2019 benefits overview - flagler schools

2019 Benefits Overview

September 1, 2019 - August 31, 2020

www.MyFlaglerBenefits.com

2019-2020 Benefit Changes Overview The below list highlights the changes that will be occurring in your 2019-2020 benefit plan options:

Medical Plan Changes

• If you are currently enrolled in the 5FK plan, your deductible and out of pocket maximum amounts are

increasing

• If you plan on enrolling, or continuing to be enrolled in the HSA medical plan, you must fill out and turn

in the HSA form

• Employee contributions have increased by 15%

• If you wish to participate in the Flexible Spending Account (FSA), please ensure that you fill out the FSA

form

Carrier Changes

• Medical - Moving from UHC to Aetna

• Long Term Disability - Moving from Aetna to USAble

• Flexible Spending Account (FSA) - Moving from Wageworks to TASC

This Benefits-At-A-Glance booklet is designed to provide basic information to employees on benefit plans and programs available September 01, 2019– August 31,

2020. It does not detail all of the provisions, restrictions and exclusions of the various benefit programs documented in the carrier contract or the Summary Plan

Description (SPD). This booklet does not constitute an SPD or Plan Document as defined by the Employee Retirement Income Security Act (ERISA). 3

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2019 Benefit Enrollment Passive Enrollment

This year we will be having a passive enrollment. What this means is, if you do not wish to make any changes

to your current elections, there is no action required on your part. It is still important to review all benefit

information though, as there are some plan design changes to your current plans.

In your 2019 Open Enrollment, Flagler County School Board continues to partner with

BenefitHelp to bring you on-line benefit enrollment. It’s quick and easy!

Visit www.myflaglerbenefits.com

The enrollment site requires a username and password to Login.

866 - 663 - 1285

Your username is the first 6 characters of your last name, followed by the first letter of your first name, followed by

the last 4 digits of your Social Security Number.

If your last name has less than 6 letters, just use your full last name, the first letter of your first name, and the last

four digits of your Social Security Number.

Your initial password is your Social Security Number. You will be able to change your password once you are in

the system.

http://www.myflaglerbenefits.com




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t Benefit Enrollment FAQ’s Q: What is Open Enrollment?

A: Period of time each year in which employees may make benefit changes without a Qualifying Event.

Q: What are the dates of the plan year and when does Open Enrollment period begin and end?

A: For the plan year beginning September 1, 2019, the open enrollment period runs from May 27— June 9, 2019.

Q: How do I make my elections this year?

A: If you would like to make plan changes, go to www.myflaglerbenefits.com from a computer with online access. This is how

you can elect or terminate coverage(s) as well as add or remove dependents. Please note, if newly adding a spouse or any other

dependents to any plan(s), you must verify that they meet eligibility requirements and supply the necessary documentation to

the Benefits Department as noted on the BenefitHelp enrollment system. For those wishing to keep coverage(s) the same, there

is no need to complete an online enrollment. If newly electing or re-electing Flexible Spending plan(s), please contact Benefits

for the necessary forms.

Q: Can I get help to complete the online enrollment?

A: Support is available by contacting BenefitHelp at 1-888-663-1285. Please also see the Open Enrollment ‘Help Schedule’ for

assistance from your Benefits team if you do not have computer access. They can be reached at 386-586-2391 ext. 1041.

Q: After Open Enrollment or my initial eligibility period, can I enroll myself or any of my dependents in the benefit plans? A: You will not be able to enroll yourself or any dependents in benefit plans until next year’s Open Enrollment unless there is

an IRS approved qualifying event. Some examples of approved qualifying events include marriage, divorce, having a baby, or a

spouse losing his/her employee group coverage. Please contact the Benefits Department within 30 days, if you experience a

qualifying event.

Q: After Open Enrollment or my initial eligibility period, can I terminate myself or any of my dependent’s benefit plan

election(s)?

A: It depends on whether or not you participate in the Section 125 Tax Savings Plan. If you elected to participate in Section

125, your benefit premiums are taken out of your pay on a pre-tax basis. Changes to your benefit plans can only be made if

there is an IRS approved qualifying event. If you elected not to participate in Section 125 Tax Savings Plan, your benefit premi-

ums are taken out of your pay on an after-tax basis and you may be able to drop coverage without having a qualifying event.

The Benefits Department will assist you in determining your ability to make changes.

Q: Are there other coverage's I can enroll in or make changes to after Open Enrollment or my initial eligibility period?

A: Yes, certain coverage's do not require a qualifying event for enrollment or changes throughout the year such as Life Insur-

ance. You may elect to participate or make changes in 403B Tax Sheltered Annuities (TSA) or supplemental insurance prod-

ucts like short term disability.

Q: I am a new hire. What is the deadline for me to do my enrollment?

A: Benefits begin on the first of the month following position start date. New employees will receive benefit information at

orientation and must complete benefit elections online no later than 30 days after their eligibility date.

Q: If I have questions after enrollment about my benefits, who do I contact?

It is always best to contact the customer service department of the applicable carrier if you have a question about your benefits.

You can find the phone numbers and websites for each of the carriers on your membership card. You may also email the Flag-

ler County Schools Benefits Department at [email protected] or call 386-586-2391 ext. 1041.

http://www.myflaglerbenefits.com

mailto:[email protected]




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Medical Insurance Basics THE BASICS:

Most health plans today have a plan design that includes a combination of copayments, coinsurance and deductibles, resulting

in the sharing of costs for services for those individuals enrolled in the plan.

Copayment: A copayment is a pre-determined amount members must pay out of pocket when seeing a participating provider.

It is paid directly to the provider and is due at the time services are rendered. If you are unsure of what you need to pay for a

particular service, you can call customer service at the toll-free telephone number listed on the back of your ID card.

Deductible: A deductible is an agreed-upon amount that must be paid out of pocket by you when receiving care from a

provider before your insurance carrier will pay for any services (excludes copays).

Coinsurance: Coinsurance is a percentage that designates the portion the insurer and you are responsible to pay when

services are obtained. Please be reminded that any deductible amount must be paid before coinsurance will apply.

PROVIDER DIRECTORIES:

Participating Aetna providers can be found on-line www.aetna.com. You have the option of searching for a provider by name,

area of speciality or location. If you would prefer, you can also order a provider directory by calling the customer service toll-

free telephone number (1-877-238-6200).

Choosing a Provider:

This is probably the most important choice you are going to make. Although your Aetna plans do not require the selection of a primary care physician, it is in your best interest to develop a relationship with a family physician. Advantages include:

(a) they’re trained to provide a broad range of medical care;

(b) they can be a valuable resource to help coordinate your overall health care needs; and

(c) they can help you determine when you need to visit a specialist.

A family physician is any doctor whose primary specialty is family practice, general practice, internal medicine or pediatrics.

How to Obtain Access to aetna.com

Go to www.myflaglerbenefits.com and click on the link “Aetna”. Then click on the “Login” link. You will then click on the

link titled “Register” under the section “Don’t Have an Account?” You will need the following information to create a User

name and Password.

First Name

Last Name

Member ID or Social Security number

Group Number—#285522

Date of Birth

Once you have set up your user name and password and logged into www.aetna.com, you can you can perform tasks such as:

Print an ID Card, View My Claims, and Find a Doctor.




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Medical Summary - HSA Plan The summary below provides a high level overview of the HSA medical plan offered to you through Aetna. Website: www. aetna.com Phone number: 877-238-6200

HEALTHCARE SERVICES IN-NETWORK

Policy Year Deductibles (PYD)

Individual

Family

(If one individual on family plan meets $2,700, their deductible will be satisfied and they will move to coinsurance)

$2,500

$5,000

($2,700 Individual)

Coinsurance Percentage Paid by Plan

(After Deductible has been met)

80% (Aetna)

20% (Employee)

Out-of-Pocket Maximum (Includes deductible):

Individual

Family

(If one individual on family plan meets $3,500, their out-of-pocket maximum will be satisfied)

$3,500

$7,000

($3,500 Individual)

Physician Services

Preventive Care Services (PCP / Specialist) (must be coded as “well” visit)

Primary Physician Office Visits

Specialist (no referral needed)

Vision Examinations (1 every 24 mos.)

Chiropractic (20 visits max PPY)

100% Covered

Deductible & Coinsurance




Hospital Services:

Inpatient Hospitalization

Outpatient Surgical Services



Diagnostic Services:

Preventive Lab & X-Ray

Diagnostic Lab & X-Ray

CT Scans, MRI, Pet Scans, Nuclear Medicine

Mammograms

Colonoscopies

100% Covered



100% Covered

100% Preventative Only

Emergency Room

Urgent Care Facility



Mental Health and Substance Abuse:

Inpatient Care

Outpatient Care



Pharmacy

Tier 1

Tier 2

Tier 3

Retail = Up to 31 day supply; Mail Order = Up to 90 day supply

Retail Mail Order

PYD then $10 PYD then $25



Total Lifetime Maximum Unlimited

Out-of-Network Benefits N/A

*PPY– Per Policy Year PYD - Policy Year Deductible




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Health Savings Account (HSA) What is a Health Savings Account?

A Health Savings Account (HSA) is designed to work with a High Deductible Health Plan (HDHP) to reduce your medical expenses and to reduce your taxable income. It can also put health insurance within reach of individuals and employees who otherwise couldn’t afford it.

With an HSA:

• You contribute to your account on a pre-tax basis

• You are reimbursed for eligible expenses tax-free

• You can “roll over” unused amounts from year to year

• Withdrawals for qualified expenses, are both penalty-free and tax-free

• You become a better health care consumer.

How long can I contribute to the HSA?

• You’re no longer eligible to contribute to an HSA when you enroll in Medicare

• At age 65 you can take penalty-free withdrawals for non-qualified expenses

• When you are getting ready to enroll in Medicare, please email [email protected]

What health plan should I choose to have the Health Savings Account?

• You must choose the Aetna HSA Plan

What is the maximum contribution I can make into my HSA in 2019?

• Contributions are based on calendar year and it is the responsibility of the account holder to assure limits are not exceeded.

• 2019 IRS limits for single coverage = $3,500

• 2019 IRS limits for Employee plus dependents = $7,000

• Additional annual $1,000 catch up contribution for age 55+

How do I get reimbursed from my HSA?

• HSA has a debit card and checkbook for you to us when paying for eligible expenses

• If you do pay for a qualified expense out of pocket, you can reimburse yourself out of your account at any time

Where can I get more information on the Health Savings Account?

• Visit www.irs.gov

If an employee chooses to participate in an H.S.A savings account, an H.S.A savings account must be opened at Space Coast Credit Union. Once this account has been opened, the employee must provide the H.S.A. savings routing and bank account information, as well as, the amount that should be deducted each pay period. The amount can be changed, paused, restarted at anytime by sending written notification to the benefits department.

Please note: payroll deductions cannot begin until all information is received at your benefits office.




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1. With Space Coast Credit Union, you can start your Health Savings Account application online or by phone at 1-800-447-7228 (option 9, then extension 855).

2. Go to Space Coast Credit Union. You will be required to go into a SCCU branch near you to complete the application process (with your signature) within 30 days of the start of your application. There are two SCCU branches in Palm Coast and the addresses are listed below for your convenience. You are able to go to any Space Coast Credit Union; you are not required to use a Palm Coast branch.

3. A one-time $10 deposit is required. $5 will apply to your one-time Space Coast Credit Union membership fee to prevent your account from closing from inactivity.

4. Your Health Savings Account card will be requested on the first-date of the account being active. Cards are processed locally; they should arrive within 3-5 business days depending on your location. If you would like to request a card replacement at any point please contact 1-800-447-7228 (Option 5 to speak with Member Ser-vices).

5. If you wish to contribute to your Health Savings Account pretax, please request a “Check Ordering Instruc-tions Sheet” or a “Direct Deposit Enrollment form” from SCCU. The information required is as follows: • Name on Account • Health Savings Account Checking/Savings (22/32 Code) • Account Number • Routing Number • Signature of Space Coast Credit Union representative verifying account information

6. If you wish to contribute to your Health Savings Account, please write “I [insert first and last name], wish to contribute $ [insert dollar amount] per pay period. Please make sure to sign and date the form at the bottom.

7. Provide the form to the Benefits Department in Human Resources. We encourage you not to use email for this correspondence as this has sensitive financial information and our email system is not considered secure. Voided checks are not an acceptable form of documentation for enrolling in HSA contributions.

For Your Infor-

mation: Health Savings Accounts are subject to closure due to inactivity. It is the responsibility of the employee to manage processes and compliance regulations regarding their ac-

count. Flagler County Schools has provided this form as an informational resource when opening up your Health

Savings Account with Space Coast Credit Union. This information is subject to change at the discretion of Space Coast Credit Union.

For additional questions or concerns please contact the Flagler County Schools Benefits Department.

Space Coast Credit Union 10 Leanni Way

Palm Coast, FL 32137

Space Coast Credit Union 258 Palm Coast Pkway NE

Palm Coast, FL 32137

Fax: In-Person Delivery:

Inter-office:

386-586-2396 Flagler County Schools Attn: Benefits Department

1769 E. Moody Blvd Bldg. #2 Bunnell, FL 32110

Attn: Benefits Dept.

Opening a Health Savings Account—Space Cost Credit Union

https://expressaccounts.sccu.com/?healthsavingschecking




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Aetna Member Payment Estimator Tool It’s easier to budget for a medical treatment if you have an idea of how much it will cost. Aetna’s Member Pay-ment Estimator Tool can help you be confident that you are choosing the right medical facility at the right price.

• Find the right physician or medical specialty as you explore the provider cost estimate • Save money by comparing network and non-network cost estimates • Learn how a procedure would affect your health account balances Treatment cost estimates are personalized for you and your family.

• Your health plan information is automatically applied to the cost estimate, including deductible, out-of-pocket maximum, copayments and coinsurance • Real-time, personalized out of pocket cost estimates for over 650 tests, services, and procedures • Estimates that cover all related costs from admission to discharge • Information on how to call customer services for an estimate or to research estimates received Need to plan for an upcoming medical expense? Take these four easy steps today.

Log in to www.aetna.com (or register if you are a first-time user). Select the Member Payment Estimator Tool to start receiving approximate estimates for your visits and procedures.




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Medical Summary - Standard Plan The summary below provides a high level overview of the Standard medical plan offered to you through Aetna. Website: www.aetna.com Phone number: 877-238-6200

*PPY– Per Policy Year


Policy Year Deductibles

Individual

Family

(excludes member copayments)

$3,000

$9,000



50% (Aetna)

50% (Employee)

Out-of-Pocket Maximum:

Individual

Family

(includes deductible, excludes copays)

$6,350

$12,700

Physician Services



Preventive Care Services (PCP / Specialist)



$50 Copay

$75 Copay

100% Covered

$50 Copay

$50 Copay

Hospital Services:



$500 + Deductible + Coinsurance

$300 + Deductible + Coinsurance





Mammograms

Colonoscopies

100% Covered

100% Covered

$100 Copay

100% Covered

100% Covered

Emergency Room


$250 Copay

$100 Copay


Inpatient Care

Outpatient Care

100% After Deductible

100% Covered

Pharmacy

Tier 1

Tier 2

Tier 3

Retail = Up to 31 day supply

Mail Order = Up to 90 day supply

Retail Mail Order

$ 10.00 $ 25.00

$ 45.00 $ 112.50

$ 80.00 $ 200.00






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Medical Summary - Premium Plan The summary below provides a high level overview of the Premium medical plan offered to you through Aetna. Website: www. aetna.com Phone number: 877-238-6200

*PPY– Per Policy Year


Policy Year Deductibles

Individual

Family

(excludes member copayments)

$3,000

$6,000



90% (Aetna)

10% (Employee)

Out-of-Pocket Maximum:

Individual

Family

(includes deductible, excludes copays)

$3,500

$7,000

Physician Services



Preventive Care Services (PCP / Specialist)



$35 Copay

$50 Copay

$100% Covered

$25 Copay

$35 Copay

Hospital Services:



Deductible + Coinsurance

$300 Copay





Mammograms

Colonoscopies

100% Covered

100% Covered

$200 Copay

100% Covered

100% Covered

Emergency Room


$250 Copay

$50 Copay


Inpatient Care

Outpatient Care

100% After Deductible

$25 Copay

Pharmacy

Tier 1

Tier 2

Tier 3

Retail = Up to 31 day supply

Mail Order = Up to 90 day supply

Retail Mail Order

$ 10.00 $ 25.00

$ 35.00 $ 87.50

$ 75.00 $ 187.50






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Flexible Spending Account FAQ’s What is a Flexible Spending Account (FSA)?

An FSA is an IRS regulated Section 125 plan that allows funds to be deducted pre-tax and deposited into an account for out

of pocket eligible medical costs or dependent care expenses.

What are some examples of eligible unreimbursed medical expenses?

• Your annual medical, dental and vision plan deductibles, coinsurance and copayments.

• Prescription copayments

• Any IRS approved medical expense in accordance with IRS Publication 502 even if it is not covered under the medical,

dental or vision plans.

What are eligible dependent daycare expenses?

• Expenses must be from a qualified dependent day care facility

• Daycare for children under the age of 13

• Disabled spouses

• Dependent parents

Why should I participate in an FSA?

The benefit to you is that you will not pay taxes on the amount(s) that are deducted from your paycheck and deposited to your

FSA account.

How will I access the money that has been deposited into the FSA Accounts?

You can access the money through the automatic reimbursement option covered under your plan by completing and

submitting a claim form, or you may request an FSA Debit Card.

What is the maximum that I can deposit into each account each year?

• Medical FSA—$2,700 per year (Minimum—$300 per year)

• Dependent Daycare FSA—$5,000 per year (if married filing separately $2,500 per year)

How do I elect to participate in the FSA plans?

Each year you must re-enroll in the FSA plans and state the annual amount you elect to contribute for the plan year. Forms

must be completed which can be obtained from the Benefits Department.

What if I do not use all of the funds that are in my FSA account(s)?

Plan Carefully! You can file for reimbursement of eligible expenses incurred during our 2019-2020 plan year (September 1,

2019-August 31, 2020). You do have an additional 2 1/2 month grace period until November 15th, 2020 to use your benefits,

and until November 30, 2020 to submit for reimbursement for claims incurred during the plan year or applicable grace

period or you will lose any unused balance. Please note that this is an IRS regulation.

If I elect the Health Savings Account, can I participate in the FSA plans?

You may elect the Dependent Daycare FSA but you may not enroll in the Medical FSA.




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Helpful Tools Visit www.aetna.com to log into your dashboard and view all of your health coverage including:

Aetna Health is an online tool that is available to all Aetna members. It serves members in a multitude of ways and can even be utilized for obtaining Harvard Medical School health information through InteliHealth®. Members may also use the Aetna member portal to change their PCP, request an ID card or look up information on Aetna plans and programs.

How do I find in-network providers?

DocFind® is Aetna’s on-line provider directory. It allows members to locate participating physicians,

hospitals and other providers in a matter of seconds. To use DocFind®, just go to www.aetna.com, and

click on the “Find a doctor” link. If you are already registered on the Aetna Health member portal you

can click on “login.” If you have not yet registered you can click on the link “Plan from an employer”

under the “guest” section. You can search for a provider based on where you live, provider specialty and

other criteria. After entering your zip code and, city, county, or state, you will then select the plan

“Aetna Select℠ (Open Access)” plan and click “Continue.”




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Prompt Care Clinic Why Use The Clinic? • During the hours listed below clinic services are FREE to all indi-

viduals enrolled in one of the three Flagler County Public Schools Medical Plans

• No Copayments

• Shorter wait times

• Physicians on site

• Walk-Ins during non-scheduled times will be charged accord-ing to your plan’s benefits for PCP

• Appointments needed during scheduled hours below:

CLINIC SERVICES AT NO COST WITH AN APPOINTMENT DURING HOURS LISTED

• Treatment of chronic illnesses such as: Dia-betes, Hypertension, and High Cholesterol

• Treatment for acute illnesses such as flu, cold, sinus or urinary tract infections

• EKG’s

• Annual Physicals

• Laboratory Tests such as:

Panels: Metabolic, Comprehensive Meta-bolic, Electrolytes, Hepatic Function, Lipid/Cardiac Risk, Renal Failure

Rapid Lab Test - strep, mono, pregnancy

• Laboratory Tests must be ordered by Prompt Care provider

• Minor Procedures: minor lacerations, su-turing

• Basic X-Rays including the radiologist

UPDATED EMPLOYEE CLINIC HOURS

FCSB Clinic Hours

Monday: 3:00pm - 6:00pm

Tuesday: 7:30pm - 8:30pm; 3:00pm - 6:00pm

Wednesday: 11:00am - 1:00pm; 3:00pm - 6:00pm

Thursday: 3:00pm - 6:00pm

Friday: 3:00pm - 6:00pm

Saturday: 8:30am, 8:45am, 9:15am, 9:30am,

10:15am, 1:15am, 12:15pm, 1:15pm

*Appointments Are Required

Walk-ins (even during clinic hours) will be processed as

a Primary Care Visit

$75 No Show Fee will be imposed without 24 hour

cancellation notice

Located At:

120 Cypress Edge Dr, Palm Coast, FL 32164

Phone: (386) 586-4280




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Did you know that poor oral health can lead to many seemingly unrelated medical conditions? In fact, oral bacteria and oral disease have been linked to a variety of serious illnesses, including heart disease, and diabetes.

Flagler County Public Schools offers two dental plans, a Copay plan and a PPO plan, both through Florida Combined Life. Both of these plans offer in and out of network coverages but provide different coverage amounts based on you and your family’s dental needs

Tip

When using in network dentists you can drastically lower your out of pocket expenses. Visiting in network dentists guar-

antees you will be charged the contracted rate for the services you have done. While you do have the flexibility of visiting

either an in or out of network dentist when enrolled in a PPO plan, it will always save you money by using a dentist in

network. To find in network dentists, you can visit www.bcbsfl.com.




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Dental Summary - PPO The summary below provides a high level overview of the PPO Dental plan offered to you through Florida Combined Life

Website: www.bcbsfl.com Telephone number: 888-223-4892

Dental Services PPO

In-Network

Non PPO

Out-of-Network

Annual Maximum Benefit $1,500

Policy Year Deductible: $50 ($150 Family) $50 ($150 Family)

PREVENTATIVE PROCEDURES: Deductible Waived

Oral Evaluations (Exams) Bitewing X-rays Panoramic X-rays Prophylaxis (Cleanings) Fluoride Treatment (Child) Sealants

Plan pays 100% Plan pays 100% of UCR

BASIC PROCEDURES: Deductible Applies

Amalgam Restorations (Silver Fillings) Resin Based Restorations (Anterior and Posterior) Root Canal Therapy Periodontal Treatments Routine Extractions

Plan pays 80% Plan pays 80% of UCR

MAJOR PROCEDURES: Deductible Applies

Crowns Complete Dentures Partial Dentures Bridges Implants

Plan pays 50%

Plan pays 50% of UCR

Orthodontic Procedures: Deductible Waived

Lifetime maximum 50% up to $1,500

Limitations and Exclusions: As with any dental plan, there are certain limitations and exclusions that may apply. Please check your plan document for more details regarding these limitations and exclusions.




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Dental Summary - Copay The summary below provides a high level overview of the Copay Dental plan offered to you through Florida Combined Life

Website: www.bcbsfl.com Telephone number: 888-223-4892

* = Non-Participating Dentists may charge fees in excess of fee schedule and may bill you for any differences.

** = In - Network deductible applies to Out-of-Network and Out-of-Network applies to In-Network

*** = Percentage of scheduled fee, plus balance of charges, if any

Copay Dental Plan

Dental Services Participating Dentist Non-Participating

Dentist

Policy Year Maximum Benefit (per person) $1,000

Policy Year Deductible (waived for preventive services)** $50 ($150 Family)

PREVENTATIVE PROCEDURES:

Oral Evaluation Teeth Cleaning (Prophylaxis) Fluoride Treatments - Child Bitewing X-Ray Full Mouth X-Ray

No Charge

80% of Scheduled Fee* 80% of Scheduled Fee* 80% of Scheduled Fee* 80% of Scheduled Fee* 80% of Scheduled Fee*

BASIC PROCEDURES:

X-Rays (Intraoral/Complete) X-Rays (Panoramic) Sealant (per tooth) Fillings (Amalgam) Resin Based Restorations Extractions Removal of Impacted Tooth

$17 Copay $14 Copay $6 Copay

$15 Copay $20 Copay $17 Copay $64 Copay

60% of Scheduled Fee* 60% of Scheduled Fee* 60% of Scheduled Fee* 60% of Scheduled Fee* 60% of Scheduled Fee* 60% of Scheduled Fee* 60% of Scheduled Fee*

MAJOR PROCEDURES:

Crowns Complete Dentures Pontic Root Canal - Bicuspid Root Canal - Molar Implants Periodontal Scaling and Root Planing (per quadrant)

$302 Copay $382 Copay $302 Copay $231 Copay $305 Copay $512 Copay $61 Copay

40% of Scheduled Fee* 40% of Scheduled Fee* 40% of Scheduled Fee* 40% of Scheduled Fee* 40% of Scheduled Fee* 40% of Scheduled Fee* 40% of Scheduled Fee*

ORTHODONTIA PROCEDURES:***

Lifetime Maximum 50% up to $1,000




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Driving to work, reading a news article and watching television are likely activities you perform every day. Your ability to do all of these, however, depends on your vision and eye health. Routine eye exams will help maintain your vision as well as detect various eye problems and concerns about your overall health

Flagler County Public Schools offers vision coverage through Aetna. Similar to your other benefits, using the vision plan in network offers the most coverage. When using the plan out of network, you will pay the full fee out of pocket and then submit a claim to be reimbursed up to a certain amount (depending on the service obtained) by Aetna.

Tip

Options on your

glasses such as

UV coating, pro-

gressive lenses,

etc., which are

not covered-in-

full, may be avail-

able at a discount

at participating




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Helpful Tip:

Please note that the provider network for the Flagler Schools Aetna vision insurance is the “EyeMed Network.”

The provider search is located at www.aetnavision.com. Please note that some providers list their corporate

name, e.g. Eyecare Express is under Palm Coast Optical in the provider search.

*Contacts and eyeglasses cannot be purchased in the same year

Vision Summary The summary below provides a high level overview of the Vision plan offered to you through Aetna. Website: www.aetnavision.com Telephone number: 877-973-3238

Benefits: In-Network Out-of-Network

Copayments: Exams Standard Contact fit /follow up:

$0

$40

Reimbursed up to $35

Not covered

Frequency: Exams Lenses Frames Contacts (in lieu of glasses)

Once every 12 months Once every 12 months Once every 24 months Once every 12 months

Standard Lenses: Single Vision: Bifocal: Trifocal: Lenticular: Standard Progessive:

$10 Copay $10 Copay $10 Copay $10 Copay $75 Copay

Reimbursed Up to $25 Reimbursed Up to $40 Reimbursed Up to $60

Reimbursed Up to $100 Reimbursed Up to $40

Frames: Benefit:

$125 Allowance (20% off balance)

Reimbursed Up to $50

Contacts: Elective (lenses): Medically Necessary:

$135 Allowance (15% off balance)

Paid in Full

$135 Allowance $210 Allowance




Lon

g Te

rm D

isab

ility

Insu

ran

ce a

nd

Em

plo

yee

Ass

ista

nce

Pro

gram

Long Term Disability Website: www.usablelife.com Telephone number: 800-370-5856 Long Term Disability Insurance provides income protection if you are unable to work for long periods of time. LTD benefit

will pay you a percentage of your income for the amount of time that you are unable to work. Flagler County School Board

offers all full time employees LTD through USAble Life. This benefit is provided to you at no additional cost as Flagler County School Board pays for the entire premium.

Your income replacement benefit would equal 66 2/3% of your pre-disability earnings reduced by any deductible income. The

maximum monthly benefit you can receive is $6,000.

Benefits will begin after you have been unable to work for 90 days due to a covered injury or illness and will continue to pay

until your Normal Social Security Retirement Age. Benefits are not payable during the benefit wait period.

Please contact the Benefits Department for more information.

Employee Assistance Program (EAP) The New Directions Employee Assistance Program through USAble Life gives you and your loved ones completely free, en-tirely confidential access to the programs, tools and services you need to live a balanced and happy life. Common issues are:

Mental health and well-being

Personal and professional relationships

Substance abuse

Family life

Daily Stress

These resources are for any issue for you or your immediate household family member.

24/7 website or phone call

3 in person counseling sessions

Access a network of attorneys and financial counselors who can provide legal expertise and advice on a multitude of chal-lenges

Search a comprehensive collection of articles, videos, self-assessments, calculators and planners for information on thou-sands of topics designed to help improve your health

Sign up for weekly tips and advice on how to work through stress, parenting, being your best at work and other helpful ma-terials—delivered right to your inbox.

Call 1-800-624-5544 or visit www.ndbh.com. Your ndbh.com login is: SGE3F.




Life Insu

rance

Tip

Keeping your

beneficiary up to

date is very im-

portant. You can

change your bene-

ficiary or add addi-

tional beneficiaries

at any point dur-

ing the year.

Having life insurance is important for people of all ages and the below ques-tions may help you think more clearly about your needs and the benefits of enrolling in life insurance coverage:

• Are you the primary household income?

• Do you have a mortgage, college loans or other unpaid loans?

• Could you (or your family) afford thousands of dollars in medical bills and/or funer-al costs?

• Who would have the burden of paying any debt or other financial responsibilities that you leave behind?

Basic Life & Accidental Death & Dismemberment Coverage - NO COST BENEFIT

Flagler County School Board provides life and AD&D coverage through Aetna to eligible em-ployees in the amount of $25,000 for Administrators and $20,000 for all other employees. This basic life and AD&D coverage is provided to you at no cost and is 100% paid for by Flagler County School Board. The following are attached to your group term life insurance policy:

• Waiver of Premium

• Accelerated Life Benefit

• Portability

• Conversion

To find more information about the point above, refer to your Aetna Certificate of Benefits




Life

Insu

ran

ce

Voluntary Life/AD&D Website: www.aetna.com Telephone number: 800-872-3862 Life EOI’s: 800-660-9913 Life Conversion: 877-503-3448

Employee Voluntary Life & AD&D

Guaranteed Issue $100,000

Minimum Benefit Amount $10,000

Maximum Benefit Amount $300,000

Increments of…. $10,000

Dependent Life Insurance Options (No more than 50% of the combined amounts of employee basic and life insurance)

Option 1 Spouse: $10,000, Child(ren): $5,000 Cost = $1.49/month

Option 2 Spouse: $20,000, Child(ren): $5,000 Cost = $2.52/month

Option 3 Spouse: $50,000, Child(ren): $10,000 Cost = $5.67/month (EOI Required)

Additional Information • Age-bracketed premiums: End of Birthday month in 5 year increments.

• Evidence of Insurability form is required for employees increasing or enrolling in coverage amounts above the guaranteed issue amounts for employee, spouse, child(ren).

• Life benefits automatically reduce beginning at age 65 and continue to reduce at the following intervals:

Reduces by 35% at age 65



• You must purchase Voluntary Life Insurance for yourself in order to purchase Voluntary Life In-surance for your eligible dependents

• If husband and wife work for FCSB, dependent life insurance on your spouse is not available

• Dependents can remain on the plan up to the end of the year of their 26th birthday.




Life Insu

rance

Voluntary Life & AD&D Costs Voluntary Life & AD&D

Employee Age Rates/$1,000 (Monthly)

29 & under $0.085

30-34 $0.090

35-39 $0.110

40-44 $0.160

45-49 $0.260

50-54 $0.390

55-59 $0.630

60-64 $0.710

65-69 $1.300

70-74 $2.120

75+ $8.710

To calculate your voluntary life cost per paycheck, follow the below calculator (Exact premiums will be calculated by Aetna)

$

Benefit Amount

÷ 1,000 = $ x’s age rate = $ / 22 =

*Monthly Cost

*Exact premiums will be calculated by Aetna

• Evidence of Insurability will be required if changes are made.

• Evidence of Insurability may be required for additional life insurance.

• New hires are guaranteed up to $100,000 during their new hire enrollment window.

$

*Per Pay Period Amount




Ad

diti

on

al B

enefi

ts

Additional Benefits FRS

The Florida Retirement System (FRS) is Flagler County School District’s sponsored retirement program. The contact in-formation is:

Toll Free Number: 844-377-1888

Website: www.myfrs.com

FSRBC

School districts join the Florida School Retiree Benefits Consortium (FSRBC) to take advantage of expanded benefit op-tions and lower rates. The FSRBC provides retirees with access to high-quality insurance and benefits, tailored especially for retirees age 65 or older, who have retired from the Florida Public School System. Visit www.myfsrbc.com for more information.

Flagler Schools Retirement Academy

To provide you with an opportunity to learn about planning and investing for your retirement, we offer the Flagler Retire-ment Academy, an online financial education program. This online curriculum is easy to use and can help you plan for your financial future. Visit flagler.retacademy.com to complete the three courses. Each course will take only 15-20 minute to complete, and includes videos and actions steps which can help you make informed decisions about your financial fu-ture.

BMG Loans

The LoansAtWork employee emergency loan program is available to benefits-eligible employees of Flagler Schools. Please visit www.LoansAtWork.com - enrolling is easy, fast and confidential. You can receive your loan proceeds in about two business days after approval.

• $500-$5,000 loans available to benefits-eligible employees with at least one year on the job

• Repayments over 12,24,36, or 48 payroll deductions (6-29 months, depending upon loan execution date and payroll deduction schedule)

• Fixed annual interest rate 23.99% (see BMG Money materials for details on interest rate)

• Semi-monthly payments as low as $15

• Automated payroll deductions

U.S. Legal Services

Legal benefit plans for defending yourself and family with a wide range of legal services provided by local attorneys. Choose from the family defender plan which covers things such as:

• Wills

• Estate Planning

• Juvenile Law

• Criminal Law

Or the Identity Defender which is designed to help defend against the fastest growing crime in the name Identity Theft. For more information and to enroll, visit www.uslegalservices.net/companies/flagler schools.

Imp

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Special Enrollment Rights Notice

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents' other coverage). However, you must request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Special enrollment rights also may exist in the following circumstances:

If you or your dependents experience a loss of eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP) coverage and you request enrollment within 60 days after that coverage ends; or

If you or your dependents become eligible for a State premi-um assistance subsidy through Medicaid or a state CHIP with respect to coverage under this plan and you request enroll-ment within 60 days after the determination of eligibility for such assistance.

If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determi-nation of eligibility for a premium assistance subsidy.

Note: The 60 day period for requesting enrollment applied only in these last two listed circumstances relating to Medicaid and state CHIP. As described above, a 30-day period applied to most special enrollments. Women’s Health & Cancer Rights Act of 1998

The Women’s Health and Cancer Act (WHCRA) requires group health plans

to provide participants with notices of their rights under WHCRA, to provide

certain benefits in connection with a mastectomy, and to provide other protec-

tions for participants undergoing mastectomies. If you have had or are going to

have a mastectomy , you may be entitled to certain benefits under the Wom-

en’s Health and Cancer Rights Act of 1998 (WHCRA). For Individuals receiv-

ing mastectomy –related benefits, coverage will be provided in a manner deter-

mined in consultation with the attending physician and the patient, for:

All stages of reconstruction of the breast on which the mastec-

tomy was performed;

Surgery and reconstruction of the other breast to produce a

symmetrical appearance;

Prostheses; and

Treatment of physical complications of the mastectomy, in-

cluding lymphedema.

These benefits will be provided subject to the same deducti-

bles and coinsurance amounts applicable to other medical and

surgical benefits provided under the health plan offered by

your employer.

Please keep this information with your other group health

plan documents. If you have any questions about the Plan’s

coverage of mastectomies and reconstructive surgeries, please

contact the Human Resources Department.

Health Insurance Portability and Accountability Act (HIPAA) Notice

Federal law requires that group health plans allow certain employees and de-

pendents special enrollment rights when they previously declined coverage and

when they have new dependents. This law, the Health Insurance Portability

and Accountability Act (HIPAA) also addresses the circumstances under which

treatment for medical condition may be excluded from health plan coverage.

This Information in this notice is intended to inform you, in a summary fash-

ion, of your rights and obligations under these laws. You, your spouse and any

dependents should all take the time to read the entire notice carefully.

Special Enrollments: If you decline enrollment for yourself or your dependents (including your spouse) because of having other health insurance coverage at

the time of your eligibility to participate, you may enroll yourself or your de-

pendents at a future point, provided that you request enrollment within 30

days after your other coverage ends. In addition, if you have a new dependent

as a result of a marriage, birth, adoption or placement for adoption, you may

be able to enroll yourself and your dependents, provided that you request

enrollment within 30 days of such an event.

If you or your dependents lose eligibility for coverage under Medicaid or the

Children’s Health Insurance Program (CHIP) or become eligible for a premi-

um assistance subsidy under Medicaid or CHIP, you may be able to enroll

yourself and your dependents. You must request enrollment within 60 days of

the loss of Medicaid or CHIP coverage or the determination of eligibility for a

premium assistance subsidy.

Obtaining Additional Information: If you need assistance in determining your rights under ERISA or HIPAA, you may contact your Plan Administrator or

the U.S. Department of Labor by writing to the Chicago Regional office at 200

W. Adams Street, Suite 1600, Chicago, IL 60606, or by calling the Department

at (312)353-0900.

If you have any questions about this notice or the law, please contact your Plan

Administrator at the number or location provided in your benefits booklet or

Summary Plan Description.

Also, if you have changed marital status, or if you, your spouse or any other

qualified dependents have changed addresses, please notify your local Human

Resources Representative.

Notice of Privacy Practices: Plan administrators, clearinghouses, business associates, and health care providers that transmit health information electroni-

cally or use electronic health records may not redistribute or unlawfully use

electronic health records without permission from the insured. The insured

may request information on how their electronic records are distributed, how

frequently they are distributed, and who they are distributed to by contacting

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

Health Insurance Marketplace Coverage Notice

The Health Insurance Marketplace is available to assist you as you evaluate

health insurance 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 is designed to help you

find private health insurance and compare private health insurance options.

You may also be eligible for a new kind of tax credit under section 36B of

Internal Revenue Code that could potentially lower your monthly premium. If

you purchase a qualified health plan through the Marketplace, you may lose

the employer contribution (if any) to any health benefit plan offered by your

employer and all or a portion of that contribution may be excludable from

income for federal income tax purposes . More information on the health

insurance Marketplace may be found at https://www.healthcare.gov.

Imp

ort

ant

No

tice

s Notice of Rescission

(a) Prohibition on rescissions - (1) A group health plan, or a health insur-ance issuer offering group or individual health insurance coverage, must not

rescind coverage under the plan, or under the policy, certificate, or contract

of insurance, with respect to an individual (including a group to which the

individual belongs or family coverage in which the individual is included)

once the individual is covered under the plan or coverage, unless the individ-

ual (or a person seeking coverage on behalf of the individual):

I. performs an act, practice, or omission that constitutes fraud

II. makes an intentional misrepresentation of material fact,

as prohibited by the terms of the plan or coverage. A group health plan, or

a health insurance issuer offering group or individual health insurance cover-

age, must provide at least 30 days advance written notice to each participant

(in the individual market, primary subscriber) who would be affected before

coverage may be rescinded under this paragraph (a)(1), regardless of, in the

case of group coverage, whether the coverage is insured or self-insured, or

whether the rescission applies to an entire group or only to an individual

within the group. (The rules of this paragraph (a)(1) apply regardless of any

contestability period that may otherwise apply.) A rescission is a cancellation

or discontinuance of coverage that has retroactive effect. For example, a

cancellation that treats a policy as void from the time of the individual's or

group's enrollment is a rescission. As another example, a cancellation that

voids benefits paid up to a year before the cancellation is also a rescission for

this purpose.

A cancellation or discontinuance of coverage is not a rescission if -

I. The cancellation or discontinuance of coverage has only a prospective

effect;

II. The cancellation or discontinuance of coverage is effective retroactive-

ly, to the extent it is attributable to a failure to timely pay required

premiums or contributions (including COBRApremiums) towards the

cost of coverage;

III. The cancellation or discontinuance of coverage is initiated by the

individual (or by the individual's authorized representative) and the

sponsor, employer, plan, or issuer does not, directly or indirectly, take

action to influence the individual's decision to cancel or discontinue

coverage retroactively or otherwise take any adverse action or retaliate

against, interfere with, coerce, intimidate, or threaten the individual; or

IV. The cancellation or discontinuance of coverage is initiated by the ex-

change pursuant (the insured).

Michelle’s Law

Michelle’s Law protects a postsecondary student from losing full-time student

status under an employer’s medical coverage if the student is (i) a dependent

child of a participant or beneficiary under the terms of the plan; and (ii)

enrolled in a plan on the basis of being student at a postsecondary education-

al institution immediately before the first day of a medically necessary leave

of absence from school. A dependent covered under the law is entitled to the

same benefits as if the dependent continued to be enrolled as a full-time

student. The law also recognizes that changes in coverage (whether due to

plan design or a subsequent annual enrollment election) pass through to the

dependent for the remainder of the medically necessary leave of absence.

Mental Health Parity & Addiction Equity Act 2008 (MHPAEA)

Under the MHPAEA, the financial requirements and treatment limits that

group health plans and health insurance issuers apply to mental health or

substance use disorder benefits generally cannot be more restrictive than

those applicable to medical and surgical benefits. If a plan covers mental

health and substance use disorder, MHPAEA provides medical and surgical

benefits and mental health and substance use disorder benefits. MHPAEA it

must comply with the federal parity requirements. The MHPAEA contains

the following parity requirements:

The financial requirements (such as deductibles, copayments, coinsurance

and out-of-pocket limits) applicable to mental health and substance use disor-

der benefits cannot be more restrictive than the predominant financial re-

quirements applied to substantially all medical and surgical benefits.

Treatment limitations (such as frequency of treatment, number of visits, days

of coverage or other similar limits on the scope or duration of coverage) must

also comply with the MHPAEA’s parity requirements. Non-quantitative

treatment limitations (such as medical management standards, formulary

design and determinations of usual, customary or reasonable amounts) are

subject to a separate parity requirement.

If medical and surgical benefits are offered on an out-of-network basis, a plan

or issuer must also offer mental health and substance use disorder benefits

on an out-of-network basis.

Newborn’s and Mothers’ Health Protection Act

Group health plans and health insurance issuers generally may not, under

Federal law, restrict benefits for any hospital length of stay in connection

with childbirth for the mother or newborn child to less than 48 hours follow-

ing a vaginal delivery, or less than 96 hours following a cesarean section.

However, Federal law generally does not prohibit the mother's or newborn's

attending provider, after consulting with the mother, from discharging the

mother or her newborn earlier than 48 hours (or 96 hours as applicable). In

any case, plans and issuers may not, under Federal law, require that a provid-

er obtain authorization from the plan or the insurance issuer for prescribing

a length of stay not in excess of 48 hours (or 96 hours).

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Cobra provides eligible individuals and their dependents who would other-

wise lose group health coverage as a result of a qualifying life event with an

opportunity to continue group health coverage for a limited time period

under certain circumstances such as:

• Voluntary or involuntary job loss

• Reduction in the hours worked

• Transition between jobs

• Death

• Divorce

• And other qualifying life events

If you are entitled to elect COBRA coverage, you will have 60 days (starting

on the date you are furnished the election notice or the date you would lose

coverage) to choose whether or not to elect continuation coverage.

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=1e85b8bb85383fa864b9b694e1127a75&term_occur=1&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=a82b34acd86a489f102c763a67c24b38&term_occur=1&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=e00a5c4b6e8e48f802d2c5dd8132a392&term_occur=4&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=e00a5c4b6e8e48f802d2c5dd8132a392&term_occur=3&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=1e85b8bb85383fa864b9b694e1127a75&term_occur=2&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=a82b34acd86a489f102c763a67c24b38&term_occur=2&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=ff1d6e31377b0372e5c82e604781ea59&term_occur=1&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=69ce97fb66a503af04c9bb00fa38a0fc&term_occur=1&term_src=Title:45:Subtitle:A:Subchapter:B:Part:147:147.128

Imp

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Qualified individuals may be required to pay the entire premium for coverage

up to 102 percent of the cost to the plan.

COBRA generally requires that group health plans sponsored by groups with

20 or more employees in the prior year offer employees and their families the

opportunity for a temporary extension of health coverage (called continuation

coverage) in certain instances where coverage under the plan would otherwise

end.

The duration of COBRA extends from the date of the qualifying event for a

limited period of 18 or 36 months. The length of time depends on the type of

qualifying life event that gave rise to the COBRA rights. A plan, however, may

provide longer periods of coverage beyond the maximum period required by

law.

COBRA Continuation coverage may be terminated earlier than the end of the

maximum period for any of the following reasons:

• Premiums are not paid in full on a timely basis

• The employer ceases to employ any group health plan

• A qualified beneficiary begins coverage under another group health plan

after electing continuation coverage;

• A qualified beneficiary becomes entitled to Medicare benefits after elect-

ing continuation coverage;

• A qualified beneficiary engages in conduct that would justify the plan in

terminating coverage of a similarly situated participant or beneficiary not

receiving continuation coverage (such as fraud).

If continuation coverage is terminated early, the plan must provide the quali-

fied beneficiary with an early termination notice. The notice must be given as

soon as practicable after the decision is made, and it must describe the date

coverage will terminate, the reason for termination, and any rights the quali-

fied beneficiary may have under the plan or applicable law to elect alternative

group or individual coverage.

If you decide to terminate your COBRA coverage early, you generally won't be

able to get a Marketplace plan outside of open enrollment period. For more

information on alternatives to COBRA coverage reach out to your HR Repre-

sentative or Plan administrator.

Contact your plan administrator or Human Resources to determine how

COBRA is administered at your workplace.

CHIP Model Notice

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 assis-

tance 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 Insur-

ance 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 on the following page, 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.insurekidsnow.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, 2019. Contact your State for more information on eligibility – ALABAMA – Medicaid ARKANSAS – Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447) ALASKA – Medicaid COLORADO – Health First Colorado & Child Health Plan Plus

The AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/ Phone: 1-866-251-4861

Email: [email protected]

Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Health First Colorado Website: https://www.healthfirstcolorado.com/

Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711

CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus

CHP+ Customer Service: 1-800-359-1991 / State Relay 711

FLORIDA – Medicaid GEORGIA – Medicaid

Website: http://flmedicaidtplrecovery.com/hipp/

Phone: 1-877-357-3268

Website: http://www.medicaid.georgia.gov

Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA – Medicaid IOWA – Medicaid

Healthy Indiana Plan for low-income adults 19-64

Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479

Other Medicaid: Website: http://www.indianamedicaid.com Phone 1-800-403-0864

Website: https://dhs.iowa.gov/hawk-i

Phone: 1-800-257-8563

KANSAS – Medicaid KENTUCKY – Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 Website: https://chfs.ky.gov Phone: 1-800-635-2570

LOUISIANA – Medicaid MAINE – Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Phone: 1-888-695-2447

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html

Phone: 1-800-442-6003 TTY: Maine relay 711 MASSACHUSETTS – Medicaid and CHIP MINNESOTA – Medicaid

Website: http://www.mass.gov/eohhs/gov/departments/masshealth/

Phone: 1-800-862-4840

Website: http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp Phone: 1-800-657-3739

MISSOURI – Medicaid MONTANA – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084 NEBRASKA – Medicaid NEVADA – Medicaid

Website: http://www.ACCESSNebraska.ne.gov

Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900 NEW HAMPSHIRE – Medicaid NEW JERSEY – Medicaid and CHIP

Website: https://www.dhhs.nh.gov/oii/hipp.htm

Phone: 603-271-5218

Toll Free - 1-800-852-3345, ext. 5218

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html Phone: 1-800-701-0710 NEW YORK – Medicaid NORTH DAKOTA – Medicaid

Website: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-844-854-4825 NORTH CAROLINA – Medicaid OKLAHOMA – Medicaid and CHIP

Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100 Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

OREGON – Medicaid PENNSYLVANIA – Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm Phone: 1-800-692-7462

RHODE ISLAND – Medicaid SOUTH CAROLINA – Medicaid

Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347 Website: https://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid TEXAS – Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059 Website: http://gethipptexas.com/ Phone: 1-800-440-0493

UTAH – Medicaid and CHIP VERMONT– Medicaid

Medicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427 VIRGINIA – Medicaid and CHIP WASHINGTON – Medicaid

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm

CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

Phone: 1-800-562-3022 ext. 15473

WEST VIRGINIA – Medicaid WISCONSIN – Medicaid and CHIP

Website: http://mywvhipp.com/

Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

Phone: 1-800-362-3002

WYOMING – Medicaid

Website: https://health.wyo.gov/healthcarefin/medicaid/ Phone: 307-777-7531

To see if any other states have added a premium assistance program since January 31, 2019 or for more information on special enrollment rights, 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/agencies/ebsa (1-866-444-3272) www.cms.hhs.gov (1-877-267-2323) , menu opt 4, ext 61565

http://myalhipp.com/

http://myarhipp.com/

http://myakhipp.com/

mailto:[email protected]

http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

https://www.healthfirstcolorado.com/

http://flmedicaidtplrecovery.com/hipp/

http://www.medicaid.georgia.gov

http://www.in.gov/fssa/hip/

http://www.indianamedicaid.com/

http://www.kdheks.gov/hcf/

https://chfs.ky.gov

https://chfs.ky.gov

http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.mass.gov/eohhs/gov/departments/masshealth/

http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jsp

http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jsp

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

http://www.state.nj.us/humanservices/%0ddmahs/clients/medicaid/

http://www.state.nj.us/humanservices/%0ddmahs/clients/medicaid/

http://www.njfamilycare.org/index.html

https://www.health.ny.gov/health_care/medicaid/

http://www.nd.gov/dhs/services/medicalserv/medicaid/

https://dma.ncdhhs.gov/

http://www.insureoklahoma.org/

http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm

http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm

http://www.eohhs.ri.gov/

https://www.scdhhs.gov

http://dss.sd.gov/

http://gethipptexas.com/

https://medicaid.utah.gov/

http://health.utah.gov/chip

http://www.greenmountaincare.org/

http://www.coverva.org/programs_premium_assistance.cfm

http://www.coverva.org/programs_premium_assistance.cfm

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

https://wyequalitycare.acs-inc.com/

2019 benefits overview - flagler schools

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