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Naperville Community Unit School District 203 Benefits

Naperville Community Unit School District 203 offers a comprehensive suite of benefits to help support the physical and financial health of you and your family. These benefits help you pay for health care and provide financial protection for you and your family. Effective January 1, 2026, medical benefits will renew with BCBS. and all ancillary lines will remain with Guardian. Effective immediately, our near-site clinic, Priority Care, is available for all members enrolled in medical to utilize for preventive, acute, mental health and more. See more details in the guide.

This guide provides highlights of your benefits programs. Keep this guide with your other important papers so you can refer to it as needed. For a complete description of your benefits please refer to your benefit plan certificates, located on your employee benefits account.

New Employee Enrollment As a newly hired employee of Naperville Community Unit School District 203, you are eligible to make an election of benefits within 31 days of your effective date.

Existing Employee Enrollment Annual Benefits Enrollment starts mid-October to make elections for benefits effective January 1 to December 31. If you wish to change benefits outside of the Annual Benefits Enrollment period, you may only do so within 31 days of an IRS qualifying life event, such as:

• Change in legal marital status (marriage, divorce, death of spouse)
• Change in employment status for you, your spouse, or a dependent that affects eligibility
• Birth, adoption, or placement for adoption of a child
• Death of a spouse or dependent
• Change in a dependent's eligibility

Benefit changes due to a qualifying life event must satisfy a consistency rule. That is, any change must be consistent with the qualifying event. Example: If you get a divorce, you can remove your spouse but cannot add existing dependents who were not on your plan.

Voluntarily terminating existing benefits does not qualify as an IRS qualifying life event. You have the right to terminate your benefits with Naperville CUSD 203 during the Annual Benefits Enrollment period. The last effective date of coverage will be December 31; you may not rejoin the plan until the next Annual Benefits Enrollment period unless you experience an IRS qualifying life event.

It is your responsibility to notify your Employee Benefits Specialist and take action within 31 days of an IRS qualifying life event date. Any misrepresentations, inaccurate information, or failure to provide information could result in the loss of coverage. If you cover an individual who is not eligible for benefits, you will be required to reimburse the plan for any expenses incurred as a result and further disciplinary actions may be taken.

Enrollment in Naperville CUSD 203's family health care plan requires proof of dependent eligibility.

Eligible dependents are spouses, civil union partners, and children (biological, adopted and those for whom you have legal guardianship and accompanying documentation) under age 26. You will be required to provide the following documents (as applicable) to the Employee Benefits Specialist:

• A copy of your Marriage or Civil Union Certificate OR a copy of your most recent joint Federal Tax Return
• A copy of the Birth Certificate for each dependent to be covered under the plan, excluding your spouse, OR Adoption Certificate or Court Order
• Spousal/Civil Union Partner Affidavit

Divorced or legally separated spouses are ineligible for coverage as of the day of the divorce or legal separation. Dependent children are eligible for coverage through the month they turn age 26. It is essential to notify your Benefits Specialist of a change in eligibility within a timely manner to ensure your dependent's right to COBRA Continuation.

Medical insurance is one of your most important benefits. When you enroll in one of the BCBS of Illinois medical plans offered by Naperville Community Unit School District 203, you have peace of mind knowing that you have coverage for medical services if you need them for you or your family. Prime Therapeutics (BlueCross BlueShield's prescription partner) administers the prescription drug plan, providing you a single ID card for medical and prescription drug coverage. Please note that CVS/Target is not covered as an in-network pharmacy benefit.

District 203 offers four choices for medical/prescription plans through BlueCross BlueShield of Illinois. Each of the plans uses a specific BCBS network. To take full advantage of each plan, it is important to confirm in-network status with BCBSIL prior to services being rendered. Visit BCBSIL.com or call View phone number on click.appcast.io to check for in-network providers for your chosen medical plan.

BlueCross BlueShield of Illinois' Benefits Value Advisor: When you enroll in any one of the District 203 Health Plans, you gain access to BCBSIL's Benefits Value Advisor (BVA), a customer service program to help you improve your quality of care and achieve cost savings.

• Find and compare In-Network providers based on quality, patient reviews and cost
• Compare treatment cost estimates among facilities to access savings
• Obtain preauthorization, schedule appointments and connect to clinical programs
• Review benefits, claims and coverage guidelines

BlueCross BlueShield of Illinois' Utilization Management Programs

Utilization Review Program: Utilization Review assists you in determining the course of treatment that will maximize your benefits. The program requires a review of inpatient hospital, skilled nursing facility, coordinated home care program, and private duty nursing services before they are rendered. Members are required to contact the Utilization Review department at the toll-free telephone number identified on your ID card one business day prior to elective admission or within two business days after an emergency or maternity admission. Failure to receive Preauthorization will result in a $200 reduction of benefits.

Mental Health Unit: The Mental Health Unit assists in the administration of Mental Illness and Substance Abuse Rehabilitation Treatment benefits. The Mental Health Unit requires a review of inpatient hospital, emergency mental illness or substance abuse admission, partial hospitalization and outpatient services before they are rendered. Members are required to contact the Mental Health Unit at View phone number on click.appcast.io at least one business day prior to non-emergency inpatient hospital admission and outpatient services or within two business days after an emergency admission or partial hospitalization treatment. Failure to receive preauthorization will result in a $200 reduction of benefits.

Prescription Prior Authorization: Certain medications and drug classes require authorization from Prime Therapeutics for benefits to be provided. To receive prior authorization, your physician must send a letter to Prime Therapeutics explaining the reason for the prescription; you and your physician will be notified of the determination. To review the formulary list of medications and drug classes which require prior authorization, contact your pharmacy or call the customer service toll-free number on your identification card.

Step Therapy: Certain medications and drug classes require documented treatment with a generic or brand therapeutic alternative medication prior to coverage of brand name medication. If your physician prescribes such a medication, they must complete a questionnaire regarding your previous treatment; you and your physician will be notified of the determination. To review the formulary list of medications and drug classes which require prior authorization, contact your Pharmacy or call the Customer Service toll-free number on your identification card.

Regular dental checkups are important to your overall health and can reveal early indications of serious conditions like osteoporosis and cardiovascular disease. An oral exam can help keep your teeth and gums healthy throughout your life.

Guardian's PPO Plan has access to one of the largest networks of dentists with two reimbursement levels that give you more control over savings. You will always save money with any dentist in Guardian's network and when the dentist belongs to a Tier 1 reimbursement level you will maximize your savings.

Reimbursement for covered services received from a non-contracted dentist will be based on a percentile of the prevailing fee data for the dentist's zip code. To find a dentist in Guardian's PPO Network (DentalGuard Preferred), log on to or call View phone number on click.appcast.io.

Vision health impacts your overall health. Routine eye exams can lead to early detection of vision problems and other diseases such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis, and rheumatoid arthritis.

It is recommended that you have an eye exam once every 12 months.

To find an in-network vision provider (Davis Vision), visit or call View phone number on click.appcast.io.

As an employee of Naperville Community Unit School District 203, you have a variety of benefits. You share the cost of your Medical/Prescription, Dental, and Vision benefits

Naperville Community Unit School District 203