1
State Employees’ Insurance Board
2013 Benefits Conference
AGENDA
Registration (Wellness Nurses Available
)…………………………………………………………..……8:00 AM
Welcome…………………………………………………………………………………………………..……9:00 AM
I. SEIB and Healthcare Reform Overview (Page 3)..
……………………………………………………9:15 AM
SEIB
II. Deferred Comp Plan Options …………………………………………………………………………..10:15 AM
Great West Retirement Solutions
Break (Wellness Nurses Available)………………………………………………………………..……..10:25 AM
III. Alabama Retired State Employees’ Association (ARSEA)……………………………………….10:45 AM
IV. Supplemental and Southland (Page 24)……………………….…………………………………....10:50 AM
SEIB
V. Wellness (Page 42).……………………………………………………………………………..…….....11:20 AM
SEIB
VI. SEIB Wellness Center & Pharmacy (Millbrook Only)……………………………………………..11:40 AM
Lunch (On your own)…………………………………………………………………………….……..….12:10 PM
VII. Retirement Benefits Overview …….……………………………………………………...…………...1:25 PM
Retirement Systems of Alabama
VIII. SEHIP Online Enrollment ……………………………………………………………….…………..…2:05 PM
SEIB
IX.
Deferred Comp Plan Options………………………………………………………..………………..2:35 PM
Retirement Systems of Alabama
Break…………………………………………………………………………………………………..…….….2:45 PM
X. Alabama State Employees’ Association (ASEA)…………………………………….………………3:05 PM
XI. Retirees (Page 53).
……………………………………………………………………………………….3:10 PM
SEIB
XII. Flexible Benefits Plan (Page 68).………………………………….………………...………………..3:40 PM
SEIB
Program Concludes………………………………………………………………………...………………..4:20 PM

A LIST OF INSURANCE COMPANIES
ELIGIBLE FOR PAYROLL DEDUCTION
A LIST OF PAYROLL DEDUCTION
CODES ADMINISTERED BY THE SEIB
A LIST OF NEARBY RESTAURANTS
A CERTIFICATE OF COMPLETION
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3
B OARD M EMBERS AND
C OMMITTEES

4
Appointed By
Governor
Governor
Lt. Governor
House Speaker
Ex Officio
Ex Officio
Elected
Elected
Elected
Elected
Elected
Position/ Name
Personnel Board Member
John Carroll
Personnel Board Member
Joe N. Dickson
Personnel Board Member
Joanne Randolph
Personnel Board Member
Jon Bargainer
RSA Executive Secretary
David Bronner
Finance Director
Bill Newton
Personnel Board Member
Faye Nelson
Active Employee Representative
Robert Wagstaff
Active Employee Representative
Paige Hebson
Retiree Representative
William Mellown
Retiree Representative
Robert Pickett
Term
6 year term
6 year term
6 year term
6 year term
Indefinite
Indefinite
6 year term
4 year term
4 year term
4 year term
4 year term

5
Acting Finance Director
Bill Newton
Active Employee Representative
Paige Hebson
Retired Employee Representative
Robert Pickett
This committee recommends benefit and premium changes to the SEIB.

6
P LAN O VERVIEW

7
State authorizes Board to offer supplemental coverage in lieu of the basic medical plan.
State requires retirees to take other-employee coverage, if offered.
State extends supplemental and optional coverages and provides a sliding premium scale to retirees, based on years of service.
State requires Board to provide discounted coverage for low income active and retired employees and their dependents.
State approves non-tobacco user discounts.

8
Increased Dental maximum from $1000 to $1500 per covered member.
Medicare retirees enrolled in Medicare Advantage
Plan.

9
Wellness Participation Discount Program adopted.
All active employees screened during 2009 received the Wellness Participation Discount of $25 per month in 2010.

10
Effective October 1, 2010, timing of the
State's premium payments changed.

11
Implemented annual wellness screenings for all active employees to receive the Wellness
Participation Discount.

12
Board can adjust premiums for spouse’s eligibility for other coverage.
Retirees must have at least 10 years of creditable coverage to be eligible for retiree health coverage.
Cancellation of coverage for fraudulent claims.
FPL discount increased to 300%.
Retiree premiums increased 1% per year for every year prior to Medicare age.
Sliding scale adjusted to charge a 4% per year penalty for less than 25 years of creditable coverage.
Contribution for non-Medicare retirees cannot exceed contribution for active employees by October 1, 2016.

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YEAR STATE
SHARE**
INDIVIDUAL
PREMIUM
DEPENDENT
PREMIUM
1975
1980
1985
1990
1995
2000
2005
2010
2012
15.70
32.43
100.00
195.00
255.00
357.00
650.00
805.00
805.00**
0.00
0.00
0.00
0.00
0.00
0.00
0.00
15.00*
15.00*
30.75
51.77
82.50
141.00
164.00
164.00
164.00
205.00*
205.00*
2013 825.00
15.00*
*Premium shown includes non-tobacco user’s discount and wellness discount.
**State share does not reflect credits returned to agencies.
***Premiums do not include dental coverage.
205.00*

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Active Employee
Single
Family
Early Retiree
Single
Family
Medicare Retiree
Single
Family
Family (non-Medicare)
Surviving Spouse < 65
Single
Family
Medicare Surviving Spouse
Single
Family
Increase $5
Increase $5
Increase $15
Increase $25
Increase $5
Increase $5
Increase $15
Increase $20
Increase $25
Increase $20
Increase $25
Non-Tobacco User Discount
Dental Premium
Increase $5 to $50
Individual $3 Family $8
Implement Monthly Spousal Surcharge $50
If the spouse’s individual coverage is more than $255 per month, the SEHIP member may qualify for a waiver.

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Mandated Affordable Care Act (ACA) Benefits
Add some preventive and women’s health
Out of pocket limits
No copay
Individual $6,250
Family $12,500
Dental Offer dental coverage separate from health (BC/BS or Southland)
Urgent Care Facilities
Outpatient Surgery
Emergency Room
Major Medical Deductible
Lab Copays
Expand Wellness Program
Increase Copay $35 to $50
Increase Copay $100 - $150
Increase Copay $50 - $150
Increase Deductible $100 - $300
Lower from $10 - $7.50
Active employee their covered spouse,
Non-Medicare retiree and their covered spouse are eligible for the wellness discount
BCBS Supplemental
Health Reimbursement Account
Limit deductible amount on primary coverage – carve-out dental
Provide up to $150 reimbursement to supplement other coverage premiums
Pharmacy Copays 90-day Supply (Tier I at 1.5 x copay)
Tier II , include high cost generics
Implement Generic First Program (new prescriptions only)

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Benefits BC/BS Southland
Deductible
Diagnostic/Preventive
Major/Restorative
$25
100% Coverage
50% Coverage up to
$1500 annual ($25 deductible)
$25
100% Coverage
Single – 80% Coverage up to $1250 annual (no deductible)
Family – 60% Coverage up to $1000/member annual ($25 deductible)
No Coverage Orthodontics 50% Coverage up to
$1,000 lifetime per child under age 19 ($25 deductible)
NOTE: Opt-out and/or plan change forms will be mailed directly to employees.

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H EALTH C ARE R EFORM

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Summary of Health Care Reform
Patient Protection and Affordable Care Act (PPACA)

Signed into law on March 23, 2010

“Grandfathered Plans”


Plans that were in existence on March 23, 2010
SEHIP will lose grandfathered status on January 1, 2014

Provide preventative services and women’s health with no copay

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Summary of Health Care Reform To Date
Lifetime Coverage Limits Prohibited

SEHIP must eliminate the $1 million lifetime limit on coverage of essential benefits but can allow certain restrictive annual limits until
2014.
Pre-existing Condition Exclusions Prohibited for Dependents

SEHIP must eliminate pre-existing condition exclusions for children under the age of 19.
Dependent Coverage Expanded up to Age 26


SEHIP must provide coverage for adult dependent children up to age 26, if the child is not eligible to enroll in other employer provided coverage.
SEHIP cannot require qualified young adults to pay more than similarly situated dependents enrolled in the plan.
Health Care Reimbursement Account


Maximum contribution capped at $2,500 annually
Over-the-Counter drugs must be pre-approved

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*For more information on the Marketplace, click here.

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Pre-existing condition exclusion for all enrollees prohibited.

SEHIP currently has a 270 waiting period less credit for time served under other group coverage.
Coverage Eligibility

Employees must be offered coverage within 90 days of employment.
Marketplace Subsidy

SEHIP members who fall between 100%-400% of the FPL may qualify to receive credit for participation in the
Marketplace.
Individual Mandate

Everyone, unless exempted by law, is required to maintain health insurance.

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Excise tax on “Cadillac” Plans
Cost of coverage exceeds $10,200 on individual and $27,500 on family coverage

SEHIP cost of coverage is currently well below these levels.

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org

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B LUE C ROSS B LUE
S HIELD (BCBS)
S UPPLEMENTAL P LAN

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The BCBS Supplemental coverage supplements primary health insurance plans by covering the copay, coinsurance, deductible that the primary insurance plan does not pay at 100%.
The primary coverage’s deductible cannot exceed $1,250 for individual coverage or
$2,500 for family coverage.

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To be eligible, members must be able to enroll in another health insurance plan through a spouse, other, or previous employer.
Primary plans NOT eligible:
SEHIP (Group 13000)
Local Government Health Insurance Plan (Group 30000)
Public Education Employees’ Health Insurance Plan (Group 14000)
Tricare
Medicare

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Individual Coverage - $0*
Family Coverage - $0*
*The tobacco user premium will be waived and the annual wellness check is not mandatory.

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A married state employee has a spouse employed with an auto manufacturer. The spouse elects family health insurance coverage offered through his employer.
With the primary health insurance now provided through the auto manufacturer, the state employee can enroll in the BCBS Supplemental, on the first day of the following month.
The BCBS Supplemental will eliminate copays, coinsurance, and deductible (up to a maximum) not covered at 100% by the auto manufacturer’s coverage.
Remember, the BCBS supplemental is free for individual and family coverage.

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 The coverage is free of charge for individual and family coverage.
 If the primary insurance does not provide dental coverage, members are eligible to enroll in the individual dental plan ($3) or the family dental plan ($8) offered through BCBS of AL or Southland National
 BCBS Supplemental will pay health and pharmacy copays, coinsurance, and deductibles (up to a maximum) that the primary plan does not pay at 100%.
 The member can move back to the BCBS basic medical plan on the first day of any month.
 Everyone covered under the supplemental is eligible for benefits offered through the SEIB Wellness Program.

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Pharmacy:
To receive reimbursement on pharmacy benefits, the member should complete a BCBS Medical Expense
Claim form (available at www.alseib.org
) and attach pharmacy receipt(s).
Pharmacy claims may also be filed online at www.bcbsal.org
with reimbursements eligible to be direct deposited into the member’s personal checking or savings account.

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Southland
Optional Plan
Dental, Vision, Hospital
Indemnity, and Cancer

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The Southland Optional Plan provides
Dental and Vision Coverage
Cancer and Hospital Indemnity Coverage

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Individual Coverage - $0*
Family Coverage - $0*
*The tobacco user premium will be waived and the annual wellness check is not mandatory.

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The SEHIP member must be eligible for primary health insurance through a spouse or other employer.*
*Primary plans not eligible:
SEHIP (Group 13000)
Tricare (SEHIP retirees are the only exception.)
Medicare

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The Southland Optional Plan is not designed to pay copays/deductibles not covered at 100% by your primary health insurance.
It does however provide dental, vision, hospital indemnity, and cancer benefits.

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Vision


Benefits are the same, regardless of provider.
The provider or the member can file the claim.
Dental


Any dentist can be used. However, if a provider in the DentaNet network is used, the member will save money on expenses over the allowed amount.
DentaNet is the second largest dental network in Alabama.

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Hospital Indemnity and Cancer



These coverages work as a supplemental to the member’s income;
The amounts of reimbursement are determined by the procedure, admission, diagnosis, etc. The member will file the claim and reimbursement will be mailed directly to them;
Payment or coverages of the primary health insurance do not affect the reimbursement amount.

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 This plan includes dental, vision, hospital indemnity and cancer coverages, all in one.
 There is no premium for individual or family coverage.
 The dental benefits exceed those offered through the SEHIP
BCBS dental plan.
 Southland is the sole dental provider for the Public Education
Employee Health Insurance Plan (PEEHIP).
 This plan can serve as the primary dental and vision benefits plan or supplement the out-of-pocket expenses th at a
 There are no pre-existing conditions for the hospital indemnity

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A minimum enrollment period of 12 months is required.
After the12-month requirement has been
*PEEHIP members are eligible to make enrollment changes during the PEEHIP Open
Enrollment period (July-August) with a
October 1 effective date.

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


Premium is $24 per month, regardless of number of dependents.
New employees may enroll within 60 days from date of employment. Existing employees should enroll during Open Enrollment (November 1-30) with a
January 1 effective date. Contract will remain in place unless cancelled by member during Open Enrollment.
This benefit will coordinate with the SEIB Discount Routine Vision Care Network .
Examination
Frames
Single Vision
Bifocals
Trifocals
Lenticular
Contacts
40.00
60.00
50.00
75.00
100.00
125.00
100.00
Note: Plan provides either contact or lenses with frames, but not both in any plan year.

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org

W ELLNESS P REMIUM
D ISCOUNT
42

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Members are screened for the following risk factors
Blood pressure
At risk if systolic reading is 160 or higher or your diastolic reading is 100 or higher
Cholesterol
At risk if 250 or higher
Glucose
At risk if 200 or higher
Body mass index
At risk if 35 or higher

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If determined at-risk, the member will receive a copay waiver and physician referral form for follow-up. The member may receive the monthly discount by doing one of the following:

Submit an office referral form indicating that you have been counseled by a healthcare provider for your identified risk(s), or

Submit a completed physician certification form. It’s a good idea to have your physician complete and sign your form while you are in for an office visit. Then you can mail or fax to us and have the peace of mind knowing that your discount is in place, or

Submit proof of participation in an approved exercise facility or SEIB approved program. Provide dates and location of participation, or

Provide proof that you are self-managing and have made improvement in your identified risk(s). You must provide documentation of your improvement.

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No contract agreement
Monthly dues are payroll deducted
No signing fee
All memberships should be executed directly with the facility.
The enrollment and payroll deduction information will be forwarded from the facility to the SEIB monthly.
For location and rate information, visit our website at www.alseib.org
or click here .

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



New employees, and their covered spouse, must participate in a wellness screening or submit a physician certification form within 60 days from their date of employment.
All active employees, their covered spouse, non-
Medicare retirees and their covered spouse are required to have a screening/physician certification on or before November 30 th of each year.
A State employee can participate in a screening offered by the SEIB, regardless of location.
Refunds will not be given for failure to submit appropriate information by deadline dates.

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To ensure the discount of $25 per month has been applied to your contract you can:

Visit our website at www.alseib.org
to create and view your account information.

Call the SEIB Wellness Division at
(866) 838.3059.

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Members and their covered spouse may receive a reimbursement of 80% of the cost of a non-covered tobacco cessation product up to $150 lifetime maximum.

49
Covered SEHIP members can receive 80%, up to $150 annually for non-covered weight management programs that are overseen by a physician.

50
The $100 reimbursement for hearing aids will no longer be available beginning
January 1, 2014.

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To receive reimbursements for both tobacco cessation and weight management, receipts should be:
Mailed: PO Box 304900,
Montgomery, AL 36104
Faxed: (334) 517-9980
Be sure to include name, contract number, and date of birth on all correspondence.

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org

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RETIREE
INSURANCE

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A retiring employee may elect to continue coverage with SEIB by completing the Form 12 that is included in the RSA retirement package.
The Form 12 authorizes the RSA to deduct the monthly insurance premium from your retirement check.
If a retiree chooses not to continue coverage at retirement, they MUST wait until the annual Open Enrollment
(November 1-30 with an effective date of January 1) period to rejoin.

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A Retiree’s Premium Is Based On:
Sliding Scale
Premium payment is based on the retirees years of service
Medicare Eligibility
Increase in premium based on years shy of Medicare eligibility, traditionally age 65

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Premiums below are based on an employee with exactly 25 years of state service.
Non-Medicare
$226 Individual*
$478 Family*
Medicare Eligible (BlueRx)**
$0 Individual*
$121 Family*
*Premiums shown include the $50 non-tobacco user’s discount.
**BlueRx copays will increase $5 per prescription beginning January 1, 2014

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For every year of service under 25, the retiree share will be increased by 4%.
For every year of service over 25, the retiree share will be reduced by 2%.
Years of service (YOS) certified through RSA may differ from years eligible under SEIB.
Participation in ERS does not necessarily mean your
YOS will count towards your insurance premium.

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A retiree will have a 1% increase for every year they are away from Medicare eligibility.
Example: A 55 year old retiree will see a 10% increase in their health insurance premium because they are 10 years away from age 65, or Medicare eligibility.
The percentage will remain the same until the member reaches Medicare eligibility.

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Visit the SEIB website at www.alseib.org
and use the Retiree Premium Calculator to estimate premiums at retirement.
Or you can click here to automatically be directed to the Premium Calculator.

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State law requires the SEHIP retiree to enroll in
the new employer’s plan if member:


 goes to work for another employer and is e ligible for coverage with the new employer and the new employer pays 50% or more of the individual premium.

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Blue Cross Blue Shield Supplemental
Picks up co-pays and deductibles that your primary insurance does not pay at 100%, subject to a maximum deductible.
Southland Optional Plan
Provides dental, vision, hospital indemnity and cancer coverage
Both of these plans are free for the retiree and their eligible dependents, regardless of age and/or years of service.

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Retired State Employees Who Return to
Work With the State of Alabama
Medicare eligible retirees returning to work:
Are classified as a non-Medicare retiree.
The employer is subject to the non-Medicare premium for the individual.
The member is responsible for the non-Medicare premium for the dependent.

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64

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 SEIB should be notified and the necessary forms should be submitted within 90 days of the date of death;
 Surviving spouses, and their covered dependents, will be eligible to continue coverage if they were covered at the time of death;
 Eligible spouse should make the appropriate monthly premium payments to SEIB.

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 The Wellness Discount is not applicable to
Medicare eligible retirees and their Medicare eligible covered dependents. However,
Medicare eligible SEHIP members are eligible to attend Worksite Wellness Screenings.
 The Southland Vision Supplemental Plan is available to both active and retired employees.
 Retirees should not opt out of the SEHIP without speaking with an SEIB advisor about the BCBS
Supplemental or Southland Optional .

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org

Health Care Reimbursement
Account (HCRA)
Dependent Care
Reimbursement Account
(DCRA)
68

F LEXIBLE E MPLOYEES ’
B ENEFITS P LAN
69

70

Determine the amount needed for out-ofpocket medical expenses for the upcoming year that include:







Physician copays
Prescription copays
Over-the-counter medications (ONLY with doctor’s written order)
Lasik surgery
Orthodontics
Dental
Glasses/Contacts

71

The total contribution is deducted in equal pre-tax increments from each pay period over the next year.

$1,000 / 24 pay periods = $41.67 per pay period.

The money is deducted pre-tax and placed into an account to use when you have an out-of-pocket medical expense not covered by your health insurance.

72
There are three types of reimbursement offered under the Flex Plan:
Manual
Traditional (Bump)
Flexible Spending Card

73

Visit your physician and pay your copay of $35

Complete and HCRA reimbursement form, available at www.alseib.org
, and forward to
BCBS along with receipt/documentation from doctor visit;

BCBS will reimburse the member $35 by either mailing a check directly to the member, or if enrolled, the reimbursement can be direct deposited into a checking/savings account.

74

Visit your physician and pay your copay of $35

When the claim is processed by BCBS, the HCRA will automatically issue a reimbursement for the out-ofpocket expenses not covered by your health insurance.*

BCBS will reimburse the member $35 by either mailing a check directly to the member, or if enrolled, the reimbursement can be direct deposited into a checking/savings account.
*If there is no claim filed with BCBS, the HCRA will not be alerted to send a reimbursement. Example, if purchasing glasses/contacts, the request for reimbursement would need to be filed manually because these are non-covered benefits under BCBS.

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
You receive a MasterCard pre-loaded with the amount of money you choose to put into your account for the upcoming plan year.

You go to the doctor.

You use your Flex Spending card to pay the $35 copay directly from your account.
The money does not have to be in the account before the charge is incurred.

76

The Health Care Reimbursement Account (HCRA) is basically an interest-free, tax-free loan.

The State is advancing you the total amount elected for the upcoming plan year, and that amount is payroll deducted from 24 pay periods, beginning January 1.*

Qualifying status changes allow enrollment and contribution changes outside of the open enrollment period.
*New employees who start after January 1 of the plan year have 60 days from date of employment to enroll. Their deductions would be divided by the number of payroll periods left in that plan year.

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HCRA
Adjusted Gross Income $20,000 $20,000
7.5% AGI Max Amt
Medical Expenses
Amount allowed as deduction
Tax Savings (15% tax)
Tax Savings (28% tax)
$1,500 N/A
$1,500 $1,500
$0
$0
$0
N/A
$225
$420

78

This program is regulated by the IRS; therefore, it has a “Use It or Lose It” rule.

The HCRA is available from January 1 until
March 15 of each following plan year.

To determine the contribution amount, only add expenses for January through
December.

79

An additional $50 will be added to your account just for enrolling!

With a minimum $120 contribution(only $5 per pay period) you will actually have $170 to spend!

F LEXIBLE E MPLOYEES ’
B ENEFITS P LAN
80

81

Determine amount needed to cover dependent care expenses for the upcoming year.

That amount is deducted pre-tax in equal increments from each pay period over the next year.

82

$2,000 / 24 pay periods = $83.34 per pay period.*

The money is placed into an account for you to use when you have a dependent care expense.
*New employees who start after January 1 of the plan year have 60 days from date of employment to enroll. Their deductions would be divided by the number of payroll periods left in that plan year.

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






Allows you to set money aside for health/dependent care expenses for the upcoming year;
HCRA money can be used for dependents, even if they are not covered under your health insurance;
$50 bonus just for enrolling in the HCRA;
Entire amount of election is 100% pre-taxed;
Helps to budget health/dependent care expenses;
HCRA money in account after December 31 st can be used until March 15 th of the next plan year;
Significant tax savings over the course of the year.

84
SEHIP members will pay for their out-ofpocket health and daycare expenses even if they are not enrolled in the HCRA or
DCRA.
So, why not pay with pre-tax money? And receive a $50 bonus just for enrolling in the
HCRA?
Encourage your employees to consider enrolling in the HCRA and DCRA.

85
Visit the SEIB website at to www.alseib.org
view last three years of claims history to help determine upcoming years HCRA contribution amount;
Visit the Blue Cross Blue Shield of Alabama website at www.bcbsal.org
to view contributions, balances, claims, etc. on both your HCRA and DCRA.

86

Be sure to use correct plan year enrollment forms*

All payroll deductions in GHRS for both the
HCRA and DCRA are administered by SEIB
* 2014 enrollment forms have been included in your folder

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org

New and Existing
Employee
Information and
Forms


Blue Cross Blue Shield Basic Medical Plan

Blue Cross Blue Shield Supplemental Plan

Southland National Benefits Plan

Federal Poverty Level Program and
Federal Poverty Level Guidelines





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SEHIP Enrollment Form (IB2)
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After initial enrollment, employee can communicate directly with their SEIB Advisor for all their health insurance benefit questions, changes, etc.
Non-Tobacco User Discount Application
Physician Certification Wellness Discount Form
Southland Vision Supplemental Enrollment Form
Federal Poverty Level Discount Application
Flexible Benefits Plan Enrollment (HCRA and/or
DCRA)

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BCBS Medical Expense Claim Form
Plan Change Form
Membership Status Change Form
Non-Tobacco User Discount Form
Physician Certification Wellness Discount Form
Federal Poverty Level Discount Application
Blue Cross Blue Shield Direct Deposit
Enrollment Form
Southland National Cancer and Hospital
Indemnity Claim Form
Southland National Dental Claim Form
Southland National Vision Claim Form

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Worksite Wellness Screening Schedule
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Tobacco Cessation Program
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Physician Administered Weight
Management Program
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Participating Exercise Facilities

Have Your New, Existing, and Retiring Employees
Contact Their SEIB Benefit Advisor For Plan and Benefit
Information
Marsha Abbett
866-841-9489 mabbett@alseib.org
Tonya Campbell
866-841-0978 tcampbell@alseib.org
Connie Grier
877-500-0581 cgrier@alseib.org
Kerry Schlenker
866-838-5027 kschlenker@alseib.org
Rick Wages
866-841-0980 rwages@alseib.org