Pinellas County Sheriff’s Office
2013 – 2014 Benefits Plan Year
Benefits Enrollment: 7/29/13 - 8/9/13
Welcome!
 Benefit Options:
– Medical – Choice of 2 plans with POS network
– Dental – Preventive Only or Direct Reimbursement
– Vision – United Healthcare Vision (Spectera)
– Employee Assistance Program (EAP)
– Life and Disability – The Standard
– Flexible Spending Accounts (FSA’s)
 Dependent Care Account
 Health Care Account
1
What Is Not Changing
 Your premium contributions
 Medical, pharmacy, dental and vision deductibles, out-of-pocket
maximums, co-insurance and co-pays
 UnitedHealthcare continues as claims administrator for medical
 United Concordia continues as claims administrator for dental
 UnitedHealthcare (Spectera) continues as claims administrator
for vision
 The Standard continues as our carrier for life and disability
2
What IS Changing
 OptumRX (a partner with UHC) will replace
Medco/Express Scripts as our Pharmacy Benefits
Manager
 A new employer paid Short-Term Disability benefit through
The Standard is being added
 The Direct Reimbursement Dental benefit is being
enhanced
 The maximum contribution to a healthcare Flexible
Spending Account is reduced to $2,500
3
Open Enrollment - July 29th to August 9th
– Add health, dental or vision coverage
– Change your current health plan and/or dental plan
– Add dependents to your coverage
– Delete dependents from your coverage
– Increase supplemental life by $20,000 (restrictions apply)
– Change your life insurance beneficiary designation
– Enroll in FSA for 2013-2014 Plan Year
4
Open Enrollment
 What you MUST do during open enrollment
– You must confirm and/or elect your benefit coverage for the
new plan year of October 1, 2013 – September 30, 2014
using the on-line enrollment platform
– You must provide documents to HR for any newly added
dependents (by August 9th)
– You must enroll and elect your FSA contributions every
year — prior year elections do not carry over
5
United Healthcare
Medical Benefits
Medical Plan
 Choice of two medical plans
– CPOS Platinum – Includes coverage for acupuncture, infertility, and weight
reduction surgery
– CPOS Gold – Does not provide coverage or follow-up care for
acupuncture, infertility, or weight reduction surgery
 Both plans use the same network of doctors and providers
 Both plans are open access and do not require a primary care
doctor or a referral to visit a specialist
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Platinum Plan
Deductible
Indiv. / Family
Out of Pocket
Maximum
Indiv. / Family
Office Visits General Practice
Office Visits Specialist
ER Visits
Outpatient Surgery
Outpatient
Diagnostics
(Lab & X-ray)
Preventative/Routine
Mammograms
Gold Plan
In Network
$750 / $1,500
Out of Network
$1,500 / $3,000
In Network
$1,000 / $2,000
Out of Network
$2,000 / $4,000
$2,500 / $5,000
$5,000 / $10,000
$2,850 / $5,600
$5,700 / $11,200
$15 Copay
40% after
deductible
40% after
deductible
$150 Copay
40% after
deductible
40% after
deductible
$20 Copay
50% after
deductible
50% after
deductible
$150 Copay
50% after
deductible
50% after
deductible
$35 Copay
$150 Copay
20% after
deductible
20% after
deductible
Paid at 100%
40% after
deductible
$40 Copay
$150 Copay
30% after
deductible
30% after
deductible
Paid at 100%
50% after
deductible
8
Visit Your Personal Website
On myuhc.com
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Tools on myuhc.com
• Check claims status and
history
• Learn about benefits and
coverage
• Find in-network physicians
and hospitals
• Online statements
• View account balances
• Estimate and compare treatment costs
• Access discounts
• Print temporary ID card/request new card
• Research health topics & read articles
• Chat with a nurse in real-time
10
ComPsych
Employee Assistance Program
www.guidanceresources.com, password: PCSO
11
EAP Benefits
 Information and assistance with life and
work issues
 24 hours a day, 7 days a week
 Life/work issues impact job performance
 Completely confidential
 All members in home may access benefit
12
EAP Services
 Up to Six (6) free face-to-face sessions
— per family member, per issue, per plan year
 Employee Assistance Specialists, Certified Employee
Assistance Professional, 3-5 years clinical experience
 EAP benefits include:
 Family, marital and relationship problems
 Emotional difficulties such as depression, anxiety, guilt
 Online personal health info, news and resource tools
 Drug and alcohol dependence
 Job stress
 Child and elder care research and referrals
 Legal and financial concerns
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OptumRx
Your Pharmacy Benefit
Manager
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Drug Co-payments
Participating Retail
Pharmacies
Participating Retail
Pharmacies
Participating Retail
Pharmacies
OptumRX by Mail
Up to a 30-day
supply*
Up to a 30-day
supply*
Up to a 90-day
supply*
Up to a 90-day
supply*
1½ x copay on 3rd fill
1½ x copay 3 months
2 x copay
Generic drugs
$10.00
$15.00
$45.00
$20.00
Brand-name
drugs (Preferred)
$25.00
$37.50
$112.50
$50.00
Brand-name
drugs (Nonpreferred)
$40.00
$60.00
$180.00
$80.00
OptumRx by Mail
Can Save You Money
* As prescribed by your doctor.
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Drug Coverage
 Retail Coverage
- Use retail pharmacy for short-term
medications
- Go to www.myuhc.com or call
Member Services at 800-3775108, Group Number 712474

OptumRx By Mail
– For maintenance/long-term
medications
– No charge for standard shipping
– Cost-effective and convenient,
medication delivered to your door
– Continue to use retail pharmacy
for short term medications
Money Saving Tips
 Generics and plan-preferred
medications will cost you less than
non-preferred medications
 Consider using OptumRx by Mail
for long-term (maintenance)
medications
16
How to use OptumRx Mail Service
Pharmacy
1. Talk to your doctor
- Request up to a 3-month supply of your prescription, with
refills up to a year (if appropriate)
2. Pass your information to the mail service pharmacy
By fax or electronically:
- Your doctor can call 1-800-788-4863 for instructions to fax
prescriptions directly to OptumRx Mail Service Pharmacy
(only doctor can fax prescription)
- Ask your doctor to send immediately by using ePrescribe
17
How to use OptumRx Mail Service
Pharmacy
Online:
- Log on to myuhc.com
- Click on “Manage my Prescriptions”
- Select “Transfer Prescriptions” and select the
medications you would like to transfer to mail service
By mail:
- As your doctor for a new prescription for up to a 3-
month supply, plus refills for up to one year (if
appropriate)
- Go to myuhc.com and download an order form
18
How to use OptumRx Mail Service
Pharmacy
 Mail the new prescription and order form to the address
provided
NOTE: Most prescriptions arrive within 7 days from the date
your completed order is received. If you need your
medication right away, ask your doctor to write a prescription
for a 1-month supply that can be immediately filled at a
participating retail pharmacy.
19
Visit www.myuhc.com
 Locate participating retail pharmacies by zip code
 View information about possible lower-cost medication
alternatives
 Compare medication prices and options
 Manage your mail order account
 View your prescription history
 Access drug information
 Set up email or text message reminders to take medications
and order refills
20
United Concordia
Dental Benefits
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Dental Plan Options
 Preventative Only plan
– Reimburse the first $200 of preventative care
– Procedures covered are:





Routine oral exams
Cleaning and scaling of teeth
Two bite wing x-rays per year
One panoramic x-ray per 36 month period
Fluoride treatments
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Dental Plan Options
Preventative Only
Plan *
Covered service
Direct Reimbursement
Full Dental Plan
100% of the first $200
100% of the first $200
50% of the next $3,600
Maximum Benefit
$200
$2,000
Deductible
None
None
* Out of Network benefits reimbursed at the 90% of Usual and Customary charge
23
Dental Plan Administration
 Contact United Concordia for dental claim
questions
– Customer Service : 1-800-332-0366
– Website: www.ucci.com
– Network: Advantage Plus
24
United Healthcare Vision
Vision Benefits
United Healthcare Vision Providers
 No change in vision benefits from last year
 Large provider network
– Over 30,000 providers nationwide
– Private practice and retail chain providers
26
Schedule of Vision Benefits
Covered Services
Exam every 12 months
Frames
Lenses
Single Vision Lens
Bifocal Lens
Trifocal Lens
Lens Options
UV Coating
Tint (Solid)
Tint (Gradient)
Scratch Resistance
Basic Polycarbonate
Standard Anti-Reflective
Other Add-ons and Services
Contact Lenses
Medically Necessary
Standard (includes clear,
s pherical, biweekly
dis pos ables )
Custom (includes toric, gas
perm eable and bifocal)
Other Services
Lasik
In-Network
$10 copay
$130 retail, $50
wholesale
Out-of-Network
$25 allowance
$50 allowance
$20 copay
$20 copay
$20 copay
$20 allowance
$30 allowance
$40 allowance
$15
$13
$16
$0
$25
$45
20% off retail price
100% after $10 exam &
$20 material copay
$20 copay* includes
fitting fee, 6 boxes of
contacts and up to 2
follow-up visits
$150 allowance toward
fitting, materials and up
Allowance
$562.50 per eye
Not
Not
Not
Not
Not
Not
Not
Covered
Covered
Covered
Covered
Covered
Covered
Covered
$200 allowance
$50 allowance
$50 allowance
Allowance
$562.50 per eye
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Accessing Vision Benefits
 Internet www.myuhcvision.com or www.myuhc.com




24-hour access
Provider Locator & FAQ
Claims and eyewear order tracking
Nominate a provider to join network
 Customer Service Center
 8:30 a.m. to 8:00 p.m. ET Monday - Friday
 9:00 a.m. to 5:00 p.m. ET Saturday
28
The Standard
Life Insurance
Accidental Death & Dismemberment
Long Term Disability
Short Term Disability
Life and AD&D Benefits
Basic Life Benefit:
1 x annual salary, not to exceed $250,000 – PCSO paid
Additional Life Benefit:
$5,000 increments, not to exceed the lesser of 5 x annual
salary or $250,000
Dependent Life Benefit:
Option 1 - $10,000 Spouse / $5,000 Child(ren)
Option 2 - Spouse - $2,500 increments, not to exceed 50%
of members’ basic + additional life
Option 2 - Child - $2,500 increments, not to exceed
$10,000 or 50% of member’s basic + additional life
Guarantee Issue:
Member not previously denied coverage may elect up to
$20,000, no medical underwriting required
— Member previously denied or amounts in excess of
$20,000 or greater than 3 x base annual earnings
are subject to medical underwriting
— Spouse and children are subject to medical
underwriting for all coverage
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Life and AD&D Benefits
 Accelerated benefit for terminally ill
 Waiver of premium - 6 months total disability
 Repatriation Benefit up to $5,000
 MEDEX Travel Assist
 Seat belt benefit - Up to $10,000
 Air bag benefit - Up to $5,000
 AD&D Family Benefits Package
– Higher education benefit – Up to $20,000
– Child care benefit – Up to $10,000
– Career adjustment benefit - Up to $10,000 for spouse training
31
Life and AD&D Benefits
 Line of duty benefit - Up to $50,000 result of action performed in
the course of controlling or reducing crime and assigned duties
 AD&D covers variety of accidental losses:
– Loss of speech or hearing in both ears
– Disappearance
– Quadriplegia, Hemiplegia, Paraplegia
– Occupational Assault
– Public Transportation
32
Short Term Disability Benefit
 New employer-paid benefit
 60% of weekly earnings for up to 26 weeks, maximum of
$2,300 paid per week
 30 day qualifying period
 Must exhaust sick leave before becoming eligible
33
Long Term Disability Provisions
 Waiting Period:
180 Days
 Benefit:
60% of the first $10,000 of
monthly pre-disability earnings
 Maximum Benefit:
$6,000
 Minimum Benefit:
$100
 Maximum Benefit Period: To age 65 or Social Security
Normal Retirement Age
34
LTD Benefits
 Return to work incentive
 $25,000 reasonable accommodation benefit
 Standard SecureCard
 Social Security assistance
 3 months survivor benefits
 Assisted Living Benefit - 80% of pre-disability earnings, adds
up to $2,000 (month) to LTD benefit, not reduced by
deductible income
 Lifetime Security Benefit - Income for severely disabled
employees beyond maximum benefit period
35
The Standard Customer Service
 Medical underwriting:
888-456-3505
 STD claim questions:
800-368-2859
 LTD claim questions:
800-368-1135
 Life claim questions:
800-628-8600
 Visit the website at www.standard.com
.
36
PayFlex
Flexible Spending Accounts
Flexible Spending Account

PayFlex Flexible Spending Account (FSA)
—

Two kinds of eligible expenses:

Healthcare - Medical FSA
—

Maximum Contribution: $2,500
Dependent care - Dependent care FSA
—

Funded with pre-tax dollars
Maximum contribution: $5,000 or $2,500 if married and
filing separately
FSA results in lower taxable income and more take-home pay
38
Flexible Spending Account (FSA)
– Medical FSA eligible expenses include:





Prescription co-pays
Doctor visit and ER co-pays
Health plan deductible and coinsurance
Dental services and orthodontics
Lasik surgery, glasses, contacts
– Dependent care expenses - Dependent children & adults
 Elderly parent or disabled spouse
 Daycare, camps
39
What is NOT covered under an FSA?
 Examples of Ineligible Health Care Expenses
– Diet Foods
– Cosmetics, Cotton Balls, Teeth Whitening
– Vitamins, Supplements, Aromatherapy
– Shampoo, Toothpaste, Suntan Lotion
– Cosmetic Surgery (unless medically necessary and approved by the plan)
– Shaving cream, Razors, Soap and Hand lotions
– Over the Counter Medications without a prescription
Refer to IRS Publication 502 for more information about eligible and
ineligible expenses
40
Tax Savings Example
Based on $30,000 annual salary
No Flexible Spending Account
Flexible Spending Account
$2,500
$2,500
Pre-tax Dependent Care
$0
$867
Pre-tax Health Care
Expenses
$0
$100
$2,500
$1,533
Federal Tax (15%)
$375
$229
FICA (7.65%)
$191
$117
After-tax Dependent Care
$867
$0
After-tax Health Care
Expenses
$100
$0
Monthly Take Home Pay
$967
$1,187
Gross Monthly Income
Taxable Income
Estimated Savings for Member who Participates in the Healthcare and Dependent Care
Flexible Spending Accounts = $220 per month or $2,640 per year
41
Using your FSA Debit Card
 Use your FSA Debit Card like a regular debit or credit card for
your FSA eligible expenses
– At your Physician’s office or the Pharmacy for copays
– NOTE: You can no longer receive
reimbursement for over-the-counter
medicine without a doctor’s prescription
based on the new healthcare law
 No Credit Check needed
 Benefits of using the Debit Card include:
– Instant Reimbursement
– Reduction in receipt submission
– Up to 80% of total claims are auto-adjudicated
42
PayFlex Contact Information

1-800-284-4885

Web Access
– 24/7 secure site
– Check account claims status
– Look up qualified expenses
– Download claim forms
– Interactive tool to calculate tax savings
– Online at www.healthhub.com
43
What’s Next?
Action Steps for Members
 Prior to August 9th at 5:00 pm:
 Active members must submit changes and/or confirm
all elections in Ebonline, and provide documents for
newly added dependents to HR
 Retired members who wish to make a change must do
so by: submitting changes in EBOnline, or by mailing
form to HR-Benefits (must be received by 8/9/13 at
5pm), or by faxing completed enrollment form to (727)
582-5893, or by e-mailing the completed enrollment
form to InsuranceBenefits@pcsonet.com. If no
change, no action is required.
 Questions? Contact HR - Benefits at (727) 582-2835
45