Transcript School District of Clay County Call Center Training

CLAY COUNTY
DISTRICT SCHOOLS
Annual Enrollment
2014-2015 Plan Year
Annual Enrollment Highlights
• Passive enrollment = July 29 – August 22
• All current elections roll over into 2014-2015 with no AE change, except FSA.
• Employees must re-enroll and make new FSA elections
• PCP required for NEW HMO enrollees
• Without PCP designation, one will be assigned
• If currently enrolled in the HMO, current PCP will remain on file (PCP entered
during AE will not overlay Florida Blue PCP on record)
• Supplemental Life Insurance Increase without EOI
• Increase existing Employee Supplemental Term Life insurance by $10,000
(one increment) without EOI
• New Elections for EE and Spouse Life insurance, and increases in excess of
$10,000 will require EOI
• Changing from Plan B to Plan A
• May enroll in $30,000 in Supplemental Life Insurance without EOI
• May enroll in STD and LTD without EOI
• Update Beneficiaries for Life Insurance
• Verify beneficiary shown or collect new assignment
• Spouse Life and Child life beneficiary is the employee
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Benefits 101 – New Hires
• All full-time (0.6 of an allocation) contracted employees are eligible for
benefits.
• Coverage becomes effective on the first day of the month after you
complete 45 calendar days of employment, provided you enroll and
submit any required forms to the Insurance Department before your
effective date of coverage.
• The District provides a comprehensive benefit program, and the cost
of benefits are partially paid by the District.
• Review your options now and make your elections soon. Deductions
for coverage begins two pay periods in advance.
• If you delay your enrollment, you could have a double deduction from a
single paycheck.
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Read your
Benefit Guide
Your Benefits
Guide contains
details about each
plan.
Read it and have it
hand when you’re
ready to enroll.
Note the page
numbers for where
to find more
information in the
Benefits Guide.
Benefits Overview
Medical Election?
Y
E
S
N
O
Plan A
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Dependent Child Eligibility
Dental
Vision
Life Insurance (if not
married or disabled)
Accident and Injury
Whole Life
Critical Illness
Medical
Dental
Vision
Life Insurance (If not
married or disabled)
Accident and Injury
Whole Life
Critical Illness (age 24)
Age 19-26 not a full time
student
Medical
Age 19-26 and full time
student
Under age 19
Children by birth, marriage, adoption, or legal guardianship – Pg. 6
Medical
Dental
Vision
Accident and Injury
Whole Life
Critical Illness
Florida Mandate Medical
Only for Age 26-30
• Unmarried
• Not eligible for other
coverage
• No children
• Florida resident or
Full Time Student
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Is your Spouse a Clay County Schools employee?
Yes, and we both need
medical coverage
Yes, but only one of us
needs medical coverage
You both will be considered Plan A.
The spouse who needs medical
coverage will be Plan A.
Notify the Insurance Department so
your enrollment is processed correctly.
The spouse who does not need
medical coverage will be Plan B.
You may choose which of you will
have deductions taken from your pay
Don’t elect coverage for your spouse
under any plan.
 You may not elect Spouse Life Insurance because as an employee you may
not be covered as an employee and a dependent.
 Only one of you may cover your dependent children.
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Plan A Benefits
• Medical Plan
– Pg. 19
• Contributions are new and subject to change
• Rates printed in the Benefit Guide are subject to Collective Bargaining
• If rates change, all employees will be notified and may be given an opportunity
to modify coverage
• District provides Basic Life Insurance $20,000 – Pg. 45
• Plan A Employee pays 100% of all other benefits
• Medical Gap – Pg. 29
• Accident and Injury – Pg. 30
• Dental – Pg. 37
• Vision – Pg. 39
• Short and Long Term Disability – Pg. 49
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Plan B Benefits
• District provides Basic Life Insurance $50,000 – Pg. 45
• District pays 100% for Employee Only coverage in the
following plans:
• Accident and Injury – Pg. 30
• Dental – Pg. 37
• Vision – Pg. 39
• Short Term Disability – Pg. 49
• Long Term Disability – Pg. 49
• Employee pays Dependent portion:
• A&I, Dental, and Vision; not available without EE election
• Dependent Spouse and Child Life 100% voluntary
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Florida Blue Medical Plans
• HMO and PPO – Pg. 20 - 23
• Both have $3000 Annual Deductible
• Preventive Care covered 100%
• All copayments apply to Out of Pocket Maximums
• Copayments for most services
• Referrals are not required to see a Specialist
• HMO
• In-Network coverage only
• Requires designation of a Primary Care Physician
• New lower out of pocket maximum - $6,350/$12,700
• PPO
• In- and Out-of-Network national provider access
• PCP designation not required
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Florida Blue Networks/PCP
• The two plans have different networks
• HMO – BlueCare network
• PPO – BlueOptions network (also called Network Blue)
• HMO requires all covered members to designate a Primary
Care Physician
• Employees can log on to www.floridablue.com and search under “Find a
Doctor” using the residence zip code.
• If PCP is not collected at time of enrollment, then the member will be
assigned a PCP by Florida Blue based on their zip code
• Only for new enrollees – current PCP assignments will not change
• Member will receive a letter notifying them of the PCP that has been assigned
with instructions to change
• Employees should watch for the letter and contact Florida Blue immediately if
they wish to change
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Medical Gap Insurance
• MUST be enrolled in a “Major Medical” Plan
• CCDS Medical or Spouse’s group medical plan
• Excludes Medicare, TRICARE, and CHAMPUS
• Pays based on what appears on the Explanation of Benefits
from the Major Medical Plan
• Two Plans – Based on Inpatient Benefit – Pg. 29
• KeyGap 3000
• KeyGap 1500
• Outpatient = 50% of Inpatient Benefit
• $350 Ambulance coverage for Accident only
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Dental Plan
• Delta Care Prepaid Plan – Pg. 37
• Requires election of Primary Care Dentist
• No out of network coverage
• Lower cost per pay period
• Delta Dental PPO Plan – Pg. 37
• Broader network of dentists
• In and out of network coverage
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Vision Plan
• Vision Care Plan with Humana – Pg. 39
• Coverage for exams, lenses, and frames or contact lenses
• In and Out of Network coverage
• Includes coverage for Lasik
• Members receive an ID card
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Flexible Spending Accounts
• FSA with Health Equity – Pg. 41-43
• Healthcare Flexible Spending
• $2,500 Annual Maximum contribution
• Debit Card provided to all participants
• Most medical claims passed through Florida Blue claims system
can be automatically substantiated
• Members can view balances, submit claims online, and provide
substantiation documentation if necessary at
www.myhealthequity.com
• Dependent Care Flexible Spending
• $5,000 Annual Maximum
• Child Care or Elderly care
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Term Life Insurance
Verify /
Update
Beneficiaries
• Basic Life – Pg. 45
• Plan A - $20,000
• Plan B - $50,000
• Supplemental Life – Pg. 46-48
• New Employees may elect up to $100,000 in Employee Life
Insurance and Spouse Life Insurance without answering medical
questions
• Elections over $100,000 require completion of Evidence of
Insurability questionnaire
• Plan A may elect up to a total of $180,000
• Plan B may elect up to a total of $150,000
• Employee and Spouse rates are age banded based on Employee’s
age as of October 1, 2014
• Child flat rate for $5,000 or $10,000
• Children who are married and/or disabled are ineligible
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Annual Enrollment Opportunity
• Supplemental Term Life – Pg. 46-48
• Employees may increase Voluntary Life by $10,000 without
submitting Evidence of Insurability (EOI) during Annual Enrollment
• New elections and increase more than one increment require EOI
• Plan A may elect up to a total of $180,000
• Plan B may elect up to a total of $150,000
• Employee and Spouse rates are age banded based on Employee’s
age as of October 1, 2014
• Child flat rate for $5,000 or $10,000
• Children who are married and/or disabled are ineligible
• Evidence of Insurability required if electing coverage for
the first time or for Employee Life in excess of $10,000
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Disability
• Short Term Disability – Pg. 50-51
• EOI is required for Plan A employees who are not currently enrolled
and electing coverage for the first time
• EOI is not required if changing from Plan B to Plan A
• Long Term Disability – Pg. 52-53
• EOI is required for Plan A employees who are not currently enrolled
and electing coverage for the first time
• EOI is not required if changing from Plan B to Plan A
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Voluntary Benefits
• Accident and Injury – Pg. 30
• Paid by Employer 100% for Plan B Employee Only
• Sickness Rider for all enrollments
• Interest Sensitive Whole Life – Pg. 54
• Employee
• Spouse
• Child
• Specified Critical Illness – Pg. 56
• Employee Only
• Employee + Spouse
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Key Dates
• First Day of Enrollment = July 29
• Last Day to Enroll = August 22
• First payroll deduction = September 15
• Effective Date of Coverage = October 1
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