BENEFLex 2014
Risk Management & Insurance
QUESTIONS
Please do not ask questions of coworkers, school
secretaries, department heads, principals. They may
not have the answers that best meet your needs.
Instead, contact the
RISK MANAGEMENT BENEFITS TEAM
for the most accurate answer at
727-588-6197
Or visit our website at www.pcsb.org/risk-benefits
#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
8/17
3/16
Deductions Begin
10/24
5/1
Benefits Effective
11/1
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
For Medical:
Dependent children up to age 30,
please contact Risk Management
at 588-6197 for further details and
documentation.
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
DOCUMENTATION IS
REQUIRED FOR DEPENDENTS
enrolled 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 January 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% coinsurance
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
•
•
•
•
PCP :
Specialist:
Outpatient surgery:
Inpatient hospital:
• ER:
• Urgent Care
• Maximum out-of-pocket
– EE only
– EE+1, EE + Family
Co-paymnets
$ 25
$ 50
$500
$500 per day for the
first 5 days
$300
$ 50
$3,000
$6,000
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.)
Choosing a Doctor
 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.
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: $500
Per 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 Premiums
Employee only
Employee +1
CDHP
$23.00
$104.00
Employee
+ Family
$164.00
2 Board Family
HMO STAFF
$39.00
$141.00
$216.00
$120.00
NPOS
$57.00
$165.00
$248.00
$152.00
$68.00
•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
$15.00
Tier 2
$35.00*
Tier 3
$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% coinsurance
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
Employee +1
Employee +Family
Two Board Family
$ 6.70
$12.47
$18.22
$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
EMPLOYEE +1
EMPLOYEE +FAMILY
TWO BOARD FAMILY
$12.62
$23.34
$33.69
$31.69
*Board Contribution (Flex Credits) may be used
EyeMed VISION COVERAGE
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
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
Sample on page 19 of
the Beneflex Guide
Video information on the life insurance plans:
mms://video.pinellas.k12.fl.us/2008Risklifea_d
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
$ 50,000
$ .77
$100,000
$1.54
$200,000
$3.08
$300,000
$4.62
*Board Contribution (Flex Credits) may be used
Employee + Family
$1.28
$2.57
$5.13
$7.70
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
Sample on Page 18 in
BeneFlex Guide
Video information on the disability plans:
mms://video.pinellas.k12.fl.us/2008Riskincomeprotect
“No Health” Board Contribution
Use your $75 per pay period Board Credit for:
Dental
Cover yourself or your family through Met Life or Comp Benefits
Vision
Quality vision care for you and your family
through EyeMed Vision Care
Accidental Death & Dismemberment Insurance
Help for dealing with financial consequences of an accident
for you and your family
Income Protection
Short and Long Term coverage will provide a monthly
benefit if you are unable to work due to illness or injury (employee only)
Flexible Spending Account
Apply up to $25 to a Health Care Reimbursement Account.
Use your FSA to pay for eligible medical expenses not covered by
insurance.
Wellness 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
•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
 Covers all eligible
employees and family
members
 8 free counseling
sessions per
incident.(no co-pays)
 Strictly confidential
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
Retirement Savings Plans
(continued)
• 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 1-866-4469377
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
588-6197
Good luck & Welcome to Pinellas County
Schools