Flexible Benefits Guide

Transcription

1 Flexible Benefits Guide Carroll County Public Schools 125 North Court Street Westminster, MD

2 Flexible Benefits Program This guide will provide information on all your available benefit options. Any necessary forms must be returned to the Department of Human Resources within 31 days of your date of hire. If forms are not returned timely, you may not enroll again until the next open enrollment (see page 4) This guide is only a brief summary of the plans sponsored by Carroll County Public Schools. The formal plan documents shall determine actual benefits and plan provisions. Please refer questions to the appropriate insurance company or the Department of Human Resources. Table of Contents Overview 3 Medical and Prescription Drug 5 Dental 8 Vision 10 Life Insurance/Long Term Disability 11 Flexible Spending Accounts 12 Enrollment Instructions 13 2

3 OVERVIEW Who is eligible for coverage? Most employees working more than 20 hours per week as a contracted employee are eligible for coverage. Cafeteria workers (contractual), temporary (contingent or hourly) and substitute employees are not eligible. Dependents are eligible as follows: Legal spouse Children up to the end of the calendar year in which they turn age 26 Children can include natural born children, step-children or adopted children regardless of marital status, student status, parent support, residence, or employment status of the child. Also included are children who are living in the employee s home under a custody order or guardianship arrangement, including grandchildren. Documentation for each dependent s eligibility will be required upon enrollment. Extended coverage may also be available for mentally or physically incapacitated children beyond age 26 if the child is unable to work. Please contact the Department of Human Resources for more information. When does my coverage take effect? Your coverage effective date is stated in your official hire letter from the Department of Human Resources. For most employees, this is the first of the month following your date of hire. What level of coverage can I elect? The following levels of coverage are available for medical, dental, and vision coverage: Individual Parent + 1 Child Employee + Spouse Family You may elect a different level of coverage for each benefit. Can I waive coverage? You may waive coverage for medical, dental, vision, and/or flexible spending accounts. You may waive supplemental life insurance benefits for yourself and dependents. You may waive long term disability insurance benefits for yourself. If you waive long term disability or supplemental life insurance when you are initially eligible, you will be required to complete a medical questionnaire and be approved by the insurance company if you decide to elect coverage later. The supplemental life insurance will allow you to make changes for specific lifestyle events (see page 11). 3

4 OVERVIEW How much will benefits cost? The cost of benefits is shown on the Benefits Cost Sheet. CCPS provides medical/prescription coverage with a contribution required by the employee at each level of coverage. CCPS provides individual dental coverage at no cost. The employee pays for the cost of any dependents for dental. The employee pays the full cost for vision. Basic life insurance is provided at no cost to the employee. Coverage for supplemental life insurance and long term disability is paid by the employee. Some employees have the LTD premium paid by CCPS for specific bargaining groups. Please refer to the booklet for more information. Can I make changes to my benefits after enrollment? The Carroll County Public Schools Flexible Benefits Program (medical, dental, vision, and flexible spending accounts) is an IRS Section 125 plan. This means you make elections each year and pay for your benefits on a pre-tax basis. You will be given the chance to make changes during Open Enrollment. These changes take effect January 1 following the open enrollment period and remain in effect until December 31. You may not change your election until the next Open Enrollment unless you have a family lifestyle change: Marriage Legal Separation/Divorce Birth or Adoption of a child Death of a dependent Change in eligible status of a child Change in spouse s insurance/open enrollment You have 31 days from the date of this event to submit changes. Except for the birth/adoption of a child, your changes take effect the first of the month following the lifestyle event. For the birth of a child, the changes are effective on the baby s date of birth. For adoption of a child, the changes take effect on the date the child is placed in your custody (pending completion of the legal adoption). The life insurance and long term disability plans are not part of the Flexible Benefits Program and changes can be made at any time. The employee premium deductions for these benefits are taken on a post-tax basis. 4

5 MEDICAL/PRESCRIPTION DRUG Medical and prescription drugs benefits are provided through Aetna. The Aetna Managed Choice Point-of-Service (POS) plan offers two levels of benefits - Preferred and Non-Preferred. You choose the level of benefits each time you seek care. Preferred care is obtained when you visit your Primary Care Physician (PCP) or obtain a referral from the PCP to a network specialist. Care certified by the PCP or specialist with Aetna is also covered at the Preferred level. You must have a referral to visit a specialist or your care will be reimbursed at the Non-Preferred level of benefits even if the provider is in the network. The Non-Preferred level of benefits is available to you if you want to self-refer to any physician of your choice. This provides a lower benefit level but still offers the freedom to choose your own provider. There are some types of care that do not require a referral from your PCP. They are: Routine Eye Exams Obstetrical/Gynecological Care (for any reason) For these types of care, you receive the Preferred level of benefits if you seek care from a network provider. You receive the Non-Preferred level of benefits if you visit a provider who does not participate in Aetna s network. The prescription drug benefits of the medical plan cover up to a 30 day supply at a network retail pharmacy and a 90 day supply at the Aetna Rx Home Pharmacy order pharmacy. You will pay $10 for a generic prescription and $25 for a name brand prescription. If the cost of the drug is less than the copay, you will pay only the cost of the drug. If your doctor prescribes a drug that has no generic equivalent, you must pay the higher brand name copay. To maximize your prescription benefits, use the mail order pharmacy for maintenance medications. Maintenance medications are drugs that you must take on a regular, ongoing basis such as heart medication, high blood pressure medication, insulin and diabetic supplies, or birth control pills. You can obtain a 90 day supply for one $10 or $25 copay as compared with three 30 day supply prescriptions at the network retail pharmacy for $30 or $75 in total copays. Ask your doctor if you can take advantage of this feature. If you are taking specialty medications (injectable therapy, IV therapy and biotechnology drugs prescribed for self-injection or administration in the physician s office), these must be obtained through Aetna Specialty Pharmacy. The local pharmacy or Aetna Rx Home Pharmacy will advise you if your medication falls into this category. Once enrolled, you can establish an account online with Aetna at to view your prescription drug claims, search for participating local pharmacies and process mail order refill requests. 5

6 MEDICAL/PRESCRIPTION DRUG The POS plan benefits are outlined below. The plan covers many wellness benefits such as: Routine Physical Exam for adults every 12 months Well Child Exams for children Routine Gynecological Exam every 12 months Routine Mammograms (subject to schedule) Routine Eye Exam every 24 months Routine Hearing Exam every 24 months Preferred (Care provided by the PCP or with a referral to a specialist) Calendar Year Deductible None $250 Individual $500 Family Non-Preferred (Care provided by a non-participating provider or without a referral) Inpatient Per Confinement Deductible Out-of-Pocket Maximum $100 (waived for newborns and if readmitted within 10 days of discharge) $1,000 Individual $2,000 Family $200 (waived for newborns and if readmitted within 10 days of discharge) $2,000 Individual $4,000 Family Out-of-Pocket Maximum includes the calendar year deductible. Once this maximum is met, covered expenses are paid at 100% for the remainder of the calendar year. (Excludes copays and per confinement deductibles.) Office Visits (including Mental Health/Substance Abuse Outpatient Care) 100% after $10 copay 75% after deductible Hospital (including Mental Health/Substance Abuse Inpatient Care) 90% after $100 per confinement deductible 75% after deductible and $200 per confinement deductible Other Services 90% 75% Prescriptions Generic $10 per prescription Brand $25 per prescription Retail Pharmacy 30 day supply Mail Order Pharmacy or Specialty Pharmacy 90 day supply 6

7 MEDICAL/PRESCRIPTION DRUG The Aetna medical program includes many services at discounted prices for plan participants. These include discounts for: Vision Care Fitness Memberships/Equipment Hearing Aids Natural Products and Services Oral Health Care Products Weight Management Programs Mayo Clinic Bookstore Information is available from the Department of Human Resources or online at You must create an account in Aetna Navigator on Aetna s website after enrollment in the plan to view the discount programs. You can use Aetna s website to view your claims, request ID cards, change your primary care physician, print temporary ID cards prior to receiving your new cards, view the available discount programs, and access your mail order prescription drug information. ******************************* Employees represented by A&S, AFSCME, CASE, Food Services, and ATSP and Cabinet employees are eligible for a separate optional medical plan, Aetna Health Fund. This plan offers a high deductible health plan and health savings account. A separate packet will be provided if you are eligible. This is a very complex plan and requires understanding of the underlying principals of participation. You may not enroll in this plan if you are eligible for Medicare or if you are covered by another insurance plan with a spouse at the time you are enrolled in this plan (unless it is also a high deductible health plan utilizing a Health Savings Account). If you enroll and do not like this plan, you may not change your medical plan election until the next open enrollment that takes effect January 1. You can drop this medical plan during the plan year only if you have a family lifestyle change. Please read the information concerning this plan carefully. If interested, the separate enrollment and beneficiary forms for this plan must be completed. 7

8 DENTAL Dental benefits are provided through CIGNA for the Traditional and Preferred Plans. The Direct Dental Plan is administered by the Department of Human Resources. The Traditional Plan offers you freedom to choose any dentist but utilizes a passive PPO plan with CIGNA. Your dentist may be a PPO dentist with CIGNA. If so, they will accept CIGNA s lower negotiated fee and you will only be responsible for the appropriate deductibles and coinsurance. These providers will file claims for you. If your dentist does not participate with CIGNA s network, the reimbursement will be based on the reasonable & customary fee with the appropriate plan percentage paid; however, the dentist may charge you any amount in excess of theis allowed benefit. The benefit percentages are the same whether you use a network dentist or not. The Traditional Plan benefits are outlined below. Traditional Plan Calendar Year Deductible Preventive Services $50 Individual $150 Family 100%, deductible waived Basic Services (fillings, root canals, periodontics, oral surgery) Major Services (bridges, crowns, dentures, implants) Orthodontics Calendar Year Maximum 80% after deductible 50% after deductible Not Covered $1,500 per person The Preferred Dental Plan offers two level of benefits. In network benefits are provided if you use a CIGNA PPO network provider and Out-of-Network benefits if you go to a non-network provider. The network providers are contracted by CIGNA and agree to accept a negotiated fee lower than the allowed benefit. For non-network providers, you will be reimbursed based on the reasonable & customary fee, which the dentist may or may not accept. The Preferred Dental Plan benefits are outlined on the next page. 8

9 Calendar Year Deductible DENTAL In-Network $25 Individual $75 Family Preferred Dental Plan Out-of-Network $50 Individual $150 Family Preventive Services 100% deductible waived 75% deductible waived Basic Services (fillings, root canals, periodontics, oral surgery) 80% after deductible 60% after deductible Major Services (bridges, crowns, dentures, implants) 50% after deductible 35% after deductible Orthodontics 50% deductible waived 35% deductible waived Calendar Year Maximum Orthodontia Lifetime Maximum (children to 19 only) $1,500 per person $1,500 per person The Direct Dental Plan is a reimbursement plan that provides payment for dental related services on a tier schedule as follows: Direct Dental Plan Tier 1 100% of the first $200 Tier 2 $50 deductible Tier 3 80% of the next $500 Tier 4 50% Calendar Year Maximum $1,500 per person To receive benefits, pay for your dental expenses at the time of service and submit an itemized bill with the direct dental reimbursement form to Human Resources. Claims are processed biweekly and payments are issued directly to the employee on their pay check (not subject to taxes). 9

10 VISION BENEFITS Vision benefits are administered by UnitedHealthcare Vision (formerly Spectera). Benefits are offered based on whether the provider participates in UHC Vision s network. For out-of-network care, you pay the provider upfront and submit a claim form for reimbursement. UHC Vision offers an extensive network of providers in chains such as United Optical (some are now being called by the new store name of EyeFit Vision Centers), Sterling Optical, Optical Solution, Opti- Care, America s Best, Wal-Mart/Sam s Club, and Allegheny Optical. The benefits are available every 12 months. Below is a summary of the Voluntary Vision Plan benefits. Benefit In Network (Member Pays) Out-of-Network (Plan Pays) Eye Exam $10 copay Up to $40 Frames $0 copay Up to $130 allowance; Up to $140 allowance at United Optical/EyeFit Up to $45 Lenses: Single $20 copay Up to $40 Bifocal $20 copay Up to $140 Trifocal $20 copay Up to $160 Standard Progressive $70 copay Based on bifocal or trifocal allowance Polycarbonate Lenses Covered for children up to 19; Covered for any member at United Optical/EyeFit Scratch Resistant Included N/A Coating Tint $13-$15 copay N/A UV Coating $16 copay N/A Contact Lenses: Medically Necessary Included Up to $210 Conventional Contacts Up to 4 boxes from the allowed selection; Up to $125 $125 allowance for non-selection; up to $150 allowance at United Optical/EyeFit Disposable Contacts Up to 4 boxes from the allowed selection; $125 allowance for non-selection; up to $150 allowance at United Optical/EyeFit Up to $125 Benefit Period Every 12 months Covers one pair of glasses or one contact lens benefit per period 10

11 LIFE INSURANCE LONG TERM DISABILITY Life Insurance provides protection for your family in the event of your death. Coverage is provided through Standard Insurance Company. Your coverage takes effect on your date of hire. Basic life insurance equal to 1.5 times your salary is provided to you at no cost. Additional life insurance may be purchased through after-tax payroll deductions as follows: Employee o $20,000 o $40,000 o $60,000 o $80,000 o $100,000 Spouse o $10,000 o $20,000 o $30,000 o $40,000 o $50,000 Children o $5,000 per child Your spouse and child(ren) can only have supplemental life insurance coverage if you elect supplemental life insurance for yourself. The spouse benefit is limited to 50% of your own supplemental life benefit. Reminder: If you waive coverage for supplemental life when initially eligible, you can only elect it by completing a medical questionnaire and being approved by the insurance company unless you do so within 31 days of the following lifestyle events: marriage, divorce, legal separation, birth/adoption of a child, death of dependent, commencement or termination of spouse s employment or a change in employment from full-time to part-time by you or your spouse. Long Term Disability benefits are offered to all employees. Coverage is provided through Standard Insurance Company. Your coverage is effective on your date of hire. Benefits are provided at 60% of your gross salary, less certain other income such as pension and Social Security benefits, up to $7,500 per month. For employees represented by A&S and for ATSP and Cabinet employees, you are provided this benefit at no cost. Reminder: If you waive coverage for long term disability when initially eligible, you can only elect it by completing a medical questionnaire and being approved by the insurance company. 11

12 FLEXIBLE SPENDING ACCOUNTS Flexible Spending Accounts are pre-tax accounts you establish to reimburse yourself for out-of-pocket health care expenses or dependent care (day care) expenses. These plans are administered by Total Administrative Services Corporation (TASC). There are two types of accounts: Healthcare Flexible Spending Account for out-of-pocket expenses you and your family have for medical, prescription drug, dental and vision care. Maximum $2,500 per family per year. Dependent Care Flexible Spending Account - for day care expenses paid for your dependents so that you may work. Maximum $5,000 per family per year. You may elect to establish either or both types of these accounts; however, you cannot transfer monies between the two accounts. You contribute money to these accounts on a pre-tax basis, thus lowering your taxable income. Once you incur eligible expenses, you can either use the debit card provided to you by TASC or submit expenses to TASC directly for reimbursement. Once enrolled in the FSA, the employee will automatically receive a debit card in the mail and can request an additional card if needed for a dependent. If claims are submitted manually, the reimbursement is issued either by direct deposit (you must provide TASC with your banking information via your online account) or the funds are placed onto your debit card to spend. If you use your debit card to pay for expenses, you must keep track of your expenses and any documentation that these expenses qualify under the FSA. If you are audited by the IRS, they may request verification of your submitted expenses. If the expense is considered ineligible, you may owe taxes on the money paid under your FSA. For cafeteria employees enrolled in the CCPS medical plan, you will receive $500 seed money that you can deposit into a Health Care FSA or Dependent Care FSA or both. You can also make additional contributions with your own money up to the account maximum (including the seed money). If you are hired during the calendar year, the annual seed money will be prorated to reflect the number of months remaining in the calendar year. The Dependent Care Spending Account allows you to pay for day care expenses for dependents under age 13 or a dependent of any age that is mentally or physically unable to care for himself/herself and you claim as a dependent on your income tax return. You will be reimbursed for care that has been provided at the time the claim is processed (pre-payments cannot be processed until care has actually been provided). The IRS allows you to receive payments from your Dependent Care FSA based on the amount of money you have in your account. This account is used in place of the IRS child care tax credit on your income tax return. The Health Care Spending Account allows you to submit out-of-pocket health care expenses that are not covered by any medical, prescription drug, dental or vision plan. This includes some over-the-counter health care supplies and drugs. The IRS allows you to access the money in your account up to your full elected amount once you have made your first biweekly contribution. Please note, the IRS requires that over-the-counter medications be submitted manually with a doctor s prescription. Therefore, you cannot use your debit card for pre-payment of these expenses. Estimate your election carefully. For dependent care, if you do not use the money, you lose it! For health care, a yearend balance of $500 or less may be carried over to the next plan year. You must submit expenses during that plan year you elect an FSA or within 90 days after the close of the plan year. 12

13 ENROLLMENT INSTRUCTIONS Complete the enrollment form and remember these important steps: Check the level of coverage for each plan. (You may elect a different level of coverage for each benefit.) Be sure to provide primary care physician code from the Aetna directory or full name for each family member for medical (if applicable). Be sure to check the specific dental plan you are electing (if applicable). Indicate if you want any FSA contributions. Complete the Enrollment Information box for yourself and each dependent, if you are covering dependents for any plan. Please remember to include the Primary Care Physician identification number (not the name) from the provider directory for each person enrolled in medical. You must complete this form even if you are waiving all coverage! Complete the separate Life Insurance and Long Term Disability enrollment form for basic life insurance beneficiary information, additional life, dependents life and LTD. You should complete this form to provide beneficiary information for basic life insurance (CCPS paid) even if you are not electing additional life insurance or LTD. ALL FORMS ARE DUE TO THE DEPARTMENT OF HUMAN RESOURCES NO LATER THAN 31 DAYS FOLLOWING YOUR DATE OF HIRE. DO NOT DELAY - THE LONGER YOU TAKE, THE LONGER IT TAKES TO NOTIFY THE INSURANCE CARRIERS OF YOUR COVERAGE AND FOR YOU TO RECEIVE YOUR IDENTIFICATION CARDS. 13