Sioux City Community Schools

Medical Information

Medical Plans 2024-2025

Benefit-eligible employees may elect health/medical coverage through UnitedHealthcare. Employees may choose between the $5,500 High Deductible, $3,500 High Deductible, or Value Plan outlined below. To understand the difference between each plan, click on the links below.

Provider: UnitedHealthcare
1-888-480-0921
Group: 754255

$5,500 High Deductible Health Plan (HDHP)

$5,500 HDHP Certificate of Coverage
$5,500 HDHP Summary of Benefits and Coverage
$5,500 HDHP Benefit Breakdown

$3,500 High Deductible Health Plan (HDHP)

$3,500 HDHP Certificate of Coverage
$3,500 HDHP Summary of Benefits and Coverage
$3,500 HDHP Benefit Breakdown

Value Health Plan

Value Health Plan Certificate of Coverage
Value Health Plan Summary of Benefits and Coverage
Value Health Plan Benefit Breakdown

Health Plan Vision Coverage

Vision Rider – Addendum to the Medical Benefit Summary

Hospital Indemnity Plan

Hospital Indemnity Protection Plan helps protect employees from costly hospital expenses. All benefits are paid directly to the insured and can be used towards any expense.

Hospital Indemnity Guide

Hospital Indemnity Manual Claim Form

Certificate of Coverage

Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for: Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in‑network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:
No Surprises Help Desk
1-800-985-3059 from 8 am to 8 pm EST, 7 days a week
www.cms.gov/nosurprises/consumers/complaints-about-medical-billing

Billing Dispute Process
www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured

Visit www.cms.gov/nosurprises for more information about your rights under federal law.

Machine-Readable Files

Our District’s health coverage is fully insured by UnitedHealthcare. UnitedHealthcare is responsible for maintaining access to all required machine-readable files.

Transparency in Coverage

Health Savings Account (HSA)

Provider: WEX Benefits
1-833-225-5939

2024 IRS Contribution Limits:
Single: $4,150
Family: $8,300

Eligible employees who elect the HDHP Health Plan can also elect to open a health savings account through WEX. This allows employees to pay for qualified medical, dental, and vision expenses tax-free.

Here’s how it works:

HDHP Plan — Pays for covered expenses once you meet the deductible
HSA — May be used to pay for qualifying medical, dental, and prescription expenses

Why choose to set up an HSA?

HSA funds roll over from year to year. If the money in the HSA isn’t spent, it adds up and stays in the account
HSA contributions are done on a pre-tax basis
Save for retirement — HSA contributions can help offset medical expenses that you incur during retirement.
Manage health care expenses — If you have a high-deductible health plan, an HSA may help you save and pay for health care.

Follow these steps to start an HSA and get the most out of your account: