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					                                                                   Niles Township High Schools
                                                                     Employee Benefits Coordinator


In preparation for your retirement, the following information will be important in planning your insurance needs.

As a June, 10 month and 12 month support staff retiree, your district insurance coverage will terminate as of September 30 in
the year you retiree (August 30 if hired after August 2005). If you have not opted for the medical insurance benefit payment
(Article XVII, Section 4), you have the option to continue your Blue Cross Blue Shield PPO health and Blue Cross Blue Shield
dental insurance through District 219 for yourself, spouse, and eligible dependents. (If you have opted for the insurance
benefit, please see your Cobra rights below.) At age 65, Medicare supplement coverage is also available. Coverage
through the District requires that premium payments must arrive in our office one month before the coverage date. For
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example, to have coverage for the month of July, the premium payment must be in our office by June 10 . For August
                                                          th
premiums they must be in our office no later that July 10 etc. Premiums should be paid by a personal check made payable
to Niles Township High Schools. For your convenience, you may have your premiums paid directly by IMRF or by the Credit
Union (for those that are members). Please contact benefits to establish your retiree insurance and confirm payment options.

Continuation of District 219 Health Coverage-Cobra:

If you opted for the medical insurance benefit (Article XVII, Section 4), you are eligible to continue your current health
coverage through the District, under COBRA. This is a maximum of 18 months of insurance coverage that can be purchased
through the District for yourself, spouse, and eligible dependents. Medicare supplemental coverage is also available.
COBRA coverage through the District requires that premium payments must arrive in our office one month before the
coverage date. For example, to have coverage for the month of October, the premium payment must be in our office by
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September 10 . Please complete the attached form and return to me indicating your Cobra choice

District 219 Blue Cross Blue Shield PPO Retiree Monthly Premiums and Cobra Premiums

      PPO                                                                Monthly Premium Cost Effective thru 12/31/2010
      Single                                                                     $ 617.17
      Family                                                                     $1542.35
      Medicare Single                                                            $ 480.93
      Medicare Employee + Single Spouse                                          $1110.62
      Single Employee + Medicare Spouse                                          $1110.62
      Medicare Employee + Medicare Spouse                                        $ 961.86
      Dental                                                             Monthly Premium Cost Effective thru 12/31/2010
      Single                                                                     $ 54.76
      Family                                                                     $ 148.32
      Medicare Single                                                            $ 54.76
      Medicare Employee + Single Spouse                                          $ 109.52
      Single Employee + Medicare Spouse                                          $ 109.52
      Medicare Employee + Medicare Spouse                                        $ 109..52


IMRF Endorsed Health Insurance Plans

IMRF also offers insurance options for you as well. An overview of their plan can be viewed at www.imrf.org. Please
contact the Doyle Rowe LTD hotline (800-564-7227) for more information on the IMRF plans.

Life Insurance

At retirement, your term life insurance policy held by the District converts to a $1,000 policy. This policy is payable to your
designated beneficiary and paid to them upon your death. Be sure to list the policy in your personal papers so that at the
appropriate time the policy amount can be paid to your designated beneficiary.

As always, please contact me at any time if you have questions. Please complete the enclosed form and return to me
prior to August 30 in the year of retirement indicating your Cobra insurance decision. Thank you.
 COBRA NOTIFICATION FORM




TO:              Support Staff Retiree

DATE:

FROM:            Kim McDermott
                 Employee Benefits Specialist
                 Niles Township High Schools District 219


This is to inform you that your District Health and/or Dental Insurance coverage will cease due to the following
event:

                            X               Termination /Leave of Absence/Resignation/Retirement
                                            Reduction of scheduled work hours
                                            Death
                                            Divorce or legal separation
                          ______            Child became ineligible for dependent
                                            coverage
                                            Eligibility for Medicare

You may, if you wish, elect to continue group coverage beyond the date that it would otherwise terminate. The
termination date of your coverage and the current monthly cost, if you elect to extend your coverage, is listed
below:


                                               CURRENT
        TYPE OF INSURANCE                   TERMINATION DATE                   MONTHLY PREMIUM

        PPO Single                                                                 $ 629.69
        Single Dental                                                              $ 54.76
        Family Dental                                                              $ 148.32
        PPO Family                                                                 $1573.76
        HMO Family                                                                 $1196.66
        HMO Single                                                                 $ 459.39



Indicate your decision on the enclosed form and return it to the Employee Benefits not more than 60 days from
the date of the qualifying event or the date of this letter, whichever is later. FAILURE TO ELECT CONTINUED
COVERAGE WITHIN 60 DAYS WILL RESULT IN TERMINATION OF COVERAGE.




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                                             MEMORANDUM



To:              Kim McDermott
                 Employee Benefits
                 Niles Township High School District 219

From:            ___________________________________

Date:            __________________________________

Re:              Election of Continuation of Group Medical and/or Dental Insurance


Having been notified of my right to purchase continuation of the above-mentioned group health insurance
coverage and of the monthly premium please enroll me in the following:



                 ___     Continued coverage:
                                               medical (HMO or PPO)
                                                   ____ single _____ family
                                               dental
                                                   ____ single _____ family


                         No continued coverage:
                                             medical
                                             dental



By electing continued coverage, I agree to pay the premium for continued coverage from the date of the
Qualifying Event to the date of this election within 45 days and to pay all other premiums by the 10th of each
month. My signature at the bottom acknowledges that failure to pay the premium by the due date will result in
permanent termination of the coverage. This also serves as an acknowledgement that should I become covered
under any other group health plan or become eligible for Medicare that I will inform the Benefits Department
within 15 days of notice of coverage.



Signature                                                             Date



_______________________________________                             _________________________
Please Return this Document to
Kim McDermott, Employee Benefits Coordinator




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