Benefits & Payroll Services
Ms. Leyshla Moscoso
Employee Benefits Coordinator
732-376-6200 ext. 30-124
firstname.lastname@example.orgMs. Daria PalmerPayroll Manager
For information & questions, please contact Member Services at 1-866-658-2455 or visit their website for a list of providers: http://www.aetna.com/
- Aetna Complaint & Appeal Form
- Aetna Dependent Continuation Ages 26 - 31
- POS II monthly rate plan = $
- POS monthly rate plan = $
- PPO monthly rate plan = $
- Aetna Request for Disabled Dependent
- Aetna EAP (Employee Assistance Program)
- Aetna Medical Claim Form
- Aetna POS II: Plan Summary
- Aetna POS: Plan Summary
- Aetna PPO: Plan Summary
- Aetna Specialty Care Rx Program - Aetna Specialty Pharmacy fills prescriptions for specialty medications, such as those that need to be injected or infused. Usually, you can't get these medications at a local pharmacy; they require special storage and handling and may be delivered to your home. For new prescriptions, your doctor can send a request via fax 1-866-329-2779 or may place a call to a registered pharmacist at 1-866-782-2779. The prescription may also be filled by completing a Patient Profile Form. Existing prescriptions may be filled by calling 1-866-353-1892.
- Health Insurance Premium Form 2020-2021
- Health Insurance Premium Form 2020-2021 (Administrators and Supervisors)
For information & questions, please contact Member Services at 1-877-723-6005 or visit their website for participating pharmacies: http://www.benecardpbf.com/
- Benecard Dependent Continuation 26 - 31
- Monthly rate plan = $
- Benecard Mail Order Form
- Benecard Plan Summary
- Benecard Reimbursement Form
DELTA DENTAL (Dental)
For information & questions, please contact Member Services at 1-800-452-9310 or visit their website for participating dentists: http://www.deltadentalnj.com/
VISION SERVICE PLAN (Vision)
For information & questions, please contact Member Services at 1-800-877-7195 or visit their website for a list of providers: http://www.vsp.com
VOLUNTARY DISABILITY AND LIFE INSURANCE
COLONIAL LIFE (Voluntary Short Term Disability, Critical Illness Insurance, Flexible Spending Account)
The Perth Amboy Board of Education offers Short Term Disability Insurance, Cancer/Critical Illness Insurance and Flexible Spending Account (FSA) through The Colonial Life Insurance Company. You can secure a policy at any time throughout the school year at your own convenience. If you are interested in either insurance, please contact a benefit counselor via e-mail at email@example.com or call 1-856-983-9600. Below is a brief description of the plans offered:
- Flexible Spending Account (FSA)
- FSAs allow you to pay for out-of-pocket expenses (medical, prescription, dental and vision) and day care expenses with tax-free money. You can set aside money for health expenses and/or day care expenses. The amount is deducted out of your pay before taxes are calculated. For a complete list of eligible expenses, click here and enter password Flex2011.
- Short Term Disability Insurance
- You may choose this plan to protect yourself should you be unable to work due to an accident, sickness or pregnancy. This plan may provide benefits for up to 12 months per disability.
- Cancer/Critical Illness Insurance
- If you are diagnosed with a covered critical illness or cancer, specified critical insurance from Colonial Life can help you with your expenses. It provides benefits you can use to help cover loss of income, out-of-network costs, deductibles, co-payments and lodging and meals.
NEW YORK LIFE (Whole Life Insurance)
The Perth Amboy Board of Education offers life insurance through The New York Life Insurance Company. Life insurance policies are available for yourself, your spouse, children and/or grandchildren. You may keep the policy if you ever leave or retire from the district and rates are locked in for life. In addition, your policy builds guaranteed tax-deferred cash value that you can borrow against. For more information, you can visit www.legacybenefitsgroup.com or call 1-215-441-6554.
UNUM LIFE INSURANCE COMPANY (Voluntary Long Term Disability, Life and Accidental Death and Dismemberment Insurance)
The Perth Amboy Board of Education offers Voluntary Long Term Disability Insurance, Voluntary Life and Accidental Death and Dismemberment Insurance through The Hartford Insurance Company. If you are interested in either insurance, please complete an enrollment form and return it to the Benefits Department in the Business Office. Upon leaving your employment with the Board of Education, you may continue your Life Insurance by completing the conversion/portability form.
- Enrollment Form (New employees must submit this form within 31 days of their hire date, even if coverage is denied.)
- Change of Beneficiary
- Insurability Questionnaire (Employees who did not enroll within 31 days of their hire date.)
- LTD & Life Insurance Highlights
- Long Term Disabilty Claim Application (Employees who are filing a long term disability claim may do so after a 90 day waiting period. It is recommended that the employee complete their portion and return to the Benefits Department along with the physician's portion. The Benefits Coordinator will then send the completed application to UNUM.)
WORKER'S COMPENSATION/STUDENT ACCIDENTS
The district uses the Qual-Lynx call center for all worker's compensation accidents. Below are the procedures for reporting an on the job injury:
- If the injury is an emergency, call 911 in order to get the injured employee to the nearest Emergency Room. As soon as possible, please report the injury to the school nurse and/or supervisor. This emergency will need to be called into Qual-Lynx at 1-800-425-3222.
- If the employee is injured while school is in session, the injury must be reported to the school nurse and/or supervisor immediately. The nurse and employee together will call Qual-Lynx at 1-800-425-3222. Unless the injury is an emergency, the employee must notify the employer within 24 hours. The injury must be documented and the district's incident form must be completed.
- Qual-Lynx will record the injury and direct the employee to an appropriate participating facility. All appointments and follow-up care will be scheduled by Qual-Lynx or an assigned case manager at New Jersey Schools Insurance Group (NJSIG) - the employer does not call the doctor.
- An ID card will be provided to the employee by the school nurse. Employees must bring this card (Mitchell Script Advisor Card) to the doctor's appointment for prescription purposes.
- Once the employee returns to work, all follow-up appointments will be scheduled by your case manager before or after work hours. Follow-up appointments will not be scheduled during work hours.
- If the employee is injured but does not want to seek medical attention, the school nurse must be informed. Qual-Lynx will not be called; the school nurse will file the report as a "record only."
- If you get injured on the job, contact your School Nurse and Buidling Administrator immediately. You will need to complete an incident report within 24 hours of the incident/injury. Please call Qual-Lynx at 1-800-425-3222 to report the injury.
- ANY QUESTIONS OR CONCERNS, PLEASE CONTACT THE BENEFITS COORDINATOR AT 732-376-6200 EXT. 30-124.
The Perth Amboy Board of Education provides coverage to protect all students involved in any school sponsored activities including sports against accidental injury or death occuring while the policy is in force. Coverage is provided by Zurich Insurance Company and administered by Bollinger, Inc. In case of an accident, notify the school nurse and the school principal/administrator immediately. Below are the procedures for filing a claim:
- If your primary medical coverage is an HMO or similar plan, you must follow their rules for obtaining benefits. If the HMO is not utilized, benefits otherwise payable under this policy may be denied.
- If the student's parent have private group insurance, the medical bills must first be submitted to the parent's insurance.
- The parent must then obtain an explanation of benefits (EOB) from the insurance company.
- The parent will then submit a copy of the original bills, the EOB and a claim form to Bollinger, Inc.
- The claim must be submitted within 90 days from the date of the accident.
- Treatment must commence within 90 days from the date of the injury.
- Itemized bills and EOBs must show treatment, dates of treatment and charges - balance due bills will not be accepted.
- If there is no primary insurance through the parent's employer, a statement of verification from employer on letterhead must be submitted.
- Additional bills and EOBs can be forwarded to Bollinger, Inc. PO BOX 1346, Morristown, NJ 07962.
- If you have any questions once your claim has been submitted, you can contact Bollinger Claims Department at 1-866-267-0092.
- Student Claim Form
- Formulario de Reclamacion
NEW JERSEY DIVISIONS OF PENSIONS & BENEFITS
Pension enrollment is mandatory for all employees. As such, there will be a 7.5% deduction of your base salary. All Perth Amboy Board of Education employees MUST be enrolled in one of the following NJ State Pension plans depending on their position:
- TPAF (Teachers’ Pension & Annuity Fund) is for certified staff. Employees who qualify are:
- Guidance Counselors
- Social Workers
- PERS (Public Employees’ Retirement System) is for non-certified staff. Employees who qualify are:
- Law Enforcement Officers
- Custodial Staff
- Food Service Staff
- Maintenance Staff
- Transportation Staff
- DCRP (Defined Contribution Retirement Program) is for part-time enrollees that work less than 32 hours per week.
For TPAF members, there will be a .4 percent deduction of your annual salary for member term life insurance through the Pension; the value of this life insurance is 3.5x your annual base salary. For PERS members, there be a .5 percent deduction of your annual salary for member term life; the value of this life insurance is 3x your annual salary. It is imperative that you register for Member Benefit Online Services (MBOS) via the pension website to name your beneficiary when you receive your membership number. Membership numbers can be found on your paystub near your sick days. Please visit the pension website at www.nj.gov/treasury/pensions/mbos-register.shtml for MBOS registration.
If you are considering retirement, please review the following steps:
- You must be registered with MBOS to complete and submit your retirement application via the Pension's website. Applications should be filed at least sixy (60) days prior to your date of retirement. Please note: your retirement is not effective until the state approves your retirement and send a letter of approval to the board office.
- You must send a letter stating the effective date of your retirement to the following:
- The Superintendent - Dr. David A. Roman
- The Director of Personnel and Evaluations - Mr. Delvis Rodriguez
- Your Building Principal/Supervisor
- You must contact the Department of Pensions and Benefits to verigy your eligibility to participate in the School Employees' Health Benefits Program. Information concerning this program will be sent to you from the Pension. Information can also be found here.
- If you wish to continue dental and vision coverage through the district, you may do so at a premium cost. Premiums must be paid in advance on a quarterly basis. Failure to provide prompt payment will result in a termination of these benefits. You must opt for this coverage prior to your retirement; you cannot enroll after your retirement date.
- If you are NOT eligible for the School Employees' Health Benefits Program, you may purchase medical benefits through the district. Medical coverage for retirees is the same as active employees, with the exception of the prescription benefits. A new medical ID card will be issued to you upon acceptance of these benefits. If you do not qualify for these benefits, your health insurance will be terminated on the effective date of your retirement. Enrollment after retirement is not permitted.
- Your NJ Division of Pension's Life Insurance policy may be coverted to a personal policy within thirty-one (31) days of your retirement by contacting Prudential at 1-800-262-1112.
- If you participate in The Hartford's voluntary life insurance plan and wish to continue your coverage upon retirement, please complete a continuation of life insurance application and submit it to The Hartford. There are two plans available; conversion or portability. For questions regarding your current life insurance coverage, please contact the Benefits Coordinator.
- Please review the current AFT contract regarding reimbursement of accumulated sick days upon retirement. You may also contact Maria Alvarado in Human Resources at 732-376-6200 ext. 30-153 or via e-mail at firstname.lastname@example.org.
Pension inquiries can be directed to Maria Hernandez at ext. 30-127 or the Pension Help Desk at 1-609-292-7524. You can also email them via the contact us link at the bottom of their website.
TAX SHELTER COMPANIES (403B)
The Perth Amboy Board of Education has partnered with several Tax Shelter (403B) companies to provide employees with a tax-deferred way to save for their future. Enrollment in these plans are voluntary. Employees should make sure to research all companies and tax-shelter plans prior to completing the “Salary Modification Form.” The following companies are Board approved:
- Met Life
- Lincoln Investment Planning
Any questions regarding 403B investments should be directed to your Tax-Shelter representative.
VERIFICATION OF EMPLOYMENT:
All forms MUST be received by the payroll department Monday through Thursday to be processed by Friday. Once completed, verified and signed by the Business Administrator, the forms will then be faxed to the Mortgage/Bank Companies. THERE WILL BE NO EXCEPTIONS.
All forms pertaining to your payroll/personal information MUST be received one (1) week prior to the pay date. Updates/New Direct Deposits will take into effect after two (2) pay periods.
- Change of Address / Change of Name Form
- Paycheck Definitions
- Payroll Schedule
- W4 - Federal
- W4 - State
CENTRAL JERSEY FEDERAL CREDIT UNION
The Perth Amboy Board of Education offers employees the opportunity to enroll in the Central Jersey Federal Credit Union for all banking needs: savings & checking accounts, summer savings, loans, mortgages, etc. Please visit the Credit Union’s website for more information or visit a local office. Information regarding the CJFCU can be found here.