BENEFLex 2014BENEFLex 2014Risk Management & InsuranceRisk Management & Insurance

Please do not ask questions of coworkers, schoolsecretaries, department heads, principals. They may

not have the answers that best meet your needs.

Instead, contact theRISK MANAGEMENT BENEFITS TEAM

for the most accurate answer at 727-588-6197

Or visit our website at www.pcsb.org/risk-benefits

QUESTIONS

#1 Question…When are my benefits effective?

• Benefits are effective the first day of the month following 60 days of employment.

Example:• Hire Date Benefits Effective 8/17 11/1 3/16 6/1• You must turn in your Enrollment and Change

form in person or by pony (interoffice envelope) to Risk Management and Insurance Department within -- 31 days -- of your hire date or full time position date.

PAYROLL DEDUCTIONS

20 Payroll Deductions per year.

You pay for 12 months of coverage during the 10 month school year.

You pay one month in advance. Example: Hire Date Deductions Begin Benefits Effective 8/17 10/24 11/1 3/16 5/1 6/1

If your benefit effective date is after Jan. 1st, you will owe prepaid

premium

If forms are not returned within 31 days of your date of hire, you may owe for missed deductions.

If you change deductions during the year, you may owe premium or you may be due a refund.

Dependent Eligibility

For Medical, Dental & Vision coverages:

• Legally married spouse• Same sex domestic partner,

requires additional documentation

• Dependent children may be covered through end of calendar year in which they reach age 26

Family OTL and Dependent Child(ren) Life Insurance coverages:

• Legally married spouse• Dependent children may be

covered up to age 26:– A.) if they are dependent upon

you for support: OR

– B.) they are a full-time student

For Medical:Dependent children up to age 30, please contact Risk Management at 588-6197 for further details and documentation.

DOCUMENTATION IS REQUIRED FOR DEPENDENTSenrolled in health, dental or vision coverage: marriage certificate for a spouse, birth certificates for children. Photocopies are acceptable.

DOCUMENTATION IS REQUIRED FOR DEPENDENTSenrolled in health, dental or vision coverage: marriage certificate for a spouse, birth certificates for children. Photocopies are acceptable.

FAMILY STATUS CHANGES

Changes may only be made within 31 days of a change in family status to the current plans that you are enrolled in: Examples: Marriage or Divorce Birth or Adoption of a child Your spouse begins or terminates employment You begin or return from a leave of absence Your dependent loses eligibility under the plan

Changes may also be made during the annual Open Enrollment period every year in the fall, effective J anuary 1st of the following year.

Staff HMO – Modest premium, narrow network of physicians and service area, access limitations

NPOS – Broader national network, out of network options, 80%/20% co-insurance

Consumer Directed Health Plan (CDHP) – Lowest premium, in-network only, greater risk (cost).

Under all 3 plans

Preventative physicals, GYN care, mammography and colonoscopy exams covered at no charge

HMO Staff

For the HMO STAFF plan, you must choose a Primary Care Physician (PCP) - who directs all of your health care needs. Humana does not assign PCP’s

***If you enroll in the Staff Plan, please note there is a limited number of PCP’s and they may only refer to a limited number of specialists. For the HMO STAFF plan you must get a referral from your PCP

before seeing a network specialist, except those mentioned in item 3 below.

Note 1. You may select a network Pediatrician for your children only. 2. You may select as many PCP’s as you have covered family

members. 3. Network OB-GYN, Chiropractors and Podiatrists do not need a

referral from PCP. You may also have up to 5 visits per year with any in-network Dermatologist without a referral.

Choosing a Doctor

NPOS (National Point of Service)

In Network Benefits

• Deductible- $100 Employee– $200 E +1 – $200 EE + Family

• Broad network of doctors

• No referral to specialist

• Co-insurance 80%/20%

• Inpatient hospital: $500Per day for a max of 5 days

Out of Network Benefits differences

• Co-insurance 60%/40%

• Inpatient hospital: 60%/40%

• Annual routine adult physical/GYN exam/mammography and colonoscopy – covered 40%

Maximum out of pocket in/out-of network:$3,000 - individual$6,000 – EE+1, EE+ family

CDHP Benefit Plan(Consumer Directed Health Plan)

In-Network Only

• Broad network of doctors• No referral to specialist• Deductible:

$1500 EE $3000 EE + or EE + Family

After deductible has been met, all expenses covered at 80% except prescription cost

• Member Allowance:$ 500 - EE only

$1000 – EE+1 or EE+ Family• Maximum out of pocket

$3,000 - individual$6,000 – EE+1, EE+ family

NOTE: You must stay within the Humana network to receive benefits. There is no coverage out of network, except for life threatening illness and emergencies. (In most cases you will have to return to the service area for follow-up care.)

Health Plan PremiumsHealth Plan Premiums

Employee only

Employee +1

Employee + Family

2 Board Family

CDHP $23.00 $104.00 $164.00 $68.00

HMO STAFF $39.00 $141.00 $216.00 $120.00

NPOS $57.00 $165.00 $248.00 $152.00

•Payroll deductions are PER PAY -- 20 pays. These are after the Board contribution has been applied. This applies to all employees no matter what pay options is selected (pages 6 & 7 in BeneFlex Guide)

•To be eligible for Two Board Family, you and your spouse are employees of the School Board, both qualify for benefits and have at least one child who meets the eligibility guidelines

3 Tier Prescription Plan

Tier 1 Tier 2 Tier 3 $15.00 $35.00* $60.00*

*$250 individual/$500 family deductible added to all health plans on tiers 2 and 3

prescriptions before the co-pays apply. Preferred Humana network - CVS, Wal-Mart and Sam’s club Non-preferred pharmacy is subject to the deductible, co-payment and 30% co-insurance

Mandatory Generics with dispensed as written Step Therapy & Preauthorization required for certain types of drugs

Money Savings Tips: Look for the $4 generic prescriptions available at Wal-Mart, Target, Publix (some free medications), etc.

Receive 3 month supply for cost of 2 co-payments at local retail preferred pharmacies or Humana’s mail order company

Mail Order Program Available for Maintenance Drugs: Prescription must read “90 day supply” (Examples: Birth Control, Blood Pressure Medication, Heart Medication)

Board Contribution

FOR EMPLOYEES WHO DO NOT SIGN UP FOR THE DISTRICT HEALTH INSURANCE…..

You may receive up to $75.00 per pay period credit to apply toward the following benefits (♦ designated on enrollment form):

See page 13 for further details

The Reimbursement Accounts

Health Care Reimbursement Acct. (HCRA) & Dependent Care Reimbursement Acct.

Box #9, #10

•Set aside your money (or up to $25 of board contribution for HCRA only) on a pretax basis in a separate account to pay for out-of-pocket medical, dental, vision expenses (for

all family members) and dependent day care

•Examples of Covered Expenses–office visit and prescription co-pays and plan deductibles–Some over the counter medications, if prescribed by PCP or Specialist–Expenses that exceed medical or dental plan limits (braces)–hearing aids –vision expenses not covered by vision plan–children under age 13 who are enrolled in a licensed day care or after school center or individual day care provided by caregiver (must give social security number)

Reimbursement Accounts

Advantages•Reduce Federal & FICA income

taxes

•Results in more money in paycheck

•Access to amount declared immediately for Health Care Acct.

•In many instances, greater tax advantage through employer plan vs. annual tax filing

Disadvantages

•Must estimate carefully

•IRS Use it or Lose it Rule

Dental Plans

• 1. Humana/CompBenefits (Dental HMO)– copayments – network providers

• 2. Met Life PPO (reimbursement plan)– chose any dentist, save on preferred providers

*Board Contribution (Flex Credits) may be used

HumanaCompBenefits Must select a provider from Humana/CompBenefits List

of Providers

No deductibles or claim forms – Only Copays at time of service

Network Specialist rates same as Primary Providers

Orthodontia Benefits, see information on age guidelines

Premium Employee $ 6.70 Employee +1 $12.47 Employee +Family $18.22 Two Board Family $16.22

*Board Contribution (Flex Credits) may be used

MetLife Dental

Use any dentist – reimbursement plan

Money Savings Tip—Reduced out of pocket expenses when you use a participating Met Life Preferred Dentist.

$50.00 per person calendar year deductible/$150 family deductible

Reimbursement based upon services –Negotiated PDP fees

100% Preventative, 80% Basic, 50% Major

Orthodontia up to age 19 and up to a $1,000 lifetime benefit

Premium EMPLOYEE $12.62 EMPLOYEE +1 $23.34 EMPLOYEE +FAMILY $33.69 TWO BOARD FAMILY $31.69

*Board Contribution (Flex Credits) may be used

Free Coverage to benefit eligible employees who enroll for routine eye care. May purchase coverage for EE+1 and/or EE+ Family

$10 co-payment routine eye examination for glasses OR $10 co-payment for a contact lens exam plus up to $40 for fitting fees

(every 12 months) $90 allowance for frames plus 20% off balance over $90 (every 24

months)

National retail and private practice optometrists & ophthalmologists Premiums: Employee $ .00

Employee + 1 $2.48 Employee + Family $4.36

*Board Contribution (Flex Credits) may be used

EyeMed VISION COVERAGE

PRUDENTIAL LIFE INSURANCE PLANS

1. Board Paid Life (Box #4) Employee Coverage:

1 X your annual salary, rounded to the next highest $1,000. Minimum coverage is $15,000 Example: Salary $18,500 Insurance coverage $19,000

2. Voluntary Family Term Life (Box #7) $ 5,000 insurance for spouse and dependent children Premium of $ 1.00 per pay period

3. Voluntary Term Life (Box #8) Optional employee coverage up to $500,000

Benefits are subject to a medical questionnaire over $100,000 Optional coverage for your spouse up to $100,000,

subject to a medical questionnaire for all coverage amounts Optional coverage for children, up to $10,000 If you are interested in coverage you must complete the separate application in the

Beneflex packet. If you do not want coverage DO NOT complete that application.

Board Contribution (Flex credits) MAY NOT be used, these premiums will be deducted from your paycheck

Rates are listed at the bottom of page 7 in the Beneflex Guide.

Prudential Life Insurance Application

Video information on the life insurance plans: mms://video.pinellas.k12.fl.us/2008Risklifea_d

Sample on page 19 of the Beneflex Guide

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)

Box #5 Benefits provided if death due to accident or for loss of eyesight,

speech, hearing, paralysis or dismemberment

$ 2,000 coverage provided free to all eligible employees

Coverage amounts: $50,000, $100,000, $200,000, and $300,000

Employee only & Employee + Family coverage available

No application required

Premiums: Benefit Amount Employee Employee + Family $ 50,000 $ .77 $1.28 $100,000 $1.54 $2.57 $200,000 $3.08 $5.13 $300,000 $4.62 $7.70

*Board Contribution (Flex Credits) may be used

ASSURANT INCOME PROTECTION (disability – employee only)

Box #6 1. Basic or Short Term Disability

2 years for sickness, 5 years for accident Guaranteed issue up to $1400—however, preexisting condition clause applies Three benefit waiting periods - 15th, 30th and 60th day. The shorter the waiting

period the higher your premium.

2. LTD or Long Term Disability You must have short term (Basic) to elect LTD coverage. Benefits begin after short term (Basic) benefits end.

Benefits exceeding $ 800 require medical approval.

3. Hospital Confinement (HIP) You must have short term (Basic) to elect HIP coverage $ 20.00 daily hospital benefit provided; $ 40.00 if hospitalized due to cancer,

heart disease or stroke or if in intensive care

If you are interested in coverage you must complete the separate application in the Beneflex packet. If you do not want coverage DO NOT complete that application. Rates are listed on page 7 in the Beneflex Guide. *Board Contribution (Flex Credits) may be used

Assurant Disability Application

Video information on the disability plans: mms://video.pinellas.k12.fl.us/2008Riskincomeprotect

Sample on Page 18 in BeneFlex Guide

“No Health” Board Contribution“No Health” Board Contribution

Use your $75 per pay period Board Credit for:

DentalCover yourself or your family through Met Life or Comp Benefits

VisionQuality vision care for you and your family

through EyeMed Vision Care

Accidental Death & Dismemberment InsuranceHelp for dealing with financial consequences of an accident

for you and your family

Income ProtectionShort and Long Term coverage will provide a monthly

benefit if you are unable to work due to illness or injury (employee only)

Flexible Spending AccountApply up to $25 to a Health Care Reimbursement Account.

Use your FSA to pay for eligible medical expenses not covered by insurance.

Wellness ProgramWellness Program• Be Smart Worksite Wellness Program, see the Wellness Champion at

your worksite for programs based on the staff survey

• Diabetes Care Program, free testing supplies once requirements are met.

• Tobacco Cessation Program, with Rx available (telephonic coaching required)

• District wide programs –stress reduction, proper hydration, skin cancer screenings, blood pressure screenings and more

• All Humana Participants: Free Telephonic Health Coaching for Weight Mgt., Physical Activity, Nutrition, Back Care, Stress Mgt.

• Employee Assistance Plan. (CCW)

Employee Assistance Program

Covers all eligible employees and family members

8 free counseling sessions per incident.(no co-pays)

Strictly confidential

•Stress (on & off the job)

•Family & Marital problems

•Divorce

•Substance or Alcohol Abuse

•Depression

•Elder Care Referral

•Legal Assistance Referrals

Corporate Care Works 1-800-327-9757

Voluntary Products

• Convenient payroll deductions• Enroll anytime throughout the year after your eligibility begins• Met Life: Great rates for cars, recreational vehicles and

motorcycles• MetLife – Auto/Motorcycle/Recreation Vehicle, Group Legal

Services and Veterinary Pet Insurance

Retirement Savings Plans

• Tax Deferred Annuity Program – Defer up to 25% of pay, not to exceed $15,500 per year.

(If you turn age 50 or older this year, you can contribute and additional $5,000.)

– Money deducted from you salary reduction is deferred from Federal income taxes

– Principal and interest accumulate through variety of investment options

– 4 monetary changes per year– NO contributions /matching funds from PCS

• Florida Retirement System (FRS)– You will contribute 3% of your gross pay – You must decide after receiving your packet from FRS in 60

days which plan to select • FRS Pension Plan• FRS Investment Plan• Free help is available at MyFRS.com or 1-866-446-

9377

Retirement Savings Plans(continued)

Risk Management & Insurance Department

• We offer a comprehensive and flexible benefit program that meets your needs today & tomorrow.

• We are here to serve you, our customer.Please call us anytime M-F, 8:00 – 4:30

588-6197Good luck & Welcome to Pinellas County

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