36	442.32	1,528.36	629.32	1,588.29	569.39	1,618.26	539.42	1,834.03	323.65	747.14	1,410.54
Employee/Child(ren)	1,392.02	1,106.66	285.36	986.02	406.00	1,024.69	367.33	1,044.02	348.00	1,183.22	208.80	747.14	644.88
Employee (Grandfathered 7/1/15)				582.63	203.83
Standard 500
Employee	691.87	550.04	141.83	557.14	134.73	578.99	112.88	518.90	172.97	588.09	103.78	657.28	34.59
Employee/Spouse	1,559.37	1,239.70	319.67	1,255.70	303.67	1,304.94	254.43	1,169.53	389.84	1,325.46	233.91	657.28	902.09
Employee/Family	1,897.95	1,508.87	389.08	1,528.36	369.59	1,588.29	309.66	1,423.46	474.49	1,613.26	284.69	657.28	1,240.67
Employee/Child(ren)	1,224.48	973.46	251.02	986.02	238.46	1,024.69	199.79	918.36	306.12	1,040.81	183.67	657.28	567.20
Employee (Grandfathered 7/1/15)				582.63	109.24
Standard 1000
Employee	659.84	524.57	135.27	557.14	102.70	578.99	80.85	494.88	164.96	560.86	98.98	626.85	32.99
Employee/Spouse	1,487.14	1,182.28	304.86	1,255.70	231.44	1,304.94	182.20	1,115.36	371.78	1,264.07	223.07	626.85	860.29
Employee/Family	1,810.05	1,438.99	371.06	1,528.36	281.69	1,588.29	221.76	1,357.54	452.51	1,538.54	271.51	626.85	1,183.20
Employee/Child(ren)	1,167.76	928.37	239.39	986.02	181.74	1,024.69	143.07	875.82	291.94	992.60	175.16	626.85	540.91

Section 125; Health/Dependent Care Spending Account

Open Enrollment Dates: May 1, 2021 through May 21, 2021

The enrollment for the Health/Dependent Care Spending Account is administered by Horace Mann. Troy True is the local agent and representatives at his office are available at 645-4779. The reimbursement plans will be processed by Health Equity. This year during the month of May, you must complete forms indicating participation or refusing participation. We must be able to document that everyone is offered this opportunity if audited by the IRS. There are three opportunities with our plan:

Paying your insurance premiums prior to taxes.
Flexible Spending Account; this benefit is an opportunity to pay for eligible out-of-pocket expenses with pre-tax dollars, thus reducing your taxable earnings at W-2 time.
Dependent Care Reimbursement; this benefit is an opportunity to pay for eligible dependent/child care expenses with pre-tax dollars, thus reducing your taxable earnings at W-2 time.

The effective dates are as follows:

July 1 for administrators, psychologists, adult ed staff, support staff, and school lunch workers
Section 125 Form for July 1, 2021 Effective Date

September 1 for teachers and other professional staff members.
Section 125 Form for September 1, 2021 Effective Date

Select the form that is appropriate for your effective date. The completed forms must be returned to Kristi Leavitt in the Business Office by May 21, 2021.

Additional Forms

Direct Deposit Forms are no longer available electronically for security reasons and are available in each District Building's Office.

Change of Address/Contact Information Form

Dental Application and Change Form

Federal W4 Form

Maine W-4 Form

MePERS Member/Benefit Recipient Data Update

Anthem Application/Change Form

Elementary EDP Time Sheet

Secondary EDP Time Sheet

Course Approval Form

P-Card Summary Card