Open Enrollment
2016
Agenda
Welcome - Online Enrollment - FBMC information
FCSRMC - Life Insurance - Long Term Disability
Medical Benefits
Florida Blue – Edith Hodges
Florida Health Care Plans – David Miller
Dental Benefits - Delta Dental
Vision Benefits - VSP
Important Enrollment Websites
Daytona State College Employee Benefits
daytonastate.edu/employee_benefits
Florida Benefits Management Center (FBMC)
bmc.myfbmc.com
FBMC Online Enrollment
The first step of the enrollment process is to login at
bmc.myfbmc.com
Last Year --- Where Were We?
Medical Plan Changes
• Reviewed plan designs / offerings
Introduced 4 choices
Varying benefits and costs
Committed to compliance and stabilization
• College contribution commitment
• Rising costs and premiums
Last Year --- Where Were We?
Dental and Vision Changes
• Change from self-insured to FCSRMC
Offered multiple choices in coverage
Rates and benefits set for 2 years
This Year --- Where Are We?
Medical Plan Coverage
• Plans stabilized as promised
FHC Plan’s have no changes to benefits
FL Blue has minimal changes to benefits
• Premium Increases (based on employee only coverage)
FHCP:
TS1 = 4.6%
FL Blue: 03769 = 3.7%
T51= 5.3%
03559*= 8.2%
*03559 was offered at the lower price in 2015
• College continues to pays $520/ month
• Employee pays balance
This Year --- Where Are We?
Dental and Vision Plans
• As stated in October 2014, there are no
changes to premiums or benefits for the
January 2016 plan year
Life Insurance
• No changes to rates or benefits
Flexible Spending Accounts
Types of Accounts
Healthcare Spending Account – Medical,
Dental, Vision & Rx
Maximum contribution - $2,500/year
Child/Dependent Care Account – Day Care
Maximum contribution - $5,000/year
Two Reimbursement Options
Debit Card
Submit claims to Health Equity for direct deposit
NOTE: Paper checks will be available; however, a fee of $2.00/check will
automatically be withheld from the reimbursed amount
2016 Life Insurance
The College pays for two times your annual base
salary up to a maximum benefit of $500,000
For example: If your annual base salary is $40,000, then
the value of your Basic Life insurance policy is $80,000.
You may purchase an additional policy up to three times your
base salary, not to exceed a maximum benefit of $500,000
If you purchase an additional policy, may also purchase a spouse life and or
a dependent life policy.
During the online enrollment with FBMC, you will have to enter
your beneficiary information. You will need your beneficiary’s
SSN, Date of Birth and Address to complete this process.
Long Term Disability
The College provides Long Term
Disability coverage and pays
100% of the cost for this benefit.
Long Term Disability coverage is
pay check insurance. This benefit
begins if you become totally and
permanently disabled and are no
longer able to work, ensuring that
your income continues.
Introducing Florida Blue
Edith Hodges
Florida Blue PPO Plans
Features & Benefits
• Access to over 44,000+ providers in Florida; 817,000+
nationally
•
•
•
•
•
Access to 200+ countries Worldwide
Local hospitals in-network Option 1
Bert Fish Medical Center in-network Option 2
Emergency covered worldwide
FloridaBlue.com – find providers, view claims, benefit
info, member handbook, order new ID Cards
• Nurse Advice Hotline (24/365) – 877-789-2583
• Dedicated Case & Disease Management
• Flu Shots available at no cost at participating pharmacies
Florida Blue - Access to Care
Brevard, Flagler and Volusia Counties
FLAGLER
BlueOptions
BREVARD
BlueOptions
Hospitals
1
Hospitals
PCPs
39
PCPs
308
Specialists
49
Specialists
473
Florida Hospital - Flagler
VOLUSIA
Hospitals
BlueOptions
6
PCPs
284
Specialists
264
Florida Hospital – Oceanside
Halifax Medical Center
Halifax Hospital Port Orange
Bert Fish Medical Center (Option 2)
Florida Hospital – DeLand
Florida Hospital – Fish Memorial
Mayo Clinic
Shands all locations (Option 2)
All Florida Hospital System locations
Cleveland Clinic
7
Wuesthoff Hospital - Rockledge
Wuesthoff Medical – Melbourne
Cape Canaveral Hospital
Holmes Regional Medical Center
Palm Bay Hospital
Parrish Medical Center
Viera Hospital
Space Coast Area
KEY PROVIDER GROUPS:
• Brevard Medical Group
• Coastal Cardiovascular and Thoracic
• Healthcare Partners of Memorial
• Medical Associates of Brevard
• Melbourne Internal Medicine Associates
• Memorial Physicians
• Omni Healthcare
• Osler Medical
• Quality Medical Care
• Royal Oaks Medical Center
Florida Blue PPO Plans
Benefit
BlueOptions 03769
BlueOptions 03559
Deductible
Person / Family
$600 / $1,800
Person / Family
$600 / $1,800
Out-of-Pocket Limit
Person / Family
$6,000 / $12,000
Person / Family
$6,000 / $12,000
Primary Care Visit
$30 copay
$30 copay
Specialist Visit
$50 copay
$50 copay
Preventative Care
No Charge
No Charge
Florida Blue PPO Plans
Benefit
BlueOptions 03769
BlueOptions 03559
$30/$50
$0 (Quest only)
$50 (Adv Imaging- Ded+20%)
DED + 20% Opt 1/Opt 2
$30/$50
$0 (Quest only)
DED + 20%
$150 Opt 1 / $250 Opt 2
ER (Facility)
ER (Physician)
DED + 20%
$100
$100 + 20%
DED + 20%
Urgent Care
$65
$50
Inpatient Hospital
Stay
$1,000 Option 1
$2,000 Option 2
$750 Option 1
$1,500 Option 2
Diagnostic Tests
Physician Office
Independent Clinical Lab
Independent Diag Test Centr
Outpatient Hospital
NOTE: Actual cost share amounts are based on location of service
Florida Blue PPO Plans
Prescription Drug
Coverage
BlueOptions
03769
BlueOptions
03559
Generic
$15 copay
$15 copay
Brand
$45 copay
$60 copay
Non-preferred Brand
$65 copay
$100 copay
25%
Specialty Pharmacy
Mail Order
(Up to 90 days supply)
(member out of pocket
max up to $250 per
month per Rx)
$100 copay
2 x Retail Copay
2 x Retail Copay
Florida Blue Medical Premiums
For Plan Year Effective January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Florida Blue Plans (PPO)
Blue Option 03559
24-Pay per Year
Blue Option 03769
Per pay
Per Month
Per pay
Per Month
College
$260.00
$520.00
$260.00
$520.00
Employee
$51.50
$103.00
$45.00
$90.00
Employee & Spouse
$182.00
$364.00
$172.50
$345.00
Employee & Child(ren)
$149.50
$299.00
$141.00
$282.00
Employee & Family
$271.50
$543.00
$261.00
$522.00
Florida Blue Plans (PPO)
Blue Option 03559
18-Pay per Year
Blue Option 03769
Per pay
Per Month
Per pay
Per Month
Employee
Employee & Spouse
$346.67
$68.67
$242.67
$693.34
$137.34
$485.34
$346.67
$60.00
$230.00
$693.34
$120.00
$460.00
Employee & Child(ren)
$199.33
$398.66
$188.00
$376.00
Employee & Family
$362.00
$724.00
$348.00
$696.00
College
The per pay totals were formula generated and may reflect slight rounding differences
Introducing FHCP
David Miller
FHCP HMO Plans
Features & Benefits
•
•
•
•
•
•
Access to over 1500 providers
All local hospitals in-network
Emergency & Urgent Care covered worldwide
WFW Extended Hour Centers reduced $10 copay
FREE Access to over 60 local Gyms
FHCP.com and myFHCP – find providers, view claims,
benefit info, member handbook, order new ID Cards
• Nurse Advice Hotline (24/365) – 866-548-0727
• Dedicated Case & Disease Management
• Flu Shots available at no cost at FHCP facilities
FHCP - Access to Care
Flagler, Volusia, Seminole and Brevard Counties
WFW Locations:
Daytona Beach
DeLand
Edgewater
Ormond Beach
Orange City
Palm Coast
Port Orange-Advanced
Urgent Care
FLAGLER
VOLUSIA
SEMINOLE
Growing Network
in:
Orange City
Altamonte
Cocoa
Lake Mary
Melbourne
Rockledge
Sanford
Titusville
And more
BREVARD
FHCP HMO Plans
Contracts with Hospitals
•
•
•
•
•
•
•
•
•
•
•
.
All Volusia/Flagler Counties Hospitals
Central Florida Regional Hospital
Putnam Community Medical Center
Mayo Clinic Hospital
Arnold Palmer Children’s Hospital (by referral)
Shands Lake Shore Regional Medical Center
Shands Live Oak Regional Medical Center
Shands Starke Regional Medical Center
Parrish Medical Center
Wuesthoff Medical Center-Melbourne
Wuesthoff Medical Center-Rockledge
FHCP HMO Plans
Benefit
HMO TS1
HMO T51
Deductible
Person / Family
$500 / $1,500
Person / Family
$1,000 / $2,000
Out-of-Pocket Limit
Person / Family
$3,500 / $10,500
Person / Family
$5,000 / $10,000
Primary Care Visit
$20 copay
$30 copay
Specialist Visit
$35 copay
$50 copay
Preventative Care
No Charge
No Charge
FHCP HMO Plans
Benefit
HMO TS1
HMO T51
Diagnostic Tests
including Radiology
$0 -10% No deductible
or 20% after deductible
$0 - 20% Coinsurance
after deductible
20% Coinsurance after
deductible
20% Coinsurance after
deductible
Outpatient Surgery
Emergency Room
Urgent Care
Hospital Stay
NOTE: Actual cost share amounts are based on location of service
Work Force Wellness
Extended Hour Centers
Florida Health Care
Primary care visit
$10 copay
Urgent care visit
$10 copay
Sports Physical, Well
Woman, Child Health and
Vaccinations
$0 copay
Routine Injections that are
administered during a
PCP visit
Included in the visit copay; no
extra participant out of pocket
Wellness Coaching faceto-face
$10 copay
Central Scheduling 386-676-7198 · Toll Free 855-210-2648
Available 7:00 – 7:00 Monday-Friday
FHCP HMO Plans
Prescription Drug
Coverage
Network Pharmacies
Preferred Generic
$3 copay
FHCP Pharmacy
Non-Preferred Generic
$10 copay
$15 copay
FHCP Pharmacy
Select Walgreen’s Pharmacy
Preferred Brand
$30 copay
$35 copay
FHCP Pharmacy
Select Walgreen’s Pharmacy
Non-preferred Brand
$55 copay
$60 copay
FHCP Pharmacy
Select Walgreen’s Pharmacy
Specialty Drugs
Formulary
$125 copay
Only available at FHCP pharmacies
Mail Order – up to 90 days
supply
$1 discount
per 31 day
supply
FHCP Pharmacy
FHCP Medical Premiums
For Plan Year Effective January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Florida Health Care Plans (HMO)
FHCP-TS1
24-Pay per Year
FHCP-T51
Per pay
Per Month
Per pay
Per Month
College
$260.00
$520.00
$260.00
$520.00
Employee
$30.35
$60.70
$12.72
$25.44
Employee & Spouse
$152.59
$305.18
$127.53
$255.06
Employee & Child(ren)
$122.10
$244.20
$98.90
$197.80
Employee & Family
$234.76
$469.52
$204.71
$409.42
Florida Health Care Plans (HMO)
FHCP-TS1
18-Pay per Year
FHCP-T51
Per pay
Per Month
Per pay
Per Month
College
$346.67
$693.34
$346.67
$693.34
Employee
$40.47
$80.94
$16.96
$33.92
Employee & Spouse
$203.45
$406.90
$170.04
$340.08
Employee & Child(ren)
$162.80
$325.60
$131.87
$263.74
Employee & Family
$313.01
$626.02
$272.95
$545.90
The per pay totals were formula generated and may reflect slight rounding differences
In-Network Benefits
Florida Blue
Florida Health Care
Deductible
Person / Family
$600 / $1,800
Person / Family
$500 / $1,500
Out-of-Pocket Limit
Person / Family
$6,000 / $12,000
Person / Family
$3,500 / $10,500
Primary Care Visit
$30 copay
$20 copay
Specialist Visit
$50 copay
$35 copay
Preventative Care
No Charge
No Charge
In-Network Benefits
Florida Blue
Diagnostic Tests
Radiology
(Office/IDTC)
$30/$50 (BOptions 03769)
DED +20% (BOptions 03559)
Florida Health Care
$0 -10% Coinsurance no
deductible
DED +20% (BOptions 03769)
Outpatient Surgery
$150 Opt 1 / $250 Opt 2
(BOptions 03559)
Emergency Room
DED + 20% (BOptions 03769)
$100 copay + 20% (BOptions
03559)
Urgent Care
$65 copay (BOptions 03769)
$50 copay (BOptions 03559)
$1000 Opt 1 / $2000 Opt 2
Hospital Stay
(BOptions 03769)
$750 Opt 1 / $1500 Opt 2
(BOptions 03559)
20% Coinsurance after
deductible
Prescription Drug Coverage
Per 31 day supply – In-network
Florida Blue
Preferred Generic
$15 copay (BOptions 03769)
$15 copay (BOptions 03559)
Florida Health Care
$3 copay
$15 copay (BOptions 03769)
Non-Preferred
Generic
Preferred Brand
Non-Preferred Brand
Specialty Drugs
Formulary
Mail Order – up to 90
days supply
$15 copay (BOptions 03559)
$45 copay (BOptions 03769)
$65 copay (BOptions 03559)
$65 copay (BOptions 03769)
$100 copay (BOptions 03559)
25% (BOptions 03769)
$100 (BOptions 03559)
2x Retail Cost
$10 copay
$15 copay
FHCP Pharmacy
FHCP Pharmacy
Select Walgreen’s Pharmacy
$30 copay
$35 copay
FHCP Pharmacy
Select Walgreen’s Pharmacy
$55 copay
$60 copay
FHCP Pharmacy
Select Walgreen’s Pharmacy
$125 copay
Only available at FHCP
Pharmacies
$1 discount
per 31 day
supply
FHCP Pharmacy
2016 Medical Premiums
For Plan Year Effective January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Florida Blue Plans (PPO)
Blue Option 03559
24-Pay per Year
Per pay
Per Month
College
$260.00
$520.00
Employee
$51.50
$103.00
Employee & Spouse
$182.00
Employee & Child(ren)
Employee & Family
Blue Option 03769
Full Premium
Per pay
Per Month
Full Premium
$260.00
$520.00
$623.00
$45.00
$90.00
$610.00
$364.00
$884.00
$172.50
$345.00
$865.00
$149.50
$299.00
$819.00
$141.00
$282.00
$802.00
$271.50
$543.00
$1,063.00
$261.00
$522.00
$1,042.00
Florida Blue Plans (PPO)
Blue Option 03559
18-Pay per Year
Per pay
Per Month
College
$346.67
$693.34
Employee
$68.67
$137.34
Employee & Spouse
$242.67
Employee & Child(ren)
Employee & Family
Blue Option 03769
Full Premium
Per pay
Per Month
$346.67
$693.34
$830.68
$60.00
$120.00
$813.34
$485.34
$1,178.68
$230.00
$460.00
$1,153.34
$199.33
$398.66
$1,092.00
$188.00
$376.00
$1,069.34
$362.00
$724.00
$1,417.34
$348.00
$696.00
$1,389.34
The per pay totals were formula generated and may reflect slight rounding differences
Full Premium
2016 Medical Premiums
For Plan Year Effective January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Florida Health Care Plans (HMO)
FHCP-TS1
24-Pay per Year
FHCP-T51
Per pay
Per Month
College
$260.00
$520.00
Employee
$30.35
$60.70
Employee & Spouse
$152.59
Employee & Child(ren)
Employee & Family
Full Premium
Per pay
Per Month
Full Premium
$260.00
$520.00
$580.70
$12.72
$25.44
$545.44
$305.18
$825.18
$127.53
$255.06
$775.06
$122.10
$244.20
$764.20
$98.90
$197.80
$717.80
$234.76
$469.52
$989.52
$204.71
$409.42
$929.42
Florida Health Care Plans (HMO)
FHCP-TS1
18-Pay per Year
FHCP-T51
Per pay
Per Month
College
$346.67
$693.34
Employee
$40.47
$80.94
Employee & Spouse
$203.45
Employee & Child(ren)
Employee & Family
Full Premium
Per pay
Per Month
$346.67
$693.34
$774.28
$16.96
$33.92
$727.26
$406.90
$1,100.24
$170.04
$340.08
$1,033.42
$162.80
$325.60
$1,018.94
$131.87
$263.74
$957.08
$313.01
$626.02
$1,319.36
$272.95
$545.90
$1,239.24
The per pay totals were formula generated and may reflect slight rounding differences
Full Premium
Health Dialog
Nurse Advice Hot Line
Florida Blue 877-789-2583

Speak to a
Health Coach or
Registered
Nurse

24 hours a day,
7 days a week,
365 days a year

Confidential
·
FHCP 866-548-0727
Delta Dental Plans
Delta Dental - Option 1
Network
Payment Basis
In-Net
PPO
Plan Year Maximum
$1000 per covered
member
Deductible (per
member/per family) per
calendar year
Out-Net
PPO
Delta Dental - Option 2
In-Net PPO
Premier
Out-Net
80th
$1000 per covered
member
DeltaCare – Option 3
In-Network Only
48N
No plan year
maximum
$50/$150
$50/$150
$50/$150
$50/$150
Office Visit $5 copay
100%
100%
100%
100%
D&P $0 - $45 copay
Basic Services
80%
60%
80%
80%
$0 - $115 copay
Major Services
50%
40%
50%
50%
$0 - $485 copay
Diagnostic/Preventive
Service (D&P)
Major Services Waiting
Period
None
None
Rates and coverage have not changed for the 2016 plan year
None
Delta Dental Plans
Delta Dental
Option 1
Delta Dental
Option 2
Network
Payment Basis
In-Net
PPO
Out-Net
PPO
In-Net PPO
Premier
Out-Net
80th
Exams, cleanings, bite-wing Xrays
100%
100%
100%
100%
Oral Surgery
80%
60%
80%
80%
Non-Surgical Periodontics
80%
60%
80%
80%
Surgical Periodontics
80%
60%
80%
80%
Space Maintainers
100%
100%
100%
100%
General Anesthesia
80%
60%
80%
80%
Endodontics (root canal)
80%
60%
80%
80%
Perio Maintenance (4910)
80%
60%
80%
80%
Crowns, bridges, inlays, onlays
50%
40%
50%
50%
Implants
Covered
Covered
DeltaCare
Option 3
In-Network Only
48N
DeltaCare
Schedule 48N
Not Covered
Rates and coverage have not changed for the 2016 plan year
Delta Dental Premiums
2016 Delta Dental
For Plan Year Effective: January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Delta Dental PPO - Option 1
Delta Dental PPO - Option 2
Delta Dental DMO - Option 3
24 Pay per Year
Per pay
Per month
Per pay
Per month
Per pay
Per month
Employee
$12.31
$24.62
$14.73
$29.46
$5.98
$11.96
Employee & Spouse
$25.86
$51.72
$30.93
$61.86
$10.46
$20.92
Employee & Child(ren)
$26.11
$52.22
$31.23
$62.46
$12.56
$25.12
Employee & Family
$43.30
$86.60
$51.79
$103.58
$17.64
$35.28
Delta Dental PPO - Option 1
Delta Dental PPO - Option 2
Delta Dental - DMO Option 3
18 Pay per Year
Per pay
Per month
Per pay
Per month
Per pay
Per month
Employee
$16.41
$32.82
$19.64
$39.28
$7.97
$15.94
Employee & Spouse
$34.48
$68.96
$41.24
$82.48
$13.95
$27.90
Employee & Child(ren)
$34.81
$69.62
$41.64
$83.28
$16.75
$33.50
Employee & Family
$57.73
$115.46
$69.05
$138.10
$23.52
$47.04
The per pay totals were formula generated and may reflect slight round differences
Rates and coverage have not changed for the 2016 plan year
VSP - Vision Plan
Choice Network
Copay
$10 Exam; $10 Materials
Exam
Every 12 months
Lenses
Every 12 months
Frames
Every 24 months
Examination
Covered after copay
Contact Lens Exam
(fitting & evaluation)
Standard Fit – covered in full after copay; member receives 15% off
contact lens exam services and copay will never exceed $60
Premium Fit – covered in full after copay; member receives 15% off contact
lens exam services and copay will never exceed $60
Lenses
Covered after copay for the following:
• Single Vision
• Lined Bifocal
• Lined Trifocal
• Lenticular
Rates and coverage have not changed for the 2016 plan year
VSP - Vision Plan
Single Vision
Multifocal
$41
$41
No copay
No copay
Polycarbonate
$31
$35
Progressive
N/A
$55
Photochromic
$70
$82
Scratch Resistant Coating
$17
$17
Anti-reflective Coating
Polycarbonate for Children
Frames
$150
Elective Contact Lenses*
$120
Necessary Contact Lenses*
Covered after copay
*Contact lenses are in lieu of spectacle lenses and frames once every 12 months.
Rates and coverage have not changed for the 2016 plan year
VSP - Vision Premiums
2016 VSP
For Plan Year Effective: January 1, 2016 through December 31, 2016
Deductions begin December 15, 2015
Vision Option
Vision Option
24 Pay per Year
Per pay
Per month
18 Pay per Year
Per pay
Per month
Employee
$2.93
$5.86
Employee
$3.91
$7.82
Employee & Spouse
$5.87
$11.74
Employee & Spouse
$7.83
$15.66
Employee & Child(ren)
$6.04
$12.08
Employee & Child(ren)
$8.05
$16.10
Employee & Family
$8.36
$16.72
Employee & Family
$11.14
$22.28
The per pay totals were formula generated and may reflect slight round differences
Rates and coverage have not changed for the 2016 plan year
Reminders: FRS Beneficiaries
www.myfrs.com
MyFRS Financial Guidance Line toll-free at 1-866-446-9377
Reminder: Dependent Verification
Dependent Verification Documentation
Verify Eligible Dependents under your Medical, Dental, and/or Vision Plans if adding for plan year 2016
All required documentation must be submitted to the Employee Benefits Department by Wednesday, October 28, 2015
Coverage will not be effective and new premium amount(s) will not begin until all required documentation has been received
and approved by the Employee Benefits Department.
Spouse
Child(ren)
REQUIRED DOCUMENTATION
Submit all required documentation to you by the Employee Benefits Department
Representative.
To add spouse coverage: A copy of the legal marriage certificate.
REMINDER: A spouse is the legally recognized marital partner (as defined by Florida Law) of a
Covered Employee.
A copy of the birth certificate, adoption papers, or other legal paperwork for the child(ren).
Documents MUST show the child(ren)'s name, date of birth, date of placement for adoption, or date
of adoption.
Questions & concerns please contact Sandra Walker 386-506-3082 or Krystal Hoy-Gentile 386-506-3394
Reminder: Employee Benefits Health Fair
Conclusion
1. Everyone must enroll (or waive coverage)
online between October 12 – October 28, 2015
2. Log into your enrollment account at
bmc.myfbmc.com
3. Have beneficiary information on hand during
the enrollment process
4. Questions