Transcript No Slide Title

BENEFlex 2015
Risk Management & Insurance
PLEASE TURN
OFF YOUR
CELL PHONES
Please Be Nice & Turn Off That Device
Sit back, relax & give your phone a rest,
so when you enroll in benefits you won’t have to make a guess.
#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:
Family OTL and Dependent
Child(ren) Life Insurance
coverages:
• Legally married spouse
• Legally married spouse
• Dependent children may be
covered through end of
• Dependent children may be
calendar year in which they
covered up to age 26:
reach age 26
– A.) if they are dependent upon
you for support: OR
For Medical:
Dependent children up to age 30,
– B.) they are a full-time student
please contact Risk Management
at 588-6197 for further details and
documentation.
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.
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):
Staff HMO – Modest premium, narrow network of physicians
and service area, access limitations, primary care physician
(PCP) required, referrals to specialists required
NPOS – Broader national network, out of network options,
80%/20% co-insurance, deductible $300 individual/$600 family,
direct access to specialists
Consumer Directed Health Plan (CDHP) – Lowest premium, innetwork only (HMO Premier), deductible $1500 individual/$3000
family, health care allowance, 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 + Children
– EE + Family
Co-payments
$ 25
$ 50
$500
$500 per day for the
first 5 days
$300
$ 50
$3,500
$7,000
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.)
NPOS
(National Point of Service)
In Network Benefits
• Deductible:
Employee
$300
$600
EE+1, EE. + Family
EE + Spouse, EE + Children
• 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
• Deductible:
Employee
$300
EE. + Family
$600
EE + Spouse, EE + Children
• 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:
$3,500 – individual
$7,000 – 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 only
$3000 EE+ Spouse, EE + Children, EE + Family
After deductible has been met, all expenses covered at 80%
except prescription cost
• Member Allowance:
$ 500 - EE only
$1000 –EE + Spouse, EE + Children, EE + Family
• Maximum out of pocket
$3,500 – individual
$7,000 – EE + Spouse, EE + Children, 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.)
Payroll Deduction Chart
•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
$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 & Sam’s Club
Non preferred pharmacy is subject to the deductible, co-payment and
30% coinsurance
Mandatory generics dispensed as written
Step Therapy & Preauthorization required for certain types of drugs
“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
Short Term/Long Term Disability
Short and Long Term coverage will provide a monthly
benefit if you are unable to work due to illness or injury (employee only)
MetLife HOSPITAL INDEMNITY (HIP)
You can receive cash benefit when you or a covered dependent is
hospitalized due to an accident or illness.
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.
Health Care Reimbursement
(HCRA)
Dependent Care Reimbursement
(DCRA)
Health Care Reimbursement
• Set aside your money up to $2500 (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)
Dependent Day Care (Dependent Care FSA)
• Up to $5000 for two working parents
• Pretax savings for day care expenses
• Children up to age 13
Advantages
• Reduce Federal & FICA income taxes
• Results in more money in paycheck
• Access to amount declared immediately for Health Care Acct. only
• •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
Box #2
• 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
Dental Comparison Chart
Begins on page 48
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
Box #3
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
Employee + 1
Employee + Family
$ .00
$2.48
$4.36
*Board Contribution (Flex Credits) may be used
PRUDENTIAL LIFE INSURANCE PLANS
1. Board Paid Life
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
Employees must complete the beneficiary section for
Board Life. Primary and Secondary beneficiaries must
equal 100%:
PRUDENTIAL LIFE INSURANCE PLANS
Voluntary Family Term Life (Box #7)
 $ 5,000 insurance for spouse and dependent children
 Premium of $ 1.00 per pay period
3. Voluntary Optional Term Life (Box #8)
 Optional employee coverage up to $500,000
 Benefits over $100,000 are subject to a medical questionnaire
 Optional coverage for your spouse up to $100,000, not to exceed employee’s
coverage
 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
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)
Box #5
 Benefits provided if death due to accident or for loss of eyesight,
speech and hearing or 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
Rates are listed on page 7 in the Beneflex Guide.
*Board Contribution (Flex Credits) may be used
ASSURANT INCOME PROTECTION
(disability – employee only)
Box #6
1. Basic or Short Term Disability
 2 years for sickness, 5 years for accident
 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.
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
TO ENROLL IN DISABILITY
COVERAGE:
1 Complete the top section
1
2 Choose New Enrollment
2
3 Check Short Term Disability
3
and Waiting Period
4 List benefits requested in
4
5
white area of form (see page
7 of Beneflex Guide for rates)
5 List deduction amount
under “20 Salary Deductions
Per Year
6 Sign and date the bottom of
the form
6
MetLife HOSPITAL INDEMNITY (HIP)
Box #4
The MetLife HIP pays a cash
benefit when you or a covered
dependent is hospitalized due to an
accident or illness.
Covered Benefits:
Hospital Admission - $500
Hospital Confinement - $250 per day, 30 day maximum
Inpatient Rehabilitation Unit - $100 per day, 15 day maximum –
Accident only
Pre-existing conditions limitations apply.
*Board Contribution (Flex Credits) may be used
Rates are listed on page 7 in the Beneflex Guide
.
A wellness and rewards program for employees enrolled in a Humana health
plan that gives its members an opportunity to:
Set goals – create a personalized plan!
Earn Vitality Points™ and shop at the Vitality Mall with Vitality Bucks!
Learn the value of making healthy choices to experience personal results!
Employees reaching Silver Status or above by August 31, 2015, will be eligible
for a premium credit during 2016!
Employee Only
Employee + Spouse
Employee + Child/ren
Employee + Family
$10 credit per pay period
$15 credit per pay period
$15 credit per pay period
$20 credit per pay period
Better health, great rewardsit's all part of Humana Vitality!
How does it work?
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
 Up to 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 - Group Legal Services may only
enroll as a new hire or during annual enrollment
• Met Life: Great rates for cars, recreational vehicles
and motorcycles
• MetLife – Auto/Motorcycle/Recreation Vehicle, and
Veterinary Pet Insurance
Enrollment any time during the
year through: 1-800-Get Met 8
(438-6388)
MetLife Defender
Benefits
 ID Theft Monitoring
Payroll Deduction
 Personal Identity
Monitoring and Security
 Employee + Spouse - $15.00
 Patented Peer-to-Peer
Network Monitoring
 Junk Mail Removal
 Health Data Protection
 Financial Data Protection
 On-Line Child Safety
 Employee Only - $9.00
 Employee + Children - $12.00
 Employee + Family - $18.00
Enrollment any time during the
year through:
http://pinellas.enrollmetdefender.com
For additional information, call
1-800-Get Met 8 (438-6388)
36
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
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
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
588-6197
Good luck & Welcome to Pinellas County Schools