Employee Benefits 2013 Benefit Plan Year

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Santa Rosa County
School Board
Employee Benefits
2013 Benefit Plan Year
Benefits Offered to Full Time
Employees:
Medical
 Dental
 Vision
 Basic and Supplemental Life
 Long Term Disability
 Flexible Spending Accounts- Health & Dependent Care
 Health Care Saving Accounts (if enrolled in HDHP)
 Tax Sheltered Annuities, Cancer & Life
 Retirement
(Interim employees need to check with HR for coverage
eligibility)
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General Guidelines
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New employees must enroll for benefits within first 30 days of
employment (exception – retirement)
Enrollment for benefits via BenefitHelp on-line system
(exception – retirement benefits)
Benefits become effective the first of the month following one
month of employment
Benefits elected will be effective thru 12/31/13
Benefit plan year January 1 to December 31
Open enrollment conducted annually (November) for the
following calendar year
Benefits end on the last day of the month employment
terminates
Retirement plan must be selected before the end of the fifth
month following his/her month of hire
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Will receive retirement information packet directly from FRS
Medical
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Florida Blue (formerly Blue Cross and Blue Shield of Florida) – 4 plan options
• Blue Options PPO #05773 (high option)
• Blue Options PPO #05301 (low option)
• Blue Options High Deductible Health Plans #05182 & 05183 (high option)
• Blue Options High Deductible Health Plans #05192 & 05193 (low option)
Plan tiers
• Employee only
• Employee + Spouse
• Employee + Child(ren)
• Employee + Family
• Two Employee Family
Cost of plan varies based on plan and tier elected
• School Board pays a large percentage of premium
All four plans have the same provider network (Blue Options)
All four plans offer out of the network and/or out of the area coverage
Effective date of coverage is the first of the month following one month of employment.
• Example: Hire Date August 12, 2013; benefits begin October 1, 2013.
• Medical insurance premiums are pre-paid one month prior to the actual month of coverage
(Payroll deduction in September 2013 pays the October 2013 monthly premium)
Will receive a membership card in the mail
Blue Options PPO #05773
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Flexibility to choose physicians from a network of
providers that includes primary care and specialists
Calendar year deductible (CYD) – in network
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$2,000 per individual and $6,000 family aggregate
Office Visit Co-pays: $35.00 Primary Care and $65.00 Specialist
Hospital Inpatient – $350 Per Admission DED + CYD + 30% co-insurance
Preventive Care – 100% coverage in-network
Annual Out of Pocket Maximum - $5000/$10,000 in-network per
individual/family aggregate
Reference plan summary for specific services and applicable co-payments
Participating physician’s network available on-line @ www.bcbsfl.com
Co-pay Prescription drug program included in plan (retail & mail order)
Blue Options PPO #05301
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Flexibility to choose physicians from a network of providers
that includes primary care and specialists
Calendar year deductible (CYD) – in network
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$5,000 per individual and $10,000 family aggregate
Office Visit Co-pays: $25 Primary Care and $45 Specialists (first six visits).
After six visits subject to CYD + 30% coinsurance
Hospital Inpatient – CYD + 30% co-insurance
Preventive Care – 100% coverage in network
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Annual Out of Pocket Maximum - $7,500/$15,000 in-network per
individual/family aggregate
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Reference plan summary for specific services and applicable co-payments
Participating physician’s network available on-line @ www.bcbsfl.com
Co-pay prescription drug program for Generics only included in plan (retail
& mail order)
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Blue Options High Deductible
Health Plans 05182 & 05183
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Calendar Year Deductible (CYD) – In network
• $2,500 single coverage
• $5,000 all other tiers (EE + Spouse, EE + Child/ren, EE + Family)
• The SRCSB makes an annual HSA contribution of $750 for single contracts
and $1500 for family contracts.
Co-insurance 20% after calendar year deductible is met (no co-pays)
Preventive care not subject to the calendar year deductible or coinsurance –
100% coverage in-network
Annual Out of Pocket Maximum - $5,000/$10,000 in-network per
individual/family aggregate
Reference plan summary for specific services and applicable coinsurance
Participating physicians network available on-line @www.bcbsfl.com
Prescription drug program included in plan (retail & mail order) subject to
calendar year deductible.
Blue Options High Deductible
Health Plans 05192 & 05193
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Calendar Year Deductible (CYD) – In network
• $2,500 single coverage
• $5,000 all other tiers (EE + Spouse, EE + Child/ren, EE + Family)
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The SRCSB makes an annual HSA contribution of $750 for single contracts and
$1500 for family contracts.
Co-insurance 20% after calendar year deductible is met (no co-pays)
Preventive care not subject to the calendar year deductible or coinsurance –
100% coverage in-network
Annual Out of Pocket Maximum - $5,000/$10,000 in-network per
individual/family aggregate
Reference plan summary for specific services and applicable co-payments
Participating physicians network available on-line @www.bcbsfl.com
Prescription drug program included in plan (retail and mail order) subject to
calendar year deductible. After CYD has been satisfied member responsibility is
20% of the cost of the prescription.
Health Savings Account
(HSA)
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IRS eligibility guidelines:
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SRCSB contributes $750 or $1500 to HSA (semi-annual deposits in January and
July)
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Covered by a high deductible health plan (HDHP)
Not covered under another medical plan that is not a HDHP
Not enrolled in Medicare
Not eligible to be claimed under another person’s tax return
HSA contribution pro-rated for new hires
Employees may also make pre-tax contributions thru payroll deduction
IRS annual contribution limits for 2013 - $3,250 single; $6,450 family. Catch up
provision of $1,000 available age 55+.
Funds can be used to help pay eligible medical expenses prior to meeting calendar
year deductible.
Unused funds roll over.
Santa Rosa County Federal Credit Union is the School Board’s designated HSA
Custodian.
Can enroll in the HDHP and not open a HSA.
Special Enrollment Rights
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If you decline enrollment during the first 30 days of
employment or during the annual open enrollment,
you may be eligible to enroll at a future date for one
of the following qualifying events:
• Marriage/Divorce
• Birth, adoption or placement for adoption
• Spouse’s job change
• Spouse’s open enrollment
• Loss of other health coverage
Request to enroll or make changes must be made
within 30 days of the qualifying event
• Contact Risk Management
My Blue Service
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Website for member self-service capabilities including:
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Request replacement ID card
Health Dialog
Blue 360
eMedicine
Healthcare Advisor
Claim status information
Benefits information
Online provider directory
Request benefit booklet
Forms center
Blue Dental Choice PPO
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Two dental plans to choose from
• High option – pays 100% for preventive care; 80% for basic care after CYD
• Low option – pays 80% for preventive care; 70% for basic care after CYD
• Major services – pays 50% after CYD under both plans
• Orthodontic services - pays at 100% after CYD under both plans up to a lifetime
maximum of $1,000
• Annual dental benefit maximum is $1,000 per person
Flexibility to choose a dentist from a network of participating providers
• Dental network available on-line @ www.bcbsfl.com
Reference plan summaries for specific services and applicable deductible and co-payments
Participating providers will file claims for you. Non-participating providers may require you to
bring a claim form with you to your appointment. Forms may be obtained from the Risk
Management website or the BenefitHelp system.
Employee pays premium
• Employees who decline health coverage may elect the low option dental plan that
is paid in full by the SRCSB (does not apply to two employee families with health
coverage)
Available to employees and eligible dependents
Will receive a membership card in the mail
Florida Combined Life is the dental carrier
Vision Care
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Coverage for all routine eye care, including eye exams
and eyeglasses (lenses and frames) or contacts
Network of participating physicians to choose from
Reference plan summary for specific services covered
and applicable co-payments
Employee pays total cost
Available to employees and eligible dependents
Will receive a membership card
Davis Vision is the vision carrier
Basic & Supplemental
Life Insurance
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The SRCSB provides all employees basic life and AD & D
insurance in the amount of $50,000
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Amount is $100,000 for employees who waive health coverage
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Employees may elect additional supplemental life insurance in
$10,000 increments from $20,000 up to $300,000
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(Does not apply to Two Employee Families with health coverage)
Guarantee issue up to $200,000 if employee enrolls during the first 30 days
of employment
Evidence of insurability required for coverage in excess of $200,000
Late enrollments (after 30 days of employment or during annual open
enrollment ) requires evidence of insurability for any amount
Cost of additional supplemental life based on age
ING is the life insurance carrier
Designate primary and contingent beneficiaries on BenefitHelp
Flexible Spending Accounts
(FSA)
Section 125 of the Internal Revenue Code allows employees to have pre-tax
amounts withheld from their paychecks placed into spending accounts.
Reimbursement is made to the employee for qualified expenses.
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Employees have the option of selecting from two different types of FSA’s:
• Health care reimbursement account
• Dependent care reimbursement account
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Reference plan summary for covered expenses
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Plan year runs concurrent with health plan year (January – December)
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Maximum annual election $2,500 – Use it or lose it
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Three options for reimbursement:
• Pay with Flexible Spending Account debit card
• Submit claim forms and receipts
• File on-line at www.tasconline.com
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Total Administrative Services Corporation (TASC) is the FSA third party
administrator for the School Board
Employees who open a Health Savings Account (HSA) may not elect to
participate in a health care flexible spending plan (IRS guidelines).
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Long Term Disability
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Monthly benefit equal to 60% of your salary
up to $5,000
Benefits start after 60 days of disability
Benefits paid to age 65
Employee pays the total cost
• Rates based on age and salary
• Premiums waived during disability period
Florida Combined Life is the LTD carrier.
Tax Sheltered Annuities
Cancer, Life, Long Term Care
Insurance
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Products available for individual
purchase
Payroll deductions for approved vendors
List of vendors, agents and contact
information on the Risk Management
website
Florida Retirement System
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Two plans to choose from:
• Pension Plan
• Investment Plan
The majority of your FRS retirement plan is funded by the School Board;
a mandatory 3% pre-tax contribution is deducted from your payroll
check each month and deposited into your retirement account with FRS.
Must make a choice before the end of the fifth month following his/her
month of hire
Resources for information:
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Human Resources Website
MyFRS.com (FAQ’s, brochures, forms, investment facts, Advisor Service and
Choice Service)
MyFRS toll-free Financial Guidance Line staffed by Ernst & Young financial
planners and DOR counselors
Employee workshops
District Liability
Insurance Programs
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Insurance coverage for all School Board
employees that includes:
• Comprehensive General Liability
• School Leaders Error and Omissions
• Sexual Harassment
• Sexual Molestation
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Exclusion for “intentional acts”
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