Innovative spirit. Inspiring success. Business Procedures ... · Business Ethics

Innovative spirit. Inspiring success.

Business Procedures Manual

2021

Business Ethics .................................................................................................................................................................. 1

Administrative Services Team List of Responsibilities ........................................................................................... 3

Table of Organization ........................................................................................................................................................ 5

Supervisor/Organizational Assignments ..................................................................................................................... 7

General Background Information .................................................................................................................................. 8

Accounting Hierarchy ....................................................................................................................................................... 8

Funds (Governmental/ Propriectery/ Fiduciary) ........................................................................................................ 8

Budget Calendar ............................................................................................................................................................... 10

Account Structure ............................................................................................................................................................ 12

Accounting Procedures.................................................................................................................................................. 13

Iowa Gift Law/ Donations ............................................................................................................................................... 14

Conflicts of Interest ......................................................................................................................................................... 14

Deposits/ Cash Management ........................................................................................................................................ 15

Electronically Scanning Checks .................................................................................................................................. 16

Activities and Athletic Cash Process ......................................................................................................................... 19

Petty Cash .......................................................................................................................................................................... 22

Parents Online Payments .............................................................................................................................................. 24

Non-Sufficient Fund Checks (NSF) ............................................................................................................................. 32

Purchase Order Procedures .......................................................................................................................................... 33

Central Store Inventory .................................................................................................................................................. 35

Completing Leave of Absence Forms ........................................................................................................................ 36

Reimbursement for Travel ............................................................................................................................................. 37

Out of District Travel Procedures ................................................................................................................................ 38

Harris Bank Travel Insurance ....................................................................................................................................... 41

Purchase Order Procedure for Harris Bank P-Cards ............................................................................................. 42

Mileage Reimbursement Form ...................................................................................................................................... 44

Equipment Breakdown Insurance ............................................................................................................................... 45

Mail Services ..................................................................................................................................................................... 46

Technology Purchases ................................................................................................................................................... 50

Print Shop and Building Copiers ................................................................................................................................. 50

SPED Purchases .............................................................................................................................................................. 51

Gifts, Grants, and Bequests .......................................................................................................................................... 53

Records – PTO/ Booster/ Foundation Requirements ............................................................................................. 53

Property & Liability Insurance ...................................................................................................................................... 54

Student Incident Report ................................................................................................................................................. 54

Workers’ Compensation Procedures .......................................................................................................................... 56

Contracts and Agreements............................................................................................................................................ 57

Board Agenda Item Submission Process .................................................................................................................. 58

Payroll and Benefits ........................................................................................................................................................ 60

Additional Teacher Compensation .............................................................................................................................. 60

Salaried Leaves of Absence .......................................................................................................................................... 60

Employee Payroll Records ............................................................................................................................................ 60

Pay Dates ........................................................................................................................................................................... 61

Electronic Time Clock ..................................................................................................................................................... 63

Benefits Guide .................................................................................................................................................................. 64

Benefit Notices (Various) ............................................................................................................................................... 80

West Des Moines Community Schools Business Procedures Manual Page 1

Business Ethics

The Business Procedures Manual is to provide guidance to employees responsible for the accounting functions in individual schools and departments of the West Des Moines Community School District.

The manual will provide:

• General accounting background information of the district. • Specific procedures to perform certain financial transaction activities. • Assignment of financial accountability (Accounting Responsibilities).

This manual is a guide for those individuals responsible to work within the district’s financial framework in a structured and disciplined way so that accuracy and reliability of financial information is at a high level. While the manual serves as a guide it still relies on the human elements of honesty, integrity, and discipline. This manual will also require teamwork throughout the district from all who are assigned responsibility so that the controls that are in place will work effectively.

Basic Beliefs

The West Des Moines Community School District Administrative Services staff are committed to conducting themselves within the highest standards of professional and personal ethics, to continue ongoing professional growth and development, and to develop these beliefs in others with whom they work.

Ethical Standards

In all activities the Administrative Services staff shall:

1. Make the well-being of all students, staff, and fellow members a fundamental value in all decision making and actions.

2. Fulfill professional responsibilities with honesty and integrity.

3. Support the principle of due process and protect the civil and human rights of all individuals.

4. Obey all local, state, and national laws.

5. Implement the policies and administrative rules and regulations of the school district.

6. Pursue appropriate measures to correct those laws, policies, and regulations that are not consistent with this code of ethics.

7. Not tolerate the failure of others to act in an ethical manner and will pursue appropriate measures to correct such failures.

8. Never use their positions for personal gain through political, social, religious, economic, or other influence.

9. Honor all contracts until fulfillment or release.


Ethical Conduct

In all activities staff shall demonstrate their adherence to the standards set forth above by:

1. Actively supporting the goals and objectives of the District.

2. Interpreting the policies and practices of the District to the staff and to the community fairly and objectively.

3. Implementing, to the best of their ability, the policies and administrative regulations of the district.

4. Assisting fellow members, as appropriate, in fulfilling their obligations.

5. Supporting a positive image of the district.

6. Not publicly criticizing Board members, superiors, administrators, or other employees.

7. Helping subordinates achieve their maximum potential through fair and just treatment.

8. Maintaining confidentiality of data and information.

9. Accurately and objectively reporting data, in a timely fashion, to authorized agencies.

Expectations of Personal and Professional Integrity

In the conduct of business and the discharge of responsibilities staff will:

1. Conduct business honestly, openly, and with integrity.

2. Avoid conflict of interest situations by not conducting business with a company or firm in which the official or any member of the official’s family has a vested interest.

3. Avoid preferential treatment of one outside interest group, company or individual over another.

4. Uphold the dignity and decorum of their office in every way.

5. Never use their position for personal gain.

6. Never accept or offer illegal payment for services rendered.

7. Not accept gifts, free services, or anything of value for or because of any act performed or withheld.

8. Support the actions of colleagues whenever possible.

9. Accept leadership roles and responsibilities when appropriate.


Administrative Services Team List of Responsibilities

Paul Bobek (633-5075) Chief Financial Officer • Leadership of fiscal management, nutrition, transportation, buildings and grounds • Develops, recommends and maintains current board policies and administrative guidelines • Participates, recommends, and evaluates personnel in areas of responsibility in accordance with board policies

and administrative guidelines • Prepares fiscal exhibits for mediation and arbitration for district staff • Works with staff and Board of Directors in developing long-range facility and site plans, coordinates design and

construction with architects and contractors • Supervises and checks accuracy the reports required by federal, state and/or local agencies • Works with building Principals and Department of Education on enrollment projections, annual certified report

and enrollment procedures • Contributing member of Superintendency, Superintendent’s Leadership Cadre, Administrative Leadership Team

and other committees • Coordinates closing of schools during inclement weather

Donna Beerman (633-5078) Director of Business Services

• General ledger chart of accounts • Journal entries • Cash receipts posting • Bank reconciliation • Monthly financial reports to Board of Directors • Audit preparation including GFOA and ASBO International certificate of excellence applications • Responsible for filing Certified Annual Report with the Iowa Department of Education • Works with Administrators and Supervisors to prepare line item budget • Print Shop Supervisor

Samantha Luong (633-5113) Executive Assistant

• Secretary to Chief Financial Officer and Director of Operations • Student accident forms collection • Property insurance claims filing • Transportation insurance claims filing • Mail Room

Kris Craig (633-5076) Benefits Advisor

• Employee & retiree benefits • Wellness program • COBRA enrollment • Benefits Connect software administration • Annual employee benefits enrollment coordination


Linda Rippentrop (633-5083) Payroll Coordinator • Certified, Supervisor, Non-Unit and Administrator payroll processing • Internal Revenue Service reporting • W2 reconciliation • Reconciliation of payroll payables and filing quarterly reports • 403b/457 employee/employer contributions and reconciliation • Collection of retiree medical & dental insurance premiums • Accounts Receivable processing and reconciliation • IPERS reconciliation and filing monthly payments • Employee Online coordinator

Starr Himes (633-5077) Payroll

• Hourly employee (TimeClock Plus) payroll processing and leaves of absence • InTouch Receipting student fees

Samantha Jave (633-5080) Accounting Specialist

• Power School (IFAS) trainer • Credit Card Program manager • InTouch Receipting electronic deposit reconciliation • 0294 professional development ‘menu money’ accounting • Cash Receipts – preparing deposits • Prepares PO’s for administrative services

Ann Crothers (633-5102) Accounts Payable

• Accounts Payable: LRC Departments • Community Ed, School Community Relations, Superintendent, Administrative Services, Human Resources,

Teaching & Learning Services, Rieman music • Electronic applications for tuition reimbursement payments • Valley High School • Utilities

Sandra James (633-5082) Accounts Payable

• Equipment Breakdown Insurance Coordinator • Nutrition • Capital improvement retainage • Prepare PO’s for Sales Tax and PPEL • Processes payments for Operations, Transportation, Warehouse, Technology

Amy Tadlock (633-5079) Accounts Payable

• Accounts Payable: Des Moines Register, Valley Athletics • Process AP checks and electronic fund transfers to vendors • Accounts Payable: Elementary Schools • Clive, Crestview, Crossroads, Fairmeadows, Hillside, Jordan Creek, Western Hills, Westridge • Accounts Payable: Secondary Schools • Valley Southwoods, Indian Hills, Stilwell, Walnut Creek Campus


Table of Organization



Supervisor/Organizational Assignments

1. Lisa Remy – Superintendent 2. Paul Bobek – Chief Financial Officer / C.P.A. 3. Michelle Lettington – Associate Superintendent Teaching & Learning Services 4. Carol Seid – Associate Superintendent Human Resources 5. Laine Mendenhall-Buck – Director of School Community Relations

6. Brian Abeling – Director of Technology 7. Willow Dye – Director of Nutrition Services 8. Jesse Johnston – Director of Human Resources 9. Donna Beerman – Director of Business Services 10. Shahna Janssen – Director of Community Education 11. Kandi Hensel – Director of Special Education 12. Mike Sherman – Data Management Director 13. Joseph Libby – Teaching and Learning Services Executive Director 14. Natalie French – English for Speakers of Other Languages Director 15. Shane Scott – Secondary Curriculum Director 16. Leigh Goldie – Elementary Curriculum Director 17. Christine Maduro – Director of Operations

18. Robin Pickard – Director of Transportation 19. Shelly Pospeshil – Clive Elementary Principal 20. Tamara Tjeerdsma – Crestview Elementary Principal 21. Robert Davis – Crossroads Park Principal 22. Brandon Pierce – Fairmeadows Elementary Principal 23. Graham Jones – Hillside Elementary Principal 24. Paul Wenger – Jordan Creek Elementary Principal 25. George Panosh – Western Hills Elementary Principal 26. Beth Brewer – Westridge Elementary Principal 27. Ann Orsini – .5 Jordan Creek / .5 Westridge Assistant Principal

28. Shane Christensen – Indian Hills Jr. High Principal 29. Zac Sinram – Indian Hills Jr. High Assistant Principal 30. Erica Whittle – Stilwell Jr. High Principal 31. David Perrigo – Stilwell Jr. High Assistant Principal

32. Kim Davis – Walnut Creek Campus Principal 33. Mitch Kuhnert – Valley Southwoods Principal 34. Haley Hockensmith – Valley Southwoods Associate Principal 35. David Maxwell – Valley High School Principal 36. Megan Thole - Valley High School Associate Principal 37. Jeff Grassmeyer – Valley High School Associate Principal 38. Shannon Campbell – Valley High School Associate Principal 39. Josh Griffith – Valley High School Associate Principal


General Background Information

All funds collected through school activities are under the financial control of the district’s Board of Directors. Timely and proper accounting of all receipts and expenditures are therefore the responsibility of the Board. The Board may delegate the responsibility of the keeping the records to others, but in the end the Board is lawfully responsible. The responsibility for school/department budgets and funds has been delegated to the principal/administrator of each site. The principal/administrator of each site has the authority and responsibility to supervise, direct, and control the activities of those employed to work within that site.

New building/department secretaries will receive individual training during the first month of employment. Principals/administrators and building/department secretaries will be required to repeat the training and review of the manual at least once a year. Additional training may be requested from the Administrative Services department at any time. All of the training will be completed by a member of the Administrative Services department. The Administrative Services department will also send timely reminders addressing the current accounting issues.

Accounting Hierarchy

The financial accounting system is structured on a fund basis of accounting designed to meet legal, state, and federal requirements of accountability. The district operates on a double entry modified accrual basis of accounting. The computerized accounting system (Business Plus) is designed to print checks, journal entries, and financial reports and to warehouse financial data. The Administrative Services department is charged with maintaining the integrity of the accounting system and verifying data that goes into the system. The department also provides the board, administration, and other end-users financial reports, summaries, and analysis as requested.

Funds (Governmental/ Propriectery/ Fiduciary)

A fund is an independent fiscal and accounting entity with its own expenses, revenues, assets, and liabilities. The fund is broken out on its own so it can follow all specific regulations and restrictions. Most district sites are accounted for in the Operating or General Fund, i.e. an elementary school. However there are some sites or certain activities that may be accounted for in a Student Activity Fund, Agency Fund, Proprietary Fund, or other Special Revenue Fund. Here is a brief description of the above funds:

General Fund (Fund #10)

This is the chief operating fund of the district. Most of the instructional, operational, and administrative activities are accounted for in the General Fund. Any financial activity that is not tagged for a specific fund will be accounted for in the General Fund. For example, 1st grade teacher compensation, building custodian compensation.

Student Activity Fund (Fund #21)

This fund is used for financial activity related to school clubs, extracurricular activities, or any other co-curricular activities at a particular site that directly benefit student clubs or activities. It is also used to account for activity related to athletics. For example, ticket sales for a high school football game.

Proprietary Fund (Funds in #60 and #70 series)

There are two sub-fund types, enterprise and internal service funds. In an enterprise fund the fund accounts are similar to a private business. The goal is not just to make sure costs are covered but to generate excess revenue and sufficient working capital. For example, Food Service (61) and Community Education (65) programs.


An internal service fund provides goods and services primarily to district sites on a cost-reimbursement basis. For example, Self-Funded Insurance (71), will generate enough revenue to offset all costs associated with providing employees with medical and dental insurance.

Agency Fund (Fund #91)

Accounts for assets held in a custodial capacity for an independent group or entity. Social funds are accounted for within this fund. The district provides the accounting for these funds but does not own or control the funds. For example, the Board and ALT keeps their checking account in this fund and the Administrative Services Team helps with the accounting (balancing the checkbook) but do not control the funds that flow in or out of the account.

If any fund should go negative it will have to be funded by the General Fund and that is not an acceptable occurrence and would require Board approval.


Budget Calendar


Budget Calendar

Deadline or Activity Date Notes Certified Enrollment October 15 Counts are submitted to DE to determine the

number of students to which the cost per pupil is multiplied to determine next fiscal year budget.

Early Retirement November Deadline for employees to submit intent to participate.

Budget Reductions December Board of Directors review budget reduction recommendations developed by District Budget Committee.

Audit Report 6.30.15

December Independent auditors present prior year audit report.

Financial Projections December Financial projections for current year (2016) and next fiscal year (2017) presented by CFO.

Dropout Prevention Plans December 15 Valuations ready for planning property tax rate changes.

Property Valuations December Valuations ready for planning property tax rate changes.

Aid and Levy Worksheet January 31 Department of Management distributes software so school districts can prepare budgets and analyze tax rates.

Offer Teacher Contracts March 15 Earliest day to offer teacher contracts. Contracts are due 21 days after receipt of contract.

Notice for Public Hearing to Approve Budget

March 10-20 day publication requirement in newspaper of general circulation in the district.

Budget Guarantee Resolution April 15 Board of Education must approve before April 15 to claim the spending authority for the budget guarantee.

Budget Certification April 15 Approved documents must be received by County Auditor’s office.

Pink Slips Issued April 30 Notice to teachers whose contracts may not be renewed.

Budget Amendment May 31 Board of Directors approve budget amendments recommended by CFO. Documentation of approval sent to County Auditor’s office.


Account Structure

Within each fund, the account coding is used to designate, record, and classify financial transactions. Each account must be well defined to ensure the accuracy so reporting is uniform and comparable. There are three major groups of accounts: Balance sheet accounts (assets, liabilities, and fund equity); Revenue accounts; and Expense accounts.

If an account needs to be created, deactivated, or closed please contact the Administrative Services Team.

The use of double entry accounting and the recognition of accruals establish a basic accounting equation. That equation is:

Assets = Liabilities + Fund Equity

Fund Equity is determined by adding the beginning balance and the surplus (deficit) from current operations (Revenue less Expenses).

Each account is assigned a unique key for processing and classification purposes. An example of a key is WCDROP240 where the two-letter prefix of “WC” represents the school, in this case Walnut Creek Campus, and the remaining characters represent a program area and individual responsible for that account.

All keys are assigned and entered into the computer system tables (Business Plus) by the Administrative Services Team. Hidden in the key are background parts that are not displayed but used for reporting purposes. The background parts include:

• Two-digit Fund (e.g. Operating, Student Activity, School Nutrition) • Four-digit Facility or School (e.g. Valley High School) • Four-digit Function (e.g. Regular Education, Special Education) • Three-digit Program (e.g. Math, Art, Science) • Four-digit Project (e.g. Core Curriculum, Teacher Leadership Compensation, Federal) • Three-digit Supervisor (e.g. Principal/Administrator)

The object code defines the classification of the account type:

• Expense = Object code always begins with a (0) (e.g. 0610) • Revenue = Object code always begins with (1-5) (e.g. 4501) • Balance Sheet = Object code always begins with (8) (e.g. 8150)

A “Chart of Accounts” report that can be found on the Business Plus dashboard. Click the link “Chart of Accounts” and a report will be generated listing all accounts under your security. The report lists the account codes along with the object codes available to use.

The “GL Key Crosswalk” report is also located on the Business Plus dashboard. Click the link to generate the report. This report provides all account codes within your security, without the object code attached. The background codes (fund, facility, function, program and project) associated with each account code are listed on the “GL Key Crosswalk” report. Reports can be run using the project code and the “GL Key Crosswalk” report can be used to obtain the project code.


Accounting Procedures

Certain accounting procedures are necessary to maintain the control and integrity of financial data for the accurate accountability of all district funds. All financial transactions must be recorded in the accounting system (Business Plus).

One of the core principles in all accounting procedures is a process of checks and balances. In order to achieve a proper check and balance there must be an appropriate and adequate segregation of duties based on the resources available. This means that no one individual should perform all phases of a transaction. Principals/administrators are REQUIRED to assign accounting duties among available office staff, NOT TEACHERS, to achieve a reasonable amount of segregation. The controls that will be important for the reader of this manual:

• Petty Cash • Cash Receipts • Accounts Payable • PO Process • Procurement Card (P-Card) • Journal Entries • Payroll

Employees of a community school district are public employees and therefore subject to more scrutiny. All financial records are public. Public funds may only be spent for public benefit. In general, district funds must be spent prudently and are prohibited (not inclusive) from being expended on the following:

• Items above and beyond normal school duties. For example, flying first class to a district conference when coach is acceptable.

• Payments to/for non-school employees. For example, paying a parent that helped work a school fundraiser dinner. All payments to non-school employees are required to flow through the business office.

• Contributions to outside organizations. For example, donating to the American Red Cross with district funds. All donations will require approval and payment would flow through the business office. A detailed procedure for contributions will be outlined later in the manual.

All funds are considered to be district funds except for agency funds. The district holds agency funds as a fiduciary agent for outside organizations and does not have access to these funds. The district acts more as a bookkeeper for the funds. For example, ALT members contribute money to a social fund for memorial condolences or ALT member significant events.


Iowa Gift Law/ Donations

Iowa Gift Law

All district employees are considered to be public employees. Per Iowa Code chapter 68B.22 public employees may accept “nonmonetary items with a value of three dollars.” Except for incidental gifts of negligible monetary value, gifts from parents or students to staff members who have direct influence over the student are prohibited. Please contact the business office if you have any questions concerning the acceptance of a gift.

Donations from Businesses, Parent Employer Donations and Booster Clubs

We encourage donations from Businesses, Parent Employer Donations and Booster Clubs, to send their donations to the West Des Moines Community Schools Foundation at the following address:

WDMCS Foundation C/O David Farnsworth McGowen, Hurst, Clark & Smith PC 1601 West Lakes Parkway STE 300 West Des Moines, IA 50266

The Foundation will record the donation and forward a check to the recipient school with a detailed list of the donations. The grant check should be deposited in InTouch.

Conflicts of Interest

According to Iowa Code chapter 68B.2 any person who is employed by the state shall not engage in any outside employment or activity which is in conflict with the person’s official duties and responsibilities. Employees’ use of their position with the school district for the purpose of financial gain shall be considered a conflict of interest with their position as employees and may subject employees to disciplinary action. The following criteria that qualify under conflicts of interest:

1. Unfair advantage: Providing information to a business that is bidding on work for the district. The information that is not accessible to the public would allow that business a better chance to win the bid.

2. Irreconcilable loyalties: Running a successful side business out of your house that is taking away some of your time to do your best work for the district. You are loyal to two different jobs but it is hurting your main job.

3. Potential for Conflict: Working for the district full time and doing some side construction work for a company trying to win a contract with the district. This could be a conflict as you work for the district and the company trying to win the bid.


Deposits/ Cash Management

West Des Moines Community School District uses a point of sale receipting system when entering cash, checks, and credit card payments. The school secretary will record collection of all revenue and apply the revenue against a student/non student record which will also apply the receipt to the correct GL account.

All monies collected in the classroom or on behalf of the District or a District related activity should be given to the building secretary at the end of the day and placed in a secure place until the deposit is made the next day.

No staff member should deposit funds in their own accounts OR store checks and/or cash in their classroom, home or car. Any funds collected on behalf of a student-related activity or event must be maintained in a secure place on school property. Monies collected for book club orders should be placed in an envelope and given to the building secretary to be placed in a secure place until the teacher is ready to place the order.

The money should be counted and placed in an envelope with the teacher’s name and dollar amount on the outside of the envelope along with the purpose of activity. The secretary will count the money and compare to the amount submitted for verification.

The money will then be prepared for deposit in the bank using the following steps:

1. Count all money and balance to the total of the calculation form(s).

2. Endorse all checks with endorsement stamp “For Deposit Only”. Make deposits daily, no matter the amount you have received. This ensures the money is deposited on a daily basis at the bank.

3. Since checks and cash are processed as separate deposits, run separate calculator tapes to confirm each total - checks, and coins/currency.

4. Electronically scan all checks for deposit. Checks must be kept in a secure place for 90 days. Shred checks over 90 days. Refer to attached check scanning procedures

5. Enter revenue into InTouch Receipting system as a bulk deposit.

6. The cash and one copy of the deposit slip will be placed in a locked bank bag. The delivery driver will collect the deposits and take to the bank daily.

7. The delivery driver will return the bank bag to the school and a copy of the cash deposit slips printed with the date and amount of deposit to Accounting Technician. The bank will notify the Business Office of any discrepancy, and the building secretary will be notified of any change.

DO NOT SEND ANY COIN OR CURRENCY TO THE BANK TO CORRECT A PREVIOUS DEPOSIT. ANY MONEY GOING TO THE BANK SHOULD INCLUDE A DEPOSIT TICKET, AND A RECEIPT SHOULD BE WRITTEN.

Make sure the keys to the bank are kept and locked in a secure place.


Electronically Scanning Checks

User ID: ALLCAPS Password: token number plus 4 digit pin Click Login.

Click on Deposit Capture in top left-hand corner. Enter dollar amount total. Store Number use school site number (for accounting is 009). Click on Create.

Stack checks by physical size of check, NOT $amount, largest on the bottom, smallest on top and RIGHT side and BOTTOM of checks aligned. Place checks in scanner slot with those aligned, right edges even with the white guide line on the scanner. Make sure scanner is turned ON. Click SCAN button.


After checks are scanned click Capture Complete when it pops up in a smaller box. This screen will then appear:

Look for:

• In the Deposit Information box, the Difference is $0.00

• Click on any pink boxes. They indicate missing or unread data. Make corrections then click update item.


• When everything is correct - there are no more pink boxes and the “difference” is $0.00, click on Submit Deposit.

This screen will appear:

Confirm the Deposit Status says submitted. Write the blue ID number and date on the daily deposit slip.

Place the checks in an envelope labeled with deposit ID, date and deposit amount. Store in secure place for 3 months. After 90 days, the checks may be shredded.


Activities and Athletic Cash Process

All District procedures and policies from the previous section pertain to monies collected at all District sponsored events including music and sports. Some additional requirements must be met while handling monies collected at events; selling tickets or otherwise charging admission.

One person at each ticket gate shall be responsible for counting the money received from ticket sales.

After counting the gate receipts at his/her gate, the responsible person will complete the Ticket Sales Reconciliation Form. The difference between beginning and ending ticket numbers will determine the number of tickets sold for both adults and students. The number of tickets sold multiplied by the price per ticket for both adult and student sales will give the amount the gate should have received.

The responsible gate person will then complete the balance of the form by counting the money. Record the bills by denomination, coins, and checks amounts on the ticket sales reconciliation form. The total of this section should then equal the calculated gate receipts after deducting the gate’s start up cash. Any differences should be noted on the form with an explanation. Finally, the responsible gate person should sign the count sheet.

The activities director or designee will collect each gate’s receipts and Reconciliation forms, recount money and verify the balance with tickets sales. A copy of the form will reside in the Activities Directors office or with the building principal.

The Activities Director will record the bulk deposit of cash, checks, and credit cards into the InTouch Receipting System.

The deposit will be processed in accordance with previous cash handling procedures, including placing the original of the deposit/count sheet in the locked money bag. If time of the event precludes recounting and preparing the deposit at that point, the monies may be taken to the bank night depository in locked bags, then picked up the next business day and processed for deposit as previously described. If that occurs, the delivery driver will pick up prepared deposit at the school facility and deliver to the bank.

After processing the deposit, the bank returns the Ticket Sales Reconciliation Form to the Business Office along with the Revenue Receipt Form and yellow deposit ticket copy. It will be verified and entered into the financial accounting system.

At random times the gate receipts may be counted by Business Office staff and verified with the Ticket Sales Reconciliation Form.



The Activities Director will maintain a current and correct inventory of all tickets by ticket number and by number of rolls.

The Activities Director will maintain an inventory of all items obtained for promotional sales. The same process as noted above will be used to balance the amount of sales against the different in the inventory balance compared to the amount of cash/checks/currency available for deposit. If items from the inventory are donated it should be recorded and deducted from inventory total. The building principal should be made aware of these donations. “Appreciation gifts” are NOT to be taken from inventory or purchased with ANY District funds, in keeping with rules established in the Procurement Card manual.

When completing the Revenue Receipt Form for gate receipts or any other deposit, the monies should be separated by project/function and the amounts listed for each. The total of these will equal the amount of the deposit listed on the bank deposit slip. The deposit can be for several events or projects but the Revenue Receipt Form must separate them by account number so the deposit is correctly credited to the correct sport/event.

Extra cash should NOT be kept on hand. Each event must submit a change request in the same manner as game bags. The startup cash amount for each event will vary with the amount of activity expected for that event

Plan ahead submit your cash bag request two weeks before event date.

Payments will be made in accordance with the District policy and guidelines as set forth in the Accounts Payable section of this manual.


Petty Cash

A petty cash fund has been established in each school facility. Funds for the Elementary Schools and Junior Highs are allowed each school year and will be distributed at the first Secretary’s meeting scheduled in August.

Elementary Schools, Junior Highs $50.00

Walnut Creek Campus $100.00

Valley High School $350.00

IMC/Print Shop $50.00

The fund must contain cash or receipts that total the amount of the petty cash fund at all times. The custodian of the fund is responsible for safekeeping of the fund and for the use of cash.

Schools keep a small amount of petty cash on hand. We recommend schools accept bills of denominations no larger than $20.00.

Petty cash funds are for infrequent and small purchases of generally less than $5 made on behalf of the district. Larger or recurring purchases should be handled via purchase order or procurement card. The petty cash fund should NOT be used as a bank. No personal checks should be cashed using these petty cash funds.

When replenishment is required, a Petty Cash Reimbursement Request (see attached example) should be submitted to the Business Office. That request is to be accompanied by all supporting cash receipts that have been paid from the petty cash fund, the total of which should match the amount being requested for replenishment. A check will be prepared in the normal Accounts Payable schedule. The Business Office will have the check cashed and the money will be delivered to the facility. This should reinstate the petty cash fund to the beginning level. It is suggested to ask for reimbursement before the funds are totally depleted.

Elementary schools and Junior Highs must submit a petty cash reimbursement request and process any remaining cash before the secretary leaves at the end of the school year, usually within a week of the end of school session. The remaining cash should be deposited into Account 10-8103 and processed just like a regular deposit.



Parents Online Payments

Student Fee Collection Guidelines Timeline

July 1, 2020 Students are “rolled forward” in Infinite Campus

July 15, 2020 Nutrition Department received direct certification information and notifies those parents who qualify for free meals. A fee waiver form is included in the mailing to parents. Fee waiver applications are processed by the Nutrition Department and 24 hours later, InTouch Receipting is updated upon approval.

July, 2020 2020-21 transportation and student fees are assessed in InTouch Receipting.

August and September, 2020 Free and Reduced applications, along with Fee Waiver, are processed for approval by the Nutrition Department.

October 1, 2020 Grace period for Free and Reduced lunch only for the 2019-20 school year expires.

October, 2020 Parents who have not paid their 2020-21 student fees are sent an invoice for payment.

June, 2021 Parents are sent final notice of unpaid fees. This notice includes a statement that any unpaid student fees will be turned over to a Collection Agency.

July, 2021 Unpaid student fee information is turned over to Collection Agency.

Notes

1. No 2020-21 student fees will be collected prior to July 1, 2020.

2. Bus passes will be provided to all students that apply. If a student has unpaid transportation fees they will not be able to ride the bus.

3. To implement consistent practices in collection procedures, parents will be notified three times for collection of unpaid balances. Parents will be notified by US Postal Services prior to the account being turned over to a collection agency to pursue collection of the outstanding fees.


Parent Online Payments

Parents will have online access to pay student fees and to deposit money in their student’s meal account through InTouch Receipting via credit card. The online system called Touchbase will show all outstanding fines and fees that are in InTouch

The payments page is available on the district website on the parent tab. A link to Online Payments is also listed in the toolbox on the right hand side of each school web page and the district website. Website: http://www.wdmcs.org/online-payments/.

TouchBase – WDMCS’ New Product for Online Payments

TouchBase is an online payment portal of our receipting system, InTouch. It offers a convenient way for parents to view student fees and/or fines and make school-related purchases with a credit or debit card - 24/7!

To access TouchBase, you will need an Infinite Campus Parent Portal account. If you don’t have one or are unsure of what it is, please call your student’s school office.


How Does It Work?

It’s like shopping online . . . you select items you want to “buy” and then click on the shopping cart to check out and pay. Parents are able to pay all basic student fees and fines at all grade levels, add money to lunch accounts, and pay for bus transportation. For our secondary students, even more options are available, such as purchasing PE clothing, yearbooks, supplies, etc. As we grow this product, so will our options.

And the best part? You can make payments and purchase items for all your students in one transaction!

Take a look at the screenshot below to see what else you can do in TouchBase:

As a parent/customer, you’ll be able to:

1. View products available for purchase online

2. Pay for fines and/or fees online

3. View open fines/fees

4. Print open fines/fees

5. Pay fines, fees, or purchase items for all your students in one transaction

6. View, print and/or save your student or customer history

7. View, print and/or save your receipts

8. Make donations And much more!

Who do I call if I have questions? If you need assistance with your account, we are happy to help you.

• If you need to set up an Infinite Campus account, please contact the main office of your child's school. The phone numbers for our schools is available here: http://www.wdmcs.org/district/our-schools/

• If you have questions about balances, payments, transaction fees, or other account-related questions, please call 633-5000 and ask for the Business Services Department regarding WDMCS Online Payments.

s Name Here


WDMCS Online Payments (TouchBase) – Creating Your Account

In order to use TouchBase, you will need to have an Infinite Campus user account. The username you use for Infinite Campus is the same username you will use for TouchBase. If you know you don’t have a user account in Infinite Campus or are unsure what your username is, please contact your student’s school office for help.

You will also need to activate your TouchBase account. Please follow the steps below to activate your account.

1. Open a web browser and go to: https://ia-westdesmoines.intouchreceipting.com/accountrecover.aspx to start the process of connecting to your account.

2. On the Identify Your Account page, enter your Infinite Campus username. This is the username you use to access the Parent Portal for Infinite Campus.

3. Click on the Search button. If TouchBase finds a match, the following pop-up will appear on your screen an email with a password reset link will be sent to the email address you have on record in Infinite Campus.

4. Open your email program to locate the email and

follow the steps. Once you set your password in TouchBase, you’ll be ready to use it!

Helpful Hint #1: If your student’s office personnel had to create an account for you or you are new to the district, it may take up to 24 hours for your Infinite Campus username to sync to TouchBase.

Helpful Hint #2: Your Infinite Campus password does not sync to TouchBase. You will need to create a new password for TouchBase. You can choose to use the same password, but you have to create it in TouchBase.


WDMCS Online Payments (TouchBase) – Making a Transaction

Our online payments portal is more than a place to make payments – we know that you’ll find it essential when managing your account or your student’s account.

TouchBase has been configured to use the following login credentials:

Username: your Infinite Campus username Password: the password you chose when you activated your account

account, you will see a RED notification button – this is your indicator to look at, and pay, any fines or fees assessed to your student’s account. There are many reasons why a fine or fee may be present on your account, and clicking on the View button will display the detail specific to your student.

Helpful Hint: If you have questions regarding a fine/fee assessed to your students account, please contact your student’s building.

students in the district, after you are logged in, you’ll be able to see all of the students who are associated with you. To

Once you’ve selected your student, specific to that student. particular screen is called the

T he most common tools you should

Fines and/or Fees may be

present on your student’s account.


B. Items at Students School is where you’ll go to browse items available to your student for purchase. This should look familiar to you if you’re familiar with online shopping. Once you’ve selected items in the webstore, you can view/edit your cart, or proceed to checkout.

C. Purchase History is an on-demand tool for you to use to track your purchase history. This allows you to confirm prior purchases or confirm payment was delivered by your student (or yourself) to the building.

D. Reprint Receipts is a tool that allows you to print a single receipt rather than your full payment ledger (Purchase History).

Purchasing Items 1. To start, click on the Items at Student’s School button. This will take you to a new page with categories (below is an

example list of categories). Click on the category to view the options available.

item to your shopping cart. Adding money to your student’s lunch account is similar . . . “buy” a preset amount for the Nutrition Deposit or scroll down to the bottom of the page and indicate your own amount.

Helpful Hint: To switch to a different category, use the navigation menu at the top of the option list and click on the button with your student’s school name.

2. Fines and fees are cannot be purchased as an item; rather they are assessed by the district and will

appear at the top of your student’s dashboard via the button. Click on that button to view the fines and

fees. To pay a fine or fee, click on the checkbox in the Select column, then click on

Below are examples of screenshots of what you may see when making purchases.


Buy

Sold Out

Pay Fines

Grade Restriction

Combination Items


Donation

3. When finished shopping, click at the top of the page. You will be redirected to the payment page.

4. If you are satisfied with your cart, click on. You may also click on

to add more items or to delete items out of your cart.

5. Enter your credit card information as requested on the payment screen. Any fields in red are

required information. Once filled in, click

6. These transactions are immediately available to both the parent as well as the school district.


Non-Sufficient Fund Checks (NSF)

NSF Procedures

West Bank sends notifications of NSF/returned checks to the Accounting office.

An Accounting Clerk makes a copy of the check and return sheet and enters the data into a spreadsheet: a log list of returned checks received and a list that includes the account number the check was originally deposited into, which now needs debited.

The Accounting Clerk attempts to perform the NSF procedure in InTouch. If the check was deposited individually, InTouch automatically reverses the deposit and creates a Journal Entry backing out the deposit and, if appropriate, reassigns the charge as a fine on the student’s account. If the check was part of a bulk deposit, InTouch is unable to perform the NSF processing.

In either case, the Accounting Clerk investigates to determine which building/office originally deposited the check, and informs that office of the return. If the NSF was processed through InTouch, the depositing office only needs to access the NSF fee. This is listed in InTouch Inventory under West Des Moines Schools (NOT under the specific sites). The item number is DWFISCL115.0355, Description is NSF Bank fees reimbursement. The charge is $30.

If the check was originally part of a bulk deposit, that site’s depositing office will need, not only to assess the NSF fee, but also to RE-assess the fee that was originally paid.

If the check was originally for a Nutrition Services lunch account, AND was part of a bulk deposit, the Accounting Clerk also notifies the Nutrition Services financial secretary who backs out the payment from their software (PrimeroEdge).

Beginning in the 2017-18 school year, the District will make several attempts to collect fees but, if unsuccessful, will turn over the information to a collection agency.

At the end of each month, the Accounting Clerk prints out the log spreadsheet pages and gives them, along with the copies of each of the returned items, to the Director of Business Services.


Purchase Order Procedures

If a purchase order is needed for a vendor

1. Complete the preliminary purchase order form identified by your school and have it approved by your administrator. Include vendor, items requested, account code and amount. On this form you will need to indicate whether you are using a P card or will be using a standard purchase order.

2. Create a purchase requisition in the IFAS financial system. Purchase Orders should include a description of what is being purchased, for what purpose or what program. Simply duplicating the contents of the invoice is not sufficient. See example A.

3. PO will go thru the electronic workflow process for approvals. Once all approvals are complete the PO will be emailed to you.

4. IFAS will email you a copy of the purchase order and it is your responsibility to mail, email, or fax the purchase order. Keep a copy for your records.

5. When the items have been received, go into the IFAS purchase order receiving screen and enter the receiving information. Example B-Keep a copy of all invoices, registration forms and emails with your copy of the purchase order. Email copies of the invoices/forms and PO to the Business Office ([email protected]) and payment will be processed.

6. You can find complete information on any PO including the payment date, check number and scan of the invoice in the IFAS report Purchases Order Status.

Please note beginning in the 19/20 year check request forms will no longer be used. All items must be submitted by PO for payment unless it is an employee mileage or expense form.

Example A Purchase Requisition Screen (POCSPR)


Example B Purchase Order Receiving Screen (POUPRC)


Central Store Inventory

Central Store orders are created using the Business Plus program. Before making purchases, review the Inventory Catalog to determine whether the item or like item is available. It is MANDATORY to use the Central Store first for site needs. If the Central Store cannot supply the item in a timely fashion, an outside vendor may be used. The catalog is updated periodically throughout the year. Site staff should be encouraged to utilize Central Store to take advantage of bulk discounts already received by the District.

A list of items available can be found on your Business Plus dashboard under the Stores Inventory reports link. Click on Inventory Catalog by Warehouse and Prod ID. This report can be printed out for reference.

Custodians will fill out a request form for items they wish to order.

Create a Central Store Order

Orders are created using the Business Plus accounting program. Click on the Create/Update orders link.

Enter the items, amounts and account codes. The prices will automatically fill in for you. The order needs to be approved by the secretary to send it thru workflow for supervisor approval. Once approved, the order will be filled by the warehouse and delivered to the site.

Questions on stores orders can be sent to John Weathers: [email protected]

mailto:[email protected]


Completing Leave of Absence Forms

All certified staff members will use the electronic leave form for requesting release time. When you need to be gone, please complete . . .

• AESOP and • Electronic leave form via Applitrack.

Please follow the directions below when completing the electronic leave form requesting release time. 1. Log into Applicant Tracking (Applitrack) via the link on the staff tab of the WDMCS website.

2. Go to the forms tab in the upper left corner of the screen

3. Click on New Form (note the following leave forms will be available): • Leave Request Form: Sick; Personal; Serious Illness; Bereavement; Demo Teacher; Athletics/Extra/Co-Curricular;

Jury; Parental Leave; Religious; Legal; Military; Veteran’s Day

• Leave Request Form: Association Leave – association leave

• Leave Request Form- HR Approval Needed: Leave request for the first 5 and last 5 days of student attendance; Leave request before/after a holiday; Absence Without Pay, adoption leave, or personal leave on a staff professional day.

4. Please complete form

5. When you have completed the form, click on the submit button. Workflow for Leave Request Form: Sick; Personal; Serious Illness; Bereavement; Demo Teacher; Athletics/Extra/Co-Curricular; Jury; Parental Leave; Religious; Legal; Military; Veteran’s Day

1. Certified staff member fills out the form – clicks submit 2. Secretary reviews form for accuracy – clicks submit 3. Supervisor/Principal responds to requests – clicks on approve or deny 4. Certified staff member is notified of approval

Workflow for Leave Request Form – Association Leave:

1. Certified staff member fills out the form – clicks submit 2. WDMEA President reviews – clicks on approve or deny 3. Supervisor/Principal responds to requests – clicks on approve or deny 4. HR Approval - clicks on approve or deny 5. Building notification 6. Certified staff member is notified of leave approval 7. Carol Rushing notified

Workflow for Leave Request Form- HR Approval Needed: Leave request for the first 5 and last 5 days of student attendance; Leave request before/after a holiday; Absence Without Pay, or personal leave on a professional development day

1. Certified staff member fills out the form – clicks submit 2. Secretary reviews form for accuracy – clicks submit 3. Supervisor/Principal responds to requests – clicks on approve or deny’ 4. HR Approval 5. Building Notification 6. Certified staff member is notified of approval

Please direct questions to Jesse Johnston the Director of Human Resources.


Reimbursement for Travel

In order to travel for the district, it is mandatory that the individual traveling will have a p-Card. Proper documentation of all receipts in accordance with the district’s travel policy and the agenda from the class/conference attended, registration confirmation emails do not fulfill this requirement. Airfare, conference registration, and hotel deposits may be paid directly by the district only when travel has been approved by an Administrator. All other costs associated with out-of-district travel will be paid using the p-Card. Note: Each employee is responsible for his/her own expenses.

A district p-Card MUST be used for: 1. Hotel 2. Rental Car (no rental car insurance, employees are covered by the district liability insurance when traveling on

behalf of the district.)

A district p-Card MUST be used for the following if the party traveling has a p-Card:

• Registration Fees • Parking • Tolls • Authorized Ground Transportation (if no rental car was approved) • Baggage Claim Fees • Hotel Internet Charges • Meals – The standard IRS rate per person per day, unless I.R.S. rules allow higher rate for larger city. If one p-

Card is used for several employees or student meals, please include the names of all attendees on the receipt. • Tips (limit 20%) • Gas for rental car (proof of rental car usage during dates of travel is required with itemized gas receipts.)

A district p-Card CANNOT be used for:

• Alcoholic beverages • Personal entertainment • Unauthorized car rentals • Gas for personal vehicle (mileage may be reimbursed at the approved rate per mile) • Personal expenditures • Airfare upgrades


Out of District Travel Procedures


INSTRUCTIONS ON MEAL ALLOWANCES/PER DIEM AMOUNTS

There are two ways to handle your meals during overnight travel. Whichever method you choose must be used for the entire trip.

Method #1 - You purchase all of your meals on your own and the district will reimburse you $22.50 per day on your travel days and $30.00 per day on all other days. If you select this method you do not have to turn in any receipts with your expense report...but you also can not use a district credit card to pay for these meals. Additionally if the conference pays for any of your meals, you must write PROVIDED on the meal space on your expense report and deduct the adjusted value of the meal from your daily total (see Table 1). For example, if you are traveling in an area where the per diem is $55.00 a day (Tier #1) and your conference provides breakfast and lunch one day, you would subtract $7.09 for breakfast and $7.64 for lunch, leaving you a total of $15.27 for dinner.

Table 1 (EFFECTIVE 10/1/18)

METHOD #1-OVERNIGHT TRAVEL/FULL DAYS-PROVIDED MEAL VALUES

TIER PER DIEM BREAKFAST LUNCH DINNER 1 $30.00 $7.09 $7.64 $15.27 2 $30.00 $6.96 $8.04 $15.00 3 $30.00 $6.89 $7.87 $15.25 4 $30.00 $7.27 $7.73 $15.00 5 $30.00 $7.18 $7.61 $15.21 6 $30.00 $7.11 $7.50 $15.39

METHOD #1-OVERNIGHT TRAVEL/DAY OF TRAVEL (75%)-PROVIDED MEAL VALUES


We don't track the amount per meal, only the amount per day

Any amount charged to the district credit card that exceeds the maximum allowable expense must be paid back to the district

Per Diem rates can be found at www.gsa.gov/portal/category/100120


INSTRUCTIONS ON MEAL ALLOWANCES/PER DIEM AMOUNTS

There are two ways to handle your meals during overnight travel. Whichever method you choose must be used for the entire trip.

Method #2 - You use your district credit card to purchase your meals and use up to your daily meal allowance for the area you are traveling to. If you select this method, you must turn in itemized receipts for each purchase (the receipts must show what you ate and drank). Additionally if the conference pays for any of your meals, you must write PROVIDED on the meal space on your expense report and deduct the IRS value of the meal from your daily total (see Table 2). For example, if you are traveling in an area where the per diem is $55.00 a day and your conference provides breakfast and lunch one day, you would subtract $13.00 for breakfast and $14.00 for lunch, leaving you a total of $28.00 for dinner.

Table 2 (EFFECTIVE 10/1/18)

METHOD #2-OVERNIGHT TRAVEL/FULL DAYS-PROVIDED MEAL VALUE


METHOD #2-OVERNIGHT TRAVEL/DAY OF TRAVEL (75%)-PROVIDED MEAL VALUE


We don't track the amount per meal, only the amount per day

Any amount charged to the district credit card that exceeds the maximum allowable expense must be paid back to the district

Per Diem rates can be found at www.gsa.gov/portal/category/100120


Harris Bank Travel Insurance

Beginning July 12 2019 the district credit card program will include embedded travel insurance.


Purchase Order Procedure for Harris Bank P-Cards

P-Card The procurement card (p-Card) is designed to eliminate the need for local purchase orders, reduce the need for employee reimbursements, and to assist the numerous small dollar purchases made by the district staff (petty cash). The p-Card is not designed to replace the purchase order process in general. Only one person is assigned a p-Card and the card is to be used for authorized purchases only. Please note the following items CANNOT be purchased with the p-Card:

• Personal items • Money orders • Gift cards • Drugs/narcotics • Firearms • Alcohol • Explosives • Salaries, wages, benefits

Purchase Order Procedure for Harris Bank p-Cards

Purchase orders for Harris Bank procurement cards are created after you have received the monthly statement. The statements can be printed on the 21st of each month. Example C shows the exact way a Harris Bank purchase order must be created. It is important that on the description field you put the name of the vendor first, then the card holder name and then the date of the transaction. Following the line in the description enter the information as to the purpose of the purchase. The purchase orders will go thru the electronic approval process and then emailed by the Business Office. A copy of the purchase order will be returned to the secretary for their records. Go to the Business Plus receiving screen, update the purchase orders to “received” status. Attach ALL backup for each transaction to a copy of the statement and send the documentation to the Business Office by the last day of the month. It is the secretary’s responsibility to ensure all p-Card rules have been followed and complete documentation is included in the backup sent to the Business Office.


P-Card purchase order procedure for credit card statements

(Harris Bank holds our p-card account)

If you are doing a PO to Harris Bank & have multiple stores where items were purchased please do the following:

1) In the description field put the name of the store the items were purchased from with an asterisk (*) afterwards. Then list the employee’s name that purchased the products and the date and description of purchase. PO total should match statement amount. If statement amount is a negative you will need to add the credit to another PO that can cover the cost. Line entry would be per store, per receipt, per line. Example as follows if I had three receipts:

By putting the store name first you’ll be able to do a report (by description) so you can drill down & see the receipt/invoice with the breakdown of all the items purchased. Having the teachers name will eliminate (or narrow down) having to look through all the TARGET’S that you’ve done during the school year. Then once you found the teachers name you can drill down to see the items purchased.

**HELPFUL REMINDER – BE CONSISTANT WHEN ENTERING IN IFAS**


Mileage Reimbursement Form

The District reimburses the Internal Revenue Service standard mileage rate. Beginning January 1, 2020, the standard mileage rate for the use of a car, van, pick-up or panel truck will be 57.5 cents per mile for business miles driven. Electronic mileage reimbursement forms are available on the district K: drive. Hand written forms will not be accepted. This amount can change every year. Make sure to get the new form from the K drive at the beginning of the year.


Equipment Breakdown Insurance

EQUIPMENT BREAKDOWN INSURANCE: THE REMI GROUP

Sandra James is the district equipment breakdown insurance coordinator.

When equipment breaks down, the Secretary will contact the vendor directly and set up the service call. Give the name “Sandra James” as the PO number. Ask the vendor to email the invoice to [email protected]

Librarians will set up the service call for laminators and follow the same process as listed above.

Marcia Sims will set up the service calls for the laminators and equipment at the IMC and follow the same processes as above.

Sandra will handle the invoicing processes.

CASH OUT OPTIONS:

If an item cannot be repaired we can request a “cash out” from Remi to help replace the item.

Documentation needed for that is something in writing from the Vendor that states the reason the equipment cannot be replaced and a quote of what it would cost for a new item. Forward those documents to Sandra James via email and she will handle the rest of that process. We can also ask for a “cash out” option if an item would be too expensive to repair. Documentation needed for that is a quote of what it would cost to repair the item and a quote of what it would cost to replace the item. Forward those documents to Sandra James via email and she will handle the rest of that process. If Remi agrees to a “cash out” option, they will cover a portion of the cost and your building will be responsible for the remaining cost. Sandra will communicate with you through the process.



Mail Services

Mail Services is an automated barcoding and presorting specialist. Customers save money in postage costs utilizing the Full Service Intelligent Mail barcode to allow presorting mail. In addition to saving costs, barcoding and presorting expedite mail delivery. For both flat and letter-sized mail pieces, Mail Services delivers the mail directly to the post office where it is given priority treatment, bypassing several processing steps. Most mailers cannot achieve the sheer volume required to qualify for USPS postage discounts. Mail Services combines its customers total mail count, resulting in postage savings for all presort customers. If you have questions about a specific mailing contact our account manager:

Christina Kruzich

Phone Number: 515-727-7745

Email: [email protected]


Mail Services

Instructions for USPS Outgoing Mail Mail Services will pick up daily from OPS and LRC

General Information

• No handwritten envelopes. • Incomplete or no piece count forms – the mail will be returned to the school/department. • The Mail Services piece count form is stored on the K: Drive, ADM-Srv-Public, MAILINGS. • A valid account key must be used, please verify your code is correct. • Please notify John Weathers or Peg Riddle if you add a new account key. • Mail Services requests we use white envelopes for everything; including 9x12, 10x13, etc. As you replace your stock, please order

white for USPS mail. • If you have a large mailing that does not fit in your yellow bag, let John Weathers know and he will get you a tray.

Mail Services Piece Count Form

• Please complete the Account # field using your account key. Do not include the object code, all account keys should have the 0531 object code.

• Fill in the current date and sign the form. • All mail will be sent first class unless you request a “bulk” mailing which is labeled “Standard Class” on the form. Refer to the

section below describing what qualifies as “bulk” mail. • Please fill out a different form for each size of envelope and if they are sealed or unsealed envelopes.

Mail Trays (LRC and OPS) Yellow Bags (Schools)

• Rubber band together all mail belonging to the same account key along with the Mail Services piece count form, or if there is enough mail to fill a tray, place it in the tray along with the Mail Services piece count form.

• Make sure the piece count form has the date and customer signature visible when attached to mail with rubber bands. • All mail should be unsealed with flaps up. If you have sealed or form envelopes those are placed at the front of the tray. • All Foreign Mail (Canadian, Mexican, Overseas) should be placed on the side of the mail tray.

Mail Tubs (LRC and OPS) Yellow Bags (Schools must be banded separate from mail tray items listed above)

• Already stamped or postage paid (rubber banded together) • Postcards • Large envelopes (6x9, 9x12, 10x13) • Small Parcels (boxes) • Priority

Standard Class or Bulk Mail

• The information in the mailing cannot contain any personal or confidential information, i.e., grade, bus routing information, studen information. Examples that would qualify are general registration letter and blank forms, information letter to all staff or parents.

• Indicate this by placing an “x” in the Standard Class box. • Enter information in the “Material Description, # of boxes (trays), Qty per Box (tray), Total Qty.

Supply Area (for the LRC and Warehouse staff only)

• Complete this area to get replacement trays, tubs, etc. All requests will be filled by Mail Services the next business day. Please call Peg Riddle x5081 or John Weathers x4930 with any questions.




Technology Purchases

Electronic equipment can be purchased by any school through the normal purchase order system or by using a p-Card at any vendor selling electronic equipment items. Here are the object codes to use for technology purchases:

• 0655 electronic equipment < $500 • 0734 electronic equipment $500 and greater • 0652 software

Print Shop and Building Copiers

The district contract for Print Shop and building copiers has been renewed with LRI Laser Resources. Our district Print Shop will continue to be run and managed by LRI Laser Resources.

Print Groove software will be replaced. A new website will be launched providing staff the ability to send print jobs to the Print Shop.

All building copiers across the district have been replaced during the summer of 2015. All replacement copiers will have increased capacity over the existing models and all new models will work off your employee badge as they currently do. The new copiers will be either a Toshiba or a Lexmark, depending on the prior usage of each specific copier. Copier location remains exactly the same as last school year.

Starting July 1, 2015, all certified staff will receive $25 on their employee badge that is available for usage at the building copiers. Certified staff will also receive $75 on their account at the Print Shop.


SPED Purchases



Gifts, Grants, and Bequests

Board Policy Code No. 703.06

The Board believes gifts, grants, and bequests to the school district may be accepted when they will further the interests of the school district. The Board will have sole authority to determine whether the gift furthers the interests of the school district. Gifts, grants, and bequests are approved by the Board. Gifts, grants, and bequests once accepted on behalf of the school district become the property of the school district. Gifts, grants, and bequests are administered in accordance with terms, if any, agreed to by the Board.

Records – PTO/ Booster/ Foundation Requirements

GASB 39

The Governmental Accounting Standards Board (GASB) statement #39 requires the district to evaluate every organization that is legally a separate tax-exempt entity, but raises and holds funding for the direct benefit of the school district. The implementation of Statement #39 does not change the relationship or control the district has over the organization. It does require the organization’s financial information to be reported within the district’s annual audited financial report as a separate column if the assessment determines a specific financial threshold has been reached.


Property & Liability Insurance

The district purchases comprehensive property and liability coverage that extends to all district owned property. Anytime a staff member encounters an event where district property is damaged the incident should be reported immediately to the building supervisor, who in turn, will participate in filing the proper forms and notification to the Benefits Advisor and Chief Financial Officer of the district.

Frequently asked questions about the district insurance coverage:

1. Any personal property a staff member brings into a district facility is NOT covered for loss by district property insurance.

2. An approved volunteer (anyone who is asked to perform a district task and who signs into the log in the building) IS covered by district liability insurance in the performance of their duties as long as they are not breaking the law while doing these tasks.

3. A staff member who is authorized (by their supervisor) to use their vehicle to perform an assigned task will be covered by district insurance should an accident occur.

4. District insurance will defend any staff member in court who was performing their assigned tasks in a reasonable and prudent way against litigation.

5. Liability coverage extends to officers of the district for decisions made while acting in their official capacity.

Student Incident Report

A student incident report is filed by any employee that witnesses a student becoming injured. Completed reports are to be sent to the Benefits Advisor in the Administrative Services department. If the student accident is a 911 emergency and an ambulance has been dispatched to the scene, contact Human Resources at 633-5162.

All available information should accompany the Student Incident Report form, including date of birth, parent name, address and phone number. An EMC adjuster will contact the Benefits Advisor if there is additional information required.



Workers’ Compensation Procedures

When a work injury occurs, it is important to make sure the employee gets the best care as soon as possible to ensure the best recovery. If you sustain an injury arising out of your employment, follow these procedures: • Get first aid promptly or call 911 (9-911 from school phone), if it is an emergency. • Report the injury to your immediate supervisor or principal/designee on the day of the incident. As soon as the injury is reported, the injured worker and his or her supervisor should call the SFM Work Injury Hotline, (855) 675-3501, together. If a supervisor isn’t immediately available, the employee should call the Hotline. For additional information or for district questions about Workers’ Compensation, contact Carol Seid, Human Resources, LRC at 633-5037.


Contracts and Agreements

Only the Board President can sign contracts and agreements. It is each administrator’s responsibility to bring contracts and agreements to the Board of Directors for approval. Here are the steps to achieving contract approval:

• Submit all new or revised contracts to district legal counsel for review. Allow 2-3 weeks for this review. Contract renewals with date and cost changes do not require a lengthy review. Communicate the change in contract language to both the district attorney and the vendor.

• Contact information: Beth Grob at Ahlers & Cooney: (515) 243-7611

• If insurance language is included in the contract – liability coverage, etc., submit insurance language to the district insurance agency for review.

• Contact information: Val Eide, INSPRO Insurance: [email protected]

tel:%28515%29%20243-7611



Board Agenda Item Submission Process



Payroll and Benefits

All hourly and substitutes are required to use the electronic time clock system, TimeClock Plus. All hours should be edited and approved by the building supervisor, principal, or manager one pay cycle prior to the payroll date. All hourly employees leave of absences are recorded in TimeClock Plus.

If an hourly employee works in a position other than their normal assignment, he/she must either use the time clock’s “job code” button to enter the different position or report to their manager that the shift’s job code needs to be edited. Unless an established part of the employee’s regular job, any such extra work, will be paid at the substitute rate of the different position, as outlined in the wage scale of the current annual WDMESP agreement. Before and After School programs will be paid at $30 per hour if the employee has a valid teaching certificate. All other employees will be paid their normal hourly rate.

Additional Teacher Compensation

Teachers who work outside the contract day will receive $30 per hour. Teachers who cover classroom time will receive $18 per hour. For either type of work, teachers must prepare timesheets and submit those to their administrator for approval. Before submission to payroll, the timesheet must include all of the following:

• Signature of employee • Employee ID or last 4 digits of his/her SSN • Dates worked • Start time and end time • Total hours worked per time and grand total for the timesheet • Valid account number from which the work is to be paid • Signature of appropriate administrator(s). The employee’s direct administrator and the administrator

responsible for the account number being charged. Salaried Leaves of Absence

All salaried employees submit leaves of absence into AESOP. Leave balances are transferred to the HR/Payroll Business Plus by the Human Resources department. Leave of absence information is processed in Human Resources and sent to payroll one month in arrears.

Employee Payroll Records

Changes in an employee’s name, address, tax information or medical/dental insurance that effect payroll processing must be submitted within 4 days of the upcoming pay date.


Pay Dates

Certified and Salaried Employees Teachers, Administrators, Supervisors

Payroll Dates 2020/2021

Pay days are on the 5th and 20th of the month. If these dates are a holiday or weekend the employees are paid on the business day before.

HOURS

WORKED CHECK DATE FROM THROUGH 7/1/20 7/15/20 7/2/20 7/16/20 7/31/20 7/20/20 8/1/20 8/15/20 8/5/20 8/16/20 8/31/20 8/20/20 9/1/20 9/15/20 9/4/20 9/16/20 9/30/20 9/18/20 10/1/20 10/15/20 10/5/20

10/16/20 10/31/20 10/20/20 11/1/20 11/15/20 11/5/20

11/16/20 11/30/20 11/20/20 12/1/20 12/15/20 12/4/20

12/16/20 12/31/20 12/18/20 1/1/21 1/15/21 1/5/21 1/16/21 1/31/21 1/20/21 2/1/21 2/15/21 2/5/21 2/16/21 2/29/21 2/19/21 3/1/21 3/15/21 3/5/21 3/16/21 3/31/21 3/19/21 4/1/21 4/15/21 4/5/21 4/16/21 4/30/21 4/20/21 5/1/21 5/15/21 5/5/21 5/16/21 5/31/21 5/20/21 6/1/21 6/15/21 6/4/21 6/16/21 6/30/21 6/18/21 7/1/21 7/15/21 7/2/21


Hourly Employees Non-Unit, Hourly, Substitutes

Payroll Dates 2020/2021

Employee Benefits The following schedule shows the pay dates that benefits will be deducted from 9-10 month employee paychecks. Pay days are on the 5th and 20th of the month. If these dates are a holiday or weekend the employees are paid on the business day before.

HOURS

WORKED CHECK DATE Benefit deduct FROM THROUGH for 20-pay EE 6/1/20 6/15/20 7/2/20 6/16/20 6/30/20 7/20/20 7/1/20 7/15/20 8/5/20 7/16/20 7/31/20 8/20/20 8/1/20 8/15/20 9/4/20 8/16/20 8/31/20 9/18/20 9/1/20 9/15/20 10/5/20 Benefits 9/16/20 9/30/20 10/20/20 Benefits 10/1/20 10/15/20 11/5/20 Benefits

10/16/20 10/31/20 11/20/20 Benefits 11/1/20 11/15/20 12/4/20 Benefits

11/16/20 11/30/20 12/18/20 Benefits 12/1/20 12/15/20 1/5/21 Benefits

12/16/20 12/31/20 1/20/21 1/1/21 1/15/21 2/5/21 Benefits 1/16/21 1/31/21 2/19/21 Benefits 2/1/21 2/15/21 3/5/21 Benefits 2/16/21 2/28/21 3/19/21 Benefits 3/1/21 3/15/21 4/5/21 Benefits 3/16/21 3/31/21 4/20/21 4/1/21 4/15/21 5/5/21 Benefits 4/16/21 4/30/21 5/20/21 Benefits 5/1/21 5/15/21 6/4/21 Benefits 5/16/21 5/31/21 6/18/21 Benefits 6/1/21 6/15/21 7/2/21


Electronic Time Clock

There are electronic time clocks located in each building. In addition, employees can clock in/out via computer at this link: https://128406.tcplusondemand.com/app/webclock/#/EmployeeLogOn/128406/1 . For their "Badge/ID Number", they can key in either the first set of numbers printed on the back of their badge or their Employee ID number found on their check stub, replacing the "E" with a 3. The 2 numbers should both work interchangeably. There is no need for a Pin Number; leave that blank.

https://128406.tcplusondemand.com/app/webclock/#/EmployeeLogOn/128406/1


Benefits Guide

















Benefit Notices (Various)

Notice of Privacy Practices MEDICAL PLAN, DENTAL PLAN, DELTA VISION PLAN, MEDICAL AND DEPENDENT CARE FLEX PLAN, AND EMPLOYEE & FAMILY RESOURCES’ EMPLOYEE ASSISTANCE PROGRAM PRIVACY PRACTICES NOTICE: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US. Our Legal Duty We are required by applicable federal and state law to maintain the privacy of your medical information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect August 1, 2012, and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and send the new notice available to our health plan subscribers at the time of the change. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice. Uses and Disclosures of Medical Information We may use and disclose medical information about you for the following purposes and situations: Treatment: We may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you. Payment: We may use and disclose your medical information to pay claims from physicians, hospitals and other providers for services delivered to you that are covered by your health plan, to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to obtain premiums, to issue explanations of benefits to the person who subscribes to the health plan in which you participate, and the like. We may disclose your medical information to a health care provider or entity subject to the federal Privacy Rules so they can obtain payment or engage in these payment activities. Health Care Operations: We may use and disclose your medical information in connection with our health care operations. Health care operations include:

• rating our risk and determining our premiums for your health plan; • quality assessment and improvement activities; • reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance,

conducting training programs, accreditation, certification, licensing or credentialing activities; • medical review, legal services, and auditing, including fraud and abuse detection and compliance; • business planning and development; and • business management and general administrative activities, including management activities relating to privacy, customer

service, resolution of internal grievances, and creating de-identified medical information or a limited data set. We may also


disclose your medical information to another entity which has a relationship with you and is subject to the federal Privacy Rules, for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.

On Your Authorization: You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any reason except those described in this notice. To Your Family and Friends: We may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. We may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care. Before we disclose your medical information to a person involved in your health care or payment for your health care, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest. To Your Employer or Organization Sponsoring Your Group Health Plan: We may disclose your medical information and the medical information of others enrolled in your group health plan to the employer or other organization that sponsors your group health plan to permit the plan sponsor to perform plan administration functions. We may also disclose summary information about the enrollees in your group health plan to the plan sponsor to use to obtain premium bids for the health insurance coverage offered through your group health plan or to decide whether to modify, amend or terminate your group health plan. The summary information we may disclose summarizes claims history, claims expenses, or types of claims experienced by the enrollees in your group health plan. The summary information will be stripped of demographic information about the enrollees in the group health plan, but the plan sponsor may still be able to identify you or other enrollees in your group health plan from the summary information. Disaster Relief: We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. Public Benefit: We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:

• as required by law; • for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to

employers regarding work-related illness or injury; • to report adult abuse, neglect, or domestic violence; • to health oversight agencies; • in response to court and administrative orders and other lawful processes; • to law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths,

crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;

• to coroners, medical examiners, and funeral directors; • to organ procurement organizations; • to avert a serious threat to health or safety; • in connection with certain research activities; • to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities; • to correctional institutions regarding inmates; and • as authorized by state worker’s compensation laws.

Health Related Services: We may use your medical information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. We may disclose your medical information to a business associate to assist us in these activities. Individual Rights


Access: You have the right to look at or get copies of your medical information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your medical information. You may also request access by sending us a letter to the address at the end of this notice. If you request copies, we will charge you a cost-based fee for staff time to locate and copy your medical information, and postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your medical information in that format. Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities, since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information. If you request this accounting more than once in a 12month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure. Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing. Confidential Communication: You have the right to request that we communicate with you about your medical information by alternative means or to alternative locations. You must make your in request writing, and you must state that the information could endanger you if it is not communicated in confidence as you request. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to collect premiums and pay claims under your health plan, including issuance of explanations of benefits to the subscriber of the health plan in which you participate. An explanation of benefits issued to the subscriber for health care that you received for which you did not request confidential communications or about the subscriber or others covered by the health plan in which you participate may contain sufficient information to reveal that you obtained healthcare for which we paid, even though you requested that we communicate with you about that health care in confidence. Amendment: You have the right to request that we amend your medical information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended and the originator remains available or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this notice in written form. Questions and Complaints If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.


Contact Office: West Des Moines Community School District ATTN: Paul Bobek, Chief Financial Officer 3550 Mills Civic Parkway West Des Moines, IA 50265 (515) 633-5075 (515) 633 -5098 FAX [email protected] # 689905.1 K/Benefits Info/WDMCS Notice of Privacy Practices 2017-18


Health Insurance Portability and Accountability Act (HIPAA)

A. Pre-existing Condition Limitations We waive the pre-existing condition clause for medical coverage options.

B. Certificates of Credible Coverage We will generate a certificate upon request when a termination date is entered for a member. Credible coverage time for a pre-existing condition can be transferred from one insurance carrier to another.

C. Nondiscrimination Provisions We will not establish rules for eligibility based on the following: - Health status - Medical condition (both physical and mental illness) - Claims experience - Receipt of health care - Medical history - Genetic information - Evidence of insurability (including conditions arising from domestic violence) - Disability

D. Enrollment

Enrollment may occur at the initial eligibility period, open enrollment scheduled for the 2017-2018 plan year, or special enrollment. Special enrollment may allow employees and dependents to enroll within 30 days (unless otherwise specified) of the following qualifying events: 1. A loss of eligibility for group coverage under another plan due to: - Legal separation - Divorce/annulment/dissolution of marriage - Death - Termination of employment (spouse) - Reduction of work hours - Significant change in employer contributions toward coverage - Termination of COBRA benefits - Loss of Title XIX/Hawk-I benefits (60 day period to enroll) - Employee/employee’s spouse loses dependent coverage under parent’s plan due to turning age 26 2. A change in family status due to: - Marriage/meeting domestic partner requirements - Birth of a child (60 day period to enroll) - Adoption or placement for adoption of a child (60 day period to enroll) 3. A change in job status: - Part-time to full-time eligibility - Full-time to part-time eligibility - Returning from leave of absence

Special enrollment is not available if the previous coverage loss resulted from fraudulent activity or because the member did not pay premiums. K/Benefits forms /HIPAA LIST–WDMCS on Letterhead 2017-18


General Notice of COBRA Continuation Coverage Introduction You’re getting this notice because you recently gained coverage under the West Des Moines Community School District Medical Plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. Both you and your spouse should take the time to read this notice carefully. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the West Des Moines Community School District Benefit Office at 3550 Mills Civic Parkway, West Des Moines, Iowa 50265-5556, (515)633-5076. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan for the following qualifying events:

• Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse.


Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events. For the West Des Moines Community School District Medical Plan, the employer and the plan administrator are the same.

• The end of employment or reduction of hours of employment; • Death of the employee; • Commencement of a proceeding in bankruptcy with respect to the employer; or • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 30 days after the qualifying event occurs. You must provide this notice to the West Des Moines Community School District Benefit Office, 3550 Mills Civic Parkway, West Des Moines, IA 50265-5556, (515) 633-5076. How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. For the West Des Moines Community School District Medical Plan, the employer and the plan administrator are the same. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. A copy of the Social Security Administration Disability Award Letter/Determination must be sent to: West Des Moines Community School District Benefits Office, 3550 Mills Civic Parkway, West Des Moines, Iowa 50265-5556. If the Social Security Administration’s disability determination was made previous to the start of COBRA continuation coverage, then a copy of the Social Security Administration Disability Award Letter/Determination must be furnished on or before the COBRA continuation coverage commences. If the Social Security Administration’s disability determination is made on or before the 60th day of COBRA continuation coverage, then a copy of the Social Security Administration Disability Award Letter/Determination must be furnished not later than 65 days after the determination is made.

Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to West Des Moines Community School District, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.


Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. For the West Des Moines Community School District Medical Plan, the employer and the plan administrator are the same. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information Group Health Plan Name: West Des Moines Community School District Medical Plan Address: West Des Moines Community School District Benefits Office 3550 Mills Civic Parkway West Des Moines, Iowa 50265-5556 Phone: (515) 633-5076 Fax: (515) 633-5098 /Benefits Info/OBRA General Notice 17-18 on Letterhead

http://www.healthcare.gov/


Notice of Coverage Options – Health Insurance Marketplace When key parts of the health care law took effect in 2014, there was a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace began in November 2016 for coverage starting January 1, 2017. Open Enrollment for 2018 will begin in November 2017. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution (as well as your employee contribution to employer-offered coverage) is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about the coverage offered by your employer, please check your summary plan description or contact: Name: Kris Craig 515-633-5076 Email: [email protected] 1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.



Information about Health Coverage Offered by Your Employer:

West Des Moines Community Schools, 3550 Mills Civic Parkway, West Des Moines, IA 50265

EIN 42-6004027

Here is some basic information about health coverage offered by your employer: As your employer, we offer a health plan to all eligible employees who work 30 or more hours per week and we also offer dependent coverage to these employees.

This coverage meets the minimum value standard, and the cost of the coverage to you is intended to affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or of you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.


Notice To West Des Moines Community Schools Medical Plan Participants

Under a Federal law known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, as amended, group health plans must generally comply with the requirements listed below. However, the law also permits State and local governmental employers that sponsor health plans to elect to exempt a plan from these requirements for any part of the plan that is “self—funded” by the employer, rather than provided through a health insurance policy. West Des Moines Community Schools has elected to exempt the West Des Moines Community Schools Medical Plan from the following requirements:

Parity in the application of certain limits to mental health benefits. Group health plans (or employers that employ more than 50 employees) that provide both medical and surgical benefits and mental health or substance use disorder benefits must ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements and treatment limitations applicable to substantially all medical and surgical benefits covered by the plan.

It is important to note that the inpatient stay and outpatient visit limitations on mental health and substance abuse benefits have been removed from our medical plan, effective July 1, 2010. Additionally, mental health and substance abuse benefits have the same deductible, coinsurance, and copay requirements as other medical and surgical benefits covered by the plan. West Des Moines Community Schools has filed the exemption because the plan designs currently do not meet the actuarial parity testing requirements as written in the final regulations.

The exemption from these Federal requirements will continue to be in effect for the 2018-19 plan year, beginning July 1, 2018 and ending June 30, 2019. The election may be renewed for subsequent plan years.

HIPAA also requires the Plan to provide covered employees and dependents with a “certificate of creditable coverage” when they cease to be covered under the Plan. There is no exemption from this requirement. The certificate provides evidence that you were covered under this Plan, because if you can establish your prior coverage, you may be entitled to certain rights to reduce or eliminate a preexisting condition exclusion if you join another employer’s health plan, or if you wish to purchase an individual health insurance policy.

If you have questions concerning this exemption, please contact Kris Craig at 515-633-5076

K/Benefits Info/WDM MHPAEA Exemption 2018-19


MHPAEA Exemption Notice—ER

Name of Plan: West Des Moines Community School District Medical Plan Plan Sponsor: West Des Moines Community School District Address: 3550 Mills Civic Parkway – West Des Moines, IA 50265 EIN: 42-6004027 Plan Year:

July 1, 2018, through June 30, 2019

Plan Administrator: Wellmark Blue Cross and Blue Shield of Iowa Address: 636 Grand Avenue – Des Moines, IA 50309 The West Des Moines Community School District Medical Plan is not provided through insurance. The West Des Moines

Community School District elects under authority of section 2721(b)(2) of the Public Health Service (PHS) Act, and 45 CFR 146.180 of Federal regulations, to exempt the District’s Medical Plan from the following requirements of title XXVII of the PHS Act:

Parity in the application of certain limits to mental health benefits.

Please note: The District’s Medical Plan has removed all stay and visit limitations related to mental health and substance abuse benefits, as well as provide coverage at the same deductible, coinsurance and copay levels as other medical services. The plan is filing exemption from the additional actuarial parity testing requirements as written in the interim final regulations issued on February 2, 2010.

This election has been made in conformity with all rules of the plan sponsor, including any public hearing, if required. I certify that the undersigned is authorized to submit this election on behalf of the District’s Medical Plan. A copy of the notice to plan enrollees is enclosed. If CMS has any questions regarding this election, please contact Paul Bobek at (515)633-5075.

Signed by West Des Moines Community School District:

Paul Bobek

CFO, West Des Moines Community School District

K/Benefits FORMS/Notices/WDM MHPAEA Exemption - ER


Health Care Notices Women’s Health and Cancer Rights Act of 1998

In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This Notice informs you of the federal regulation that requires all health plans that cover mastectomies to also cover reconstruction of the removed breast.

For members receiving mastectomy-related benefits, coverage will be provided, in a manner determined in consultation with the attending physician and patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance;

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductible and coinsurance applicable to other medical and surgical benefits provided under this plan.

Newborns' and Mothers' Health Protection Act of 1996

The District’s Medical Plans do not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, the mother's or newborn's attending provider, after consulting with the mother, may discharge the mother or her newborn earlier than 48 hours (or 96 hours as applicable). Our plan does not require that a provider obtain authorization from the plan for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Michelle’s Law

Michelle’s Law provides that group health plans and group health insurers must continue coverage for up to one year for dependent college students who take a leave of absence from school or experience a change in enrollment status that:

• commences during a serious illness or injury,

• is medically necessary, and

• causes the dependent child to lose student status for purposes of the plan.

The Plan may require written certification from a treating physician before the child is entitled to continue his coverage. A medically necessary Leave of Absence entitles the child to the same benefits as enrolled in immediately before the leave. If changes are made to the plan during the leave, the child is entitled to the changed coverage. Coverage will continue until the earlier of:

• one year from the date the medically necessary Leave of Absence began, or

• the date coverage would otherwise terminate under the plan.

Notice of Grandfathered Health Plan Status


West Des Moines Community School District believes this Wellmark Alliance Select plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.

Being a grandfathered health plan means that your Wellmark plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator, Kris Craig at 633-5076.

HIPAA HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) – THE HIPAA PRIVACY RULE WAS ISSUED TO PROTECT THE PRIVACY AND CONFIDENTIALITY OF PERSONAL HEALTH INFORMATION. THE WEST DES MOINES COMMUNITY SCHOOL DISTRICT IS VERY COMMITTED TO THIS LAW. IN ORDER TO BEST COMPLY WITH THE LEGISLATION, WE ASK THAT YOU DIRECT ALL YOUR PERSONAL HEALTH QUESTIONS/CLAIMS TO THE TOLL FREE NUMBER ON THE BACK OF YOUR INSURANCE CARD. YOUR INSURANCE CARRIER IS THE BEST SOURCE TO DIRECTLY RESOLVE YOUR CONCERNS/QUESTIONS. QUESTIONS REGARDING HIPAA SHOULD BE DIRECTED TO DONNA BEERMAN, THE HIPAA COMPLIANCE OFFICER FOR THE WEST DES MOINES COMMUNITY SCHOOL DISTRICT AT 633-5078.

If you have questions regarding the information contained in this document, please contact the WDMCS Benefits Office at 633-5076.

K/Benefits Info/2015-16 Benefits Notice, Meetings and Forms/Required Notices/Health Care Notices 15-16


Medicaid and the Children’s Health Insurance Program (CHIP)

Free or Low-Cost Health Coverage to Children and Families

Premium Assistance under Medicaid and the

Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

http://www.healthcare.gov/

http://www.askebsa.dol.gov/


If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2017. You should contact your State for further information on eligibility –

Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

You should contact your State for further information on eligibility –

Iowa – Medicaid

Website: http://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp

Phone: 1-888-346-9562

To see if any more States have added a premium assistance program since January 31, 2015, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor U.S. Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare & Medicaid Services

www.dol.gov/ebsa www.cms.hhs.gov

1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

K/Benefits Info/2017-18 26.7 Chip Medicaid and the Children

http://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp

http://www.dol.gov/ebsa

http://www.cms.hhs.gov/


Medicare Part D Creditable Coverage Notice

Important Notice About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with West Des Moines Community School District and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage

if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. West Des Moines Community School District has determined that the prescription drug coverage offered by the

Wellmark Alliance Select plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

More information available on Pages 2-3.


When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current West Des Moines Community School District coverage will not be affected. Calendar year deductible: $50 per person/ $100 per family Copayment:

$5 for Tier 1 medications (most generic drugs)

$20 for Tier 2 medications (selected brand name and branded generic drugs). $45 for Tier 3 medications (other than brand name drugs).

See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible

Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D.

If you do decide to join a Medicare drug plan and drop your current West Des Moines Community School District coverage, be aware that you and your dependents will not be able to get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with West Des Moines CSD, and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join.


For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through West Des Moines Community School District changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the

“Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare &

You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: 3/22/18 Name of Entity/Sender: West Des Moines Community Schools Contact--Position/Office: Kris Craig, Benefits Adviser Address: 3550 Mills Civic Parkway, West Des Moines, IA 50265 Phone Number: 515.633.5076

CMS Form 10182-CC Updated March 28, 2018

http://www.medicare.gov/

http://www.medicare.gov/

http://www.socialsecurity.gov/

http://www.socialsecurity.gov/


Your Rights & Responsibilities Wellmark Blue Cross and Blue Shield believes it is important for you to understand your health care coverage and the rights you have as a user of our services. This is a summary of your rights and responsibilities when you apply for health insurance coverage. If you have questions, talk to your authorized Wellmark representative, or visit www.wellmark.com.

Genetic Information Nondiscrimination Act (GINA) Do not include any family medical history or any information related to genetic testing, genetic services, genetic counseling or genetic disease.

Special Enrollment Notice

If you are declining enrollment for yourself or your dependents (including your spouse or domestic partner) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within the timeframes noted below:

Event Grandfathered and Pre-2014 Non-Grandfathered Plans

ACA Plans eff. 1/1/2014 and after

Involuntary loss of creditable coverage for you or your dependents

31 days after other coverage ends

60 days after other coverage ends

Lose eligibility for Medicaid or CHIP or become eligible for Medicaid or CHIP premium assistance 60 days after event 60 days after event

New dependent as a result of marriage 31 days after marriage 60 days after marriage

Add dependent as a result of birth, adoption, or placement for foster child/adoption 60 days after event 60 days after event

You or your dependent return from military service 120 days after date of discharge 120 days after date of discharge NOTE: This chart lists only the most common - not all - special enrollment events.

To request special enrollment or obtain more information contact Customer Service, Wellmark, Inc., PO Box 9232, Station 3E499, Des Moines, IA 50306-9232 or call 800-524-9242.

Notice of Women’s Health and Cancer Rights Act

Members who have a mastectomy and elect breast reconstruction in connection with the mastectomy are covered, in a manner determined in consultation with the attending physician and the patient, for the following:

• Reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.

Privacy Practices Notice

The privacy of your medical information is important to Wellmark. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Our Legal Duty We are required by applicable federal and state law to maintain the privacy of your medical information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect January 1, 2014, and will remain in effect until we replace it.

http://www.wellmark.com/


We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and send the new notice to our health plan contract holders at the time of the change.

You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this section.

Organizations Covered By This Notice This notice applies to the privacy practices of the group health plans, health insurers and HMO listed below. These organizations are each participants in an organized health care arrangement. As such, we may share your medical information and the medical information of others we service with each other as needed for the payment activities or health care operations relating to our organized health care arrangement.

Wellmark, Inc., doing business as Wellmark Blue Cross and Blue Shield of Iowa Wellmark Health Plan of Iowa, Inc.

Safeguard Steps Wellmark Has Taken The steps Wellmark has taken to safeguard members’ medical information include but are not limited to:

• Disseminated a Notice of Privacy Practices to insured members and posted it on the Wellmark Web site at www.wellmark.com;

• Disseminated a Notice of Privacy Practices and other information practitioners and facilities need to know about Wellmark’s privacy practices in the provider newsletter, Blue Ink, and on the Wellmark Web site;

• Established a Privacy Office as a primary point of contact concerning questions or issues regarding privacy matters, including toll-free phone access and email address, and published the contact information in the Notice of Privacy Practices on the Wellmark Web site;

• Established internal policies and procedures for compliance with the Privacy Rule and disseminated the information to employees through corporate-wide privacy training, and department-specific training for Customer Service and other areas;

• As a condition of employment, all members of Wellmark’s workforce are required to sign a Confidentiality and Nondisclosure Agreement;

• In daily interaction with members and providers, Wellmark provider and Customer Service representatives inform providers and members of our procedures to verify identity and authority of callers to discuss protected health information;

• Limited physical and information system access to medical information to people who need it to do their jobs; • Strict security regarding access to facility, personal computers, and medical information.

Uses and Disclosures of Medical Information We use and disclose medical information about you for treatment, payment, and health care operations. For example:

Treatment: We may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you.

Payment: We may use and disclose your medical information to pay claims from physicians, hospitals and other providers for services delivered to you that are covered by your health plan, to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to issue explanations of benefits to the person enrolled in the health plan in which you participate, and the like. We may disclose your medical information to health care providers or entities subject to the federal Privacy Rules so they can obtain payment or engage in these payment activities.

Health Care Operations: We may use and disclose your medical information in connection with our health care operations. Health care operations include:

http://www.wellmark.com/


• Rating our risk and determining our premiums for your health plan; • Quality assessment and improvement activities; • Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider

performance, conducting training programs, accreditation, certification, licensing or credentialing activities; • Medical review, legal services, and auditing, including fraud and abuse detection and compliance; • Business planning and development; and • Business management and general administrative activities, including management activities relating to privacy,

customer service, resolution of internal grievances, and creating de-identified medical information or a limited data set.

Other Entities: We may disclose your medical information to other entities that have a relationship with you and are subject to the federal Privacy Rules for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.

On Your Authorization: You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any reason except those described in this notice.

To Your Family and Friends: We may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. We may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care.

Before we disclose your medical information to a person involved in your health care or payment for your health care, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest.

Your Employer or Organization Sponsoring Your Group Health Plan: As a member of a group health plan, we may disclose your medical information and the medical information of others enrolled in your group health plan to the employer or other organization that sponsors your group health plan to permit the plan sponsor to perform plan administration functions. Please see your Coverage Manual for a full explanation of the limited uses and disclosures that the plan sponsor may make of your medical information in providing plan administration.

We may also disclose summary information about the members in your group health plan to the plan sponsor to use to obtain premium bids for the health insurance coverage offered through your group health plan or to decide whether to modify, amend, or terminate your group health plan. The summary information we may disclose summarizes claims history, claims expenses, or types of claims experienced by the members in your group health plan. The summary information will be stripped of demographic information about the members in the group health plan, but the plan sponsor may still be able to identify you or other members in your group health plan from the summary information.

Disaster Relief: We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

Public Benefit: We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:

• As required by law; • For public health activities, including disease and vital statistic reporting, child-abuse reporting, FDA oversight,

and to employers regarding work-related illness or injury; • To report adult abuse, neglect, or domestic violence; • To health oversight agencies;


• In response to court and administrative orders and other lawful processes; • To law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims,

suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;

• To coroners, medical examiners, and funeral directors; • To organ procurement organizations; • To avert a serious threat to health or safety; • In connection with certain research activities; • To the military and to federal officials for lawful intelligence, counterintelligence, and national security activities; • To correctional institutions regarding inmates; and • As authorized by state workers’ compensation laws.

Health Related Services: We may use your medical information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. We may disclose your medical information to a business associate to assist us in these activities.

Individual Rights Access: You have the right to look at or get copies of your medical information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your medical information. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending us a letter to the address at the end of this notice. If you request copies, we will charge you a cost-based fee for staff time to locate and copy your medical information, and postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your medical information in that format. If you prefer, we will prepare a summary or an explanation of your medical information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing.

Confidential Communication: You have the right to request that we communicate with you about your medical information by alternative means or to alternative locations. You must make your request in writing, and you must state that the information could endanger you if it is not communicated in confidence as you request. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to collect premiums and pay claims under your health plan, including issuance of explanations of benefits to the contract holder of the health plan in which you participate. An explanation of benefits issued to the contract holder for health care that you received for which you did not request confidential communications or about the contract holder or others covered by the health plan in which you participate may contain sufficient information to reveal that you obtained health care for which we paid, even though you requested that we communicate with you about that health care in confidence.

Amendment: You have the right to request that we amend your medical information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the


information you want a mended and the originator remains available or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.

Electronic Notice: If you receive this notice on our Web site or by electronic mail (email), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this section in written form.

Questions and Complaints If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this section. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may contact us using the contact information listed at the end of this section. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S Department of Health and Human Services.


3550 Mills Civic Parkway | West Des Moines, IA 50265

515-633-5000 | www.wdmcs.org

The West Des Moines Community School District does not discriminate on the basis of race, color, national origin, gender, disability, religion, creed, age (for employment), marital status (for programs), sexual orientation, gender identity and socioeconomic status (for programs) in its educational programs and its employment practices. There is a grievance procedure for processing complaints of discrimination. If you have questions or a grievance related to this policy please contact the district’s Equity Coordinator Carol Seid, Associate Superintendent of Human Resources, 3550 Mills Civic Parkway, West Des Moines, IA 50265; 515-633-5037; email: [email protected]

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