Your Open Enrollment period is: October 19, 2015 through November 13, Your Period of Coverage is: January 1, 2016, through December 31, 2016.

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1 Your Open Enrollment period is: October 19, 2015 through November 13, Your Period of Coverage is: January 1, 2016, through December 31, Welcome to Broward County s Open Enrollment for We are green this year no paper packets! Find all of the carrier information on our new website at broward.org/benefits, select Open Enrollment. Website is accessible from work or from home, and automatically adjusts from full screen to tablet or phone size. WHAT S NEW for 2016! Paperless Open Enrollment-carrier material available online at broward.org/benefits, then click on Open Enrollment. Health Plans rates increasing. New High Deductible Health Plan with Out of Network coverage replacing CDH OON plan. Special one-time County- funding of HDHP plan deductible based on tier of coverage. Phase-out of HRA for CDH plans. Dental PPO plan has a rate increase. CatamaranRx now OptumRx, plan info has not changed, new card not required. Rx formulary changing to new, narrower Value Formulary. IMPORTANT NOTICE: Engagement Incentive continues for 2016 for enrolled employees and enrolled spouses/dps. If completed by 11/30/15, no paperwork required, system automatically updated. If completed after 11/3015, submission of 2016 Engagement Incentive form required. NEW DEADLINE FOR 2016-complete by 3/31/16 to receive 2016 funding copies of this document were promulgated at a cost of $1,926 or $0.963 per copy to inform our employees about their benefits. Important Dates: for health Submit enrollment online by 5:00pm. 11/13/15 Proof of relationship documentation for newly 11/13/15 added dependents. Proof of Over Age Dependent (age 26-30) financial dependence. 11/13/15 Review new deductions on pay voucher. 01/08/16 Proof of other group health coverage. 1/15/16 Proof of Over Age Dependent (age 26-30) 1/15/16 student status. Deadline to complete 2016 Engagement Incentive to receive HRA or HSA funding. 3/31/16

2 HEALTH PLAN OPTIONS FOR 2016 In response to significant increases in our pharmacy plan costs, claim costs for two plans exceeding premiums, and the potential impact of Health Care Reform s Cadillac Tax (a 40% excise tax based on the actuarial value of the plans) in 2018, we are implementing several changes for The major change is the replacement of the Consumer Driven Health Plan (CDH OON) with Out of Network coverage with a new High Deductible Health Plan with Out of Network coverage (HDHP OON). Members enrolled in the current CDH OON plan will see a significant reduction in their bi-weekly premium for the new HDHP OON plan. Highlights of HDHP Plans All health and prescription services are subject to the annual deductible and coinsurance based on tier of coverage with the exception of mandated preventive services or designated preventive prescriptions (see Preventive Rx list at broward.org/benefits, click on Open Enrollment, then Pharmacy). Medical and prescription expenses will be applied toward meeting the annual deductible and coinsurance amount based on tier of coverage (Member Only coverage or Member + Dependent(s) coverage). Once the annual deductible is met, the health and pharmacy plan pays 70% and you pay 30% coinsurance of the eligible discounted costs (in-network). When you reach the out-of-pocket maximum, the Plan pays 100% of eligible in-network health and prescription expenses for the remainder of the calendar year. Preventive services and designated preventive prescriptions are covered at 100%. Student Passport program for dependents attending college outside of the service area (HDHP Base Plan only as HDHP OON has a national network). Annual eye exam at no cost at a participating optometrist. Discount dental plan included at participating dental providers. Highlights of CDH High and Low Plans No changes to CDH Plan design, deductibles, coinsurance, copays, and out-of-pocket maximums for CDH High and CDH Low Plans. Both plans have higher premiums due to significant increase in pharmacy costs. Preventive services covered 100% in-network. Some services received for a copay (varies by CDH plan). Some services subject to the annual deductible/co-insurance (varies by CDH plan). Student passport program for dependents attending college outside of the service area. Behavioral health out-patient services first 20 visits covered at no cost (CDH High only). Diagnostic tests at a participating freestanding facility capped at $100 per test. Annual eye exam at no cost at a participating optometrist. Discount dental plan included at participating dental providers. Networks HDHP Base Plan, CDH High and CDH Low-Humana s Florida Premier HMO network-open Access* HDHP Out of Network Humana s National POS network-open Access* * Open Access means a referral to see most network specialists is not required. However, certain services require Prior Authorization. NOTE: If moving outside of the Humana Florida Premier HMO network, you must notify Benefits and change to the HDHP with Out of Network coverage. 2

3 CDH AND HDHP PLAN COMPARISONS (See Humana Brochure for more details at broward.org/benefits, click on Open Enrollment) HDHP PLAN DESIGNS CDH PLAN DESIGNS COVERAGE HDHP BASE PLAN HDHP WITH OUT-OF- NETWORK PLAN CDH LOW PLAN CDH HIGH PLAN Preventive Care at no cost - in-network No out-of-network Preventive Prescriptions at no cost* in-network Not covered out-ofnetwork No No Primary Care Physician (PCP) Required No No No No Out of Network Coverage No No No Network South Florida HMO National POS South Florida HMO South Florida HMO Copays No No Some services & Rx More services & Rx Annual Deductible, for services without copays Prescriptions Apply to Annual in-network Deductible & Coinsur- Not covered out-of- No ance network, for services without copays *Preventive medications are defined as those prescribed to prevent the occurrence or recurrence of a chronic disease or condition, such as high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, and heart disease. See applicable category on Catamaran s Formulary list for covered generic and formulary medications. No The primary difference between the two health plans is the CDH plans have some health services and Rx for copays, whereas the HDHP has no copays for health or Rx. Other than preventive services and designated preventive drugs, under the HDHP, all services (including lab work) and prescriptions are paid by the member at the discounted plan cost until the deductible is met. Example: Type of Service HDHP CDH HIGH Preventive Exam $0 $0 Primary Care Physician Average $30 - $70 (based on type of office $25 visit) plus any lab work. Specialist Average $120 (based on type of office visit $50 and services provided). Lab Work Plan cost based on prescribed tests (Avg. Lipid Included in office visit copay Panel $35-$50). Urgent Care Facility Plan cost based on services provided. $50 Emergency Room Plan cost based on services provided. $250 Prescription - on Formulary List If discounted drug cost is $548, member pays $548 until deductible is met, then 30% until Max Out of Pocket is met. Need assistance with Humana health or dental coverage? Contact one of the Humana on-site Representatives: Susan Kaus skaus@humana.com Marc Dormeus mdormeus@humana.com 3 Generic: $14 for 90 day supply Preferred: $60 for 90 day supply Non-preferred: $90 for 90 day supply Look up providers, cost comparisons, facility comparisons, claims history and more at myhumana.com

4 2016 BIWEEKLY RATES FULL TIME and PART TIME 20 EMPLOYEES HEALTH INSURANCE FULL TIME EMPLOYEES (Employees waving medical (1) receive $ Waiver Credit biweekly.) FULLTIME Premium High Deductible Health Plan (Base Plan) Subsidy Annual HSA/ HRA High Deductible Health Plan (Out-of-Network) Premium Subsidy Annual HSA/ HRA Employee $ $ $5.00 $2, $ $ $15.38 $1, Emp+Spouse $ $ $15.00 $4, $ $ $35.20 $3, Emp+Child $ $ $10.00 $4, $ $ $28.68 $3, Emp+Family $ $ $60.00 $4, $ $ $70.49 $3, FULLTIME Premium Consumer Driven Health (CDH) Plan - Low Subsidy Annual HRA Premium Subsidy Consumer Driven Health (CDH) Plan - High Annual HRA Employee $ $ $42.29 $ $ $ $59.80 $ Emp+Spouse $ $ $93.08 $ $ $ $ $ Emp+Child $ $ $78.18 $ $ $ $ $ Emp+Family $ $ $ $ $ $ $ $ PT20 HEALTH INSURANCE PT20 EMPLOYEES (Employees waving medical (1) receive $59.61 Waiver Credit biweekly.) Premium High Deductible Health Plan (Base Plan) Subsidy Annual HSA/ HRA High Deductible Health Plan (Out-of-Network) Premium Subsidy HSA/HRA Employee $ $ $64.62 $2, $ $ $75.00 $1, Emp+Spouse $ $ $74.62 $4, $ $ $94.82 $3, Emp+Child $ $ $69.62 $4, $ $ $88.30 $3, Emp+Family $ $ $ $4, $ $ $ $3, PT20 Premium Consumer Driven Health (CDH) Plan - Low Subsidy Annual HRA Premium Subsidy Consumer Driven Health (CDH) Plan - High Annual HRA Employee $ $ $ $ $ $ $ $ Emp+Spouse $ $ $ $ $ $ $ $ Emp+Child $ $ $ $ $ $ $ $ Emp+Family $ $ $ $ $ $ $ $ DENTAL INSURANCE VISION INSURANCE TIER DHMO CS15PB Dental PPO TIER UNITEDHEALTHCARE Employee $5.59 $12.24 Employee $3.20 Emp+Spouse/DP $10.05 $24.30 Emp+Spouse/DP $6.41 Emp+Child $11.18 $28.51 Emp+Child $6.08 Emp+Family $13.41 $40.57 Emp+Family $9.55 4

5 PHARMACY PLAN FORMULARY CHANGE Pharmacy benefits are provided under the County s selfinsured plan through OptumRx (formerly Catamaran). The pharmacy plan includes: An open formulary with five tiers of coverage (generic, brand preferred, non-preferred, specialty and Dispense As Written) 90 day mandatory maintenance medication program at retail or mail order Large network of participating pharmacies (Walgreens, Target, CVS, Publix etc.) Restricted generic policy (generics will be dispensed if available unless the doctor indicates Dispense As Written (DAW1) due to medical necessity on the prescription Due to a 43% increase in pharmacy costs for 2016, the County has elected to implement a slightly narrower formulary called the VALUE FORMULARY. View the list of restricted drugs with their Value Formulary alternative and discuss with your physician prior to filling your prescriptions in Access to drugs restricted due to the change in formulary from the Advantage Formulary to the Value Formulary are still available, if your physician documents that you have tried and failed the alternatives on the Value formulary. If approved, members in the CDH plans will pay a higher copay of $75 for a 30 day supply/$150 for a 90 day supply. Members in the HDHP plans will pay the full plan cost until the combined health and pharmacy annual deductible is met, then 30% coinsurance until the annual max out of pocket is met. 30 day Specialty pharmacy home delivery CDH PLANS Prescriptions subject to applicable copay based on tier of coverage. See chart below. CDH HIGH AND LOW PLANS ONLY HDHP BASE PLAN HDHP OON Tiers 30 Day Supply* 90 Day Supply (Maintenance Medication) All Tiers Generic $7 $14 Combined Health and Pharmacy Brand-Preferred $30 $60 Deductible/ Coinsurance: Non-Preferred $45 $90 EE Only: $2,100, then 30% Dispense As Written $75 $150 EE+Deps: $4,200, then 30% (DAW1) Excluded drug tried $75 $150 and failed Specialty $75 N/A HDHP Prescriptions on the designated Preventive Drug List provided at no cost to member. All other prescriptions subject to combined Health and Pharmacy Deductible and Coinsurance. All Tiers IN-NETWORK ONLY Combined Health and Pharmacy Deductible/ Coinsurance: EE Only: $1,500, then 30% EE+Deps: $3,000, then 30% *Pharmacy can only fill a 30 day supply for maintenance medication 3 times before requiring a 90 day fill Clinical Prior Authorization Program Certain prescriptions require clinical prior authorization, or approval from your plan s Pharmacy Benefit Manager (OptumRx), before they will be covered. To verify in advance, members may contact OptumRx. Contact OptumRx Member Services at or mycatamaranrx.com for more information. Specialty Pharmacy Briova Rx is OptumRx s specialty pharmacy provider. They will assist members with their specialty medications to ensure safe and effective administration. Briova Rx provides free home delivery to your address. Contact Briova Rx at or briovarx.com for more information regarding specialty pharmacy. 5

6 DENTAL PLANS NO PLAN DESIGN CHANGES DHMO DENTAL Plan Humana/CompBenefits See Humana s Dental brochure at broward.org/benefits for more information. NO RATE INCREASE FOR Highlights: PPO HIGH DENTAL PLAN Humana See Humana s Dental brochure at broward.org/benefits for more information. RATE INCREASE FOR Highlights: In-network coverage only In- or out-of network coverage No referral for specialty services Extensive national network Must select a Primary Care Dentist or Facility Covered services based on Fee Schedule, all other services received at a discount Orthodontia coverage for children and adults No claim forms to file Maximum annual benefit of $1,500 per person innetwork, $1,000 per person out-of-network Orthodontia coverage for children (must be banded by 17 th birthday) Some exclusions and limitations (missing tooth) VISION PLAN UnitedHealthcare (UHC) NO PLAN DESIGN OR PREMIUM CHANGES See UHC s material at broward.org/benefits for more information Highlights: In- and out-of-network coverage Exams, Eyeglass Frames Lenses and Contact Lens coverage Large network of providers DEFINITIONS: CDH Consumer Driven Health Plan some medical services received for a set copay, all prescriptions received for set copays. HDHP High Deductible Health Plan all medical services and pharmacy, other than designated preventive services and designated drugs on the Preventive List, subject to deductible and coinsurance. HSA Health Savings Account Reimbursement Account funded by employer and employee for eligible medical, prescription, dental, vision and hearing expenses. HRA Health Reimbursement Account Reimbursement Account funded by employers, subject to plan rules. PLAN Name of health plan HDHP Base Plan, HDHP OON Plan, CDH High Plan, CDH Low Plan. REIMBURSEMENT ACCOUNT HRA or HSA TIER Based on dependents enrolled in plan- EE Only, EE+Sp/DP, EE+Child(ren), EE+Family. 6

7 WELLBEING INITIATIVES WELLBEING IS A PRIORITY Continuing in 2016 Engagement Incentive to receive County-funding in HRA or HSA Improved process complete (1) a preventive exam or (2) HumanaVitality online health assessment and finger stick screening (available at all Vendor Fairs) by November 31, 2015 and system will automatically be updated no paperwork required. Complete between December 1, 2015 and March 31, 2016 submission and verification required before County will fund HRA or HSA account. New Deadline to complete Engagement Incentive March 31, Continuing in Pharmacy Copay Waiver Incentive Program We are pleased to continue the Wellbeing Program Pharmacy Copay Waiver Program for members and spouses/ domestic partners enrolled in one of the County s health plans. The current Waiver will expire on 12/31/2015. Complete the Eligibility Criteria below to receive the Waiver for 2016 (or through coverage termination date, if sooner) and will cover generic and formulary medications for the following disease states: Asthma Chronic Kidney Disease Cardiovascular Disease (CAD, COPD, CHF, Heart Failure, Hypertension ) Diabetes Note: Only drugs that are classified in the drug therapeutic class for the eligible disease state will be covered. Eligibility Criteria: Enroll in the Humana Vitality online wellness program at myhumana.com. Complete the free Vitality Check (finger stick screening for cholesterol, blood sugar). (Available at Vendor Fairs throughout Open Enrollment. Register at broward.org/ Disease Management Programs benefits, Open Enrollment.) Complete the online Vitality Health Risk Assessment. Participate in Disease Management Coaching through Humana (if applicable). To receive the Rx copay waiver, submit the 2016 Rx Waiver form to Humana s on-site representatives who will verify completion of the eligibility criteria and, with the member s consent will release the member s name and disease state(s) to Employee Benefit Services who will then request an Rx copay override for the applicable prescription drug(s) through our Pharmacy Benefit Manager, OptumRx. Managing chronic, long term diseases by following established medical protocols can keep the disease under control and help the member live a more healthy and productive life. The Disease Management Program managed by Humana will focus on several disease states in 2016 including: Asthma Congestive Heart Failure (CHF) Diabetes Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Hypertension Participants will receive one-on-one coaching and education from Humana s Disease Management nurses and will be eligible for the Rx copay waiver and rewards based on compliance with following the established protocols for each disease state. Example: Diabetic care is not just monitoring blood sugar levels. It is recommended that patients have an annual exam, foot exam, dental exam, vision exam, along with semi-annual AIC blood tests. 7

8 Tobacco Cessation Pharmacy Waiver Continuing in Rx or OTC Smoking Cessation Products Copay Waiver Continuing in 2016 waiver of the copay or cost for prescription or Over-the-Counter smoking cessation products up to the plan cost maximum of $500 per person per calendar year. Over-the-Counter products (Nicorette gum, Nicoderm patches, etc.) require a prescription to be eligible for coverage through the pharmacy plan. HumanaVitality Wellness Program The number of people living longer is increasing dramatically. Healthy living is all about the choices you make. For example; embrace a positive attitude, stimulate your mind, limit stress, support your body with exercise, and make healthy diet choices. HumanaVitality rewards its members for making healthy choices and striving to achieve wellness goals with rewards like brand name merchandise, gift cards, and more. No matter your stage in life or health, HumanaVitality has something to offer everyone. Log in to or register at MyHumana.com to go to HumanaVitality today. Make a Plan learn your Vitality age by completing the Vitality Assessment, see your current health status by getting a Vitality Check, set personalized goals, participate in online conversations and courses. Earn Vitality Points earn points for getting active: download steps from a pedometer, workouts using heart rate monitor, taking a CPR class, donating blood and much more. Get Rewards redeem Vitality Bucks on over 600,000 rewards, including movie tickets, gift cards, merchandise, or electronics! Flu shots The Health Department recommends getting an annual flu shot. Flu shots are covered at no cost through our health plans as a Preventive benefit and may be obtained through your physician or at a retail health clinic such as Walgreens Take Care Clinic or CVS Minute Clinic. If service is for anything other than the flu shot, you will be responsible for the applicable copay or cost. Flu shots are not available through the pharmacist. See Open Enrollment Vendor Fair schedule for dates and times of on-site flu shots Broward.org/benefits, click on Open Enrollment Disclaimer The health information in We ve Got You Covered is for educational purposes only. Employee Benefits and/or the Broward County Board of Commissioners are not engaged in rendering medical advice or professional services and cannot provide consultation on individual health conditions. The information provided in We ve Got You Covered should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should seek appropriate medical attention from your health care provider. 8

9 How Do You Choose? You Do the MATH! Everyone has different needs and only you can make the decision for you and your family as to what is the best option to meet your health insurance needs. To help, here are some examples, worksheets and decision tree to help you make your choice. Worksheet to Calculate Plan Costs 1) Look up annual premium based on plan and tier of coverage 2) Estimate your health care costs 3) Estimate your Rx costs for the year based on copays for CDH High and Low plans 4) Total lines 2 and 3 to compare your estimated health & Rx costs by plan 5) Enter HRA or HSA $ (Use Total Health/Rx Expense if less than Annual HRA/HSA funding) 6) Subtract #5 from #4 to see Total Health/Rx expense 7) Add Annual Premium (#1) to Total Health/Rx Expense (#6) for total plan cost per year. EXAMPLE: Employee Only Coverage (4 office visits + Rx) # Expense HDHP BASE HDHP OON CDH LOW CDH HIGH 1. Annual Premium (Biweekly Premium x 26) $ $ $1, $1, Estimated Out of Pocket Health $ $ $ $ Estimated Out of Pocket Rx* $ $ $ $ Total Health/Rx Expense $ $ $ $ Minus HRA or HSA -$ $ $ $ Total Health/Rx Expense 0 $ $ $ Total Cost for Premium and health, Rx (#2 + #7) $ , , * CDH pharmacy Max Out of Pocket is $3,000 per year for Member Only coverage EXAMPLE: Employee Only Coverage Maximum Out of Pocket # Expense HDHP BASE HDHP OON CDH LOW CDH HIGH 1. Annual Premium $ $ $1, $1, Out of Pocket Health $3, $3, $3, $2, Out of Pocket Rx* Included in health Included in health $ $ Max Out of Pocket Health/Rx Expense $3, $3, $4, $3, Minus HRA or HSA -$2, $1, $ $ Total Health/Rx Expense $1, $1, $3, $3, Total Cost for Premium and health, Rx (#2 + #7) $1, $ $4, $4, * CDH pharmacy Max Out of Pocket is $3,000 per year for Member Only coverage 9 Continue

10 USE THESE CHARTS TO CALCULATE YOUR COSTS UNDER EACH PLAN 2016 ANNUAL PAYROLL DEDUCT TIER HDHP BASE PLAN HDHP OON PLAN CHD LOW PLAN CDH HIGH PLAN Employee $ $ $1, $1, EE + SP $ $ $2, $3, EE + CH $ $ $2, $2, EE + Fam $1, $1, $4, $5, ANNUAL MAX OUT OF POCKET HEALTH TIER HDHP BASE PLAN HDHP OON PLAN CHD LOW PLAN CDH HIGH PLAN Health + Rx cannot exceed Health + Rx cannot exceed Employee $3, $2, $3, $3, in network EE + Sp, Ch, or Family Health + Rx combined cannot exceed $6, Health + Rx combined cannot exceed $6, innetwork $7, Individual Family member cannot exceed $3, $5, Individual Family member cannot exceed $2, ANNUAL MAX OUT OF POCKET RX TIER HDHP BASE PLAN HDHP OON PLAN CHD LOW PLAN CDH HIGH PLAN Employee EE + Sp, Ch, or Family Health + Rx combined cannot exceed $3, Health + Rx combined cannot exceed $6, Health + Rx combined cannot exceed $3, innetwork Health + Rx combined cannot exceed $6, innetwork $3, $3, $6, Individual Family member cannot exceed $3,000 $6, Individual Family member cannot exceed $3,000 ANNUAL HRA/HSA FUNDING TIER HDHP BASE PLAN HDHP OON PLAN CHD LOW PLAN CDH HIGH PLAN Employee $2, $1, $ $ EE + SP $4, $3, $ $ EE + CH $4, $3, $ $ EE + Fam $4, $3, $ $ Estimate Your Costs Healthcare Expenses Primary/Family Care Visits Specialist visits Chiropractor Visits Lab Work Urgent Care Visits Emergency Room Visits Outpatient Surgery Other Prescriptions # Visits Cost HDHP BASE PLAN HDHP OON PLAN CHD LOW PLAN CDH HIGH PLAN 10

11 Worksheet to Calculate Plan Costs 1) Look up annual premium based on plan and tier of coverage 2) Estimate your health care costs 3) Estimate your Rx costs for the year based on copays for CDH High and Low plans 4) Total lines 2 and 3 to compare your estimated health & Rx costs by plan 5) Enter HRA or HSA $ (Use Total Health/Rx Expense if less than Annual HRA/HSA funding) 6) Subtract #5 from #4 to see Total Health/Rx expense 7) Add Annual Premium (#1) to Total Health/Rx Expense (#6) for total plan cost per year. # Expense HDHP BASE HDHP OON CDH LOW CDH HIGH 1. Annual Premium (Biweekly Premium x 26) 2. Estimated Out of Pocket Health expense 3. Estimated Out of Pocket Rx* expense 4. Total Health/Rx Expense (#2 + #3) 5. Minus HRA or HSA 6. Final Health/Rx Expense 7. Total Cost for Premium and health, Rx (#1 + #6) HSA OR HRA DECISION TREE Key Components HRA HSA Member Eligibility Requirements: CDH Plans HDHP Plans HDHP Plans Who Contributes: Employer Only Employer& Employee on a pre-tax basis through payroll deduction Who Owns the Money: Employer with vesting requirements Employee owns from day one Rollover of Account Balance at end of Plan Year Coverage Period: Current Plan Year and previous Plan Year (if enrolled in plan at time expense was No Plan Year limit, expense must be incurred after HSA start date incurred) Portable: No, subject to vesting rules, balance is moved to a Retirement Health Savings Account at ICMA. Maximum Account Balance: Capped at $20,000 Unlimited Earns Interest: No, and has an Investment program Expense Documentation: Substantiation is required for all dental, Employee responsible for maintaining documentation vision, hearing and for medical costs that do not match a CDH copay. (Per IRS substantiation requirements) Taxability of distributions/reimbursements None None, if made for qualified medical expenses, otherwise subject to income tax and 20% penalty. Eligible for Medicare but not enrolled in Part A or B Enrolled in Medicare No, per IRS rules Enroll in Medicare mid-year Employee cannot contribute to HSA once Medicare starts. Can continue to use account balance. 11

12 Enrollment Decisions Regarding HRA or HSA NOTE: Reimbursement account funding (HRA or HSA) is based on plan and tier of coverage, not on type of reimbursement account. Example: Everyone enrolled in the HDHP Base Plan (PLAN) will receive $2,100 for EE only coverage or $4,200 for EE+ Dependent coverage (TIER). It will funded into the HSA or HRA (REIMBURSEMENT ACCOUNT) based on your answers to the questions below. Everyone enrolled in the CDH High Plan (PLAN) will receive $300 (REIMBURSEMENT ACCOUNT) for EE Only coverage or $800 for EE+Family coverage (TIER). CDH plans do not have reimbursement account choices, funding will automatically go into an HRA account. Which plan are you going to enroll in? Plan enrollment will determine reimbursement account options. CDH High or Low Plans: You are only eligible to participate in the HRA account. County will fund your HRA account with the reduced amount for 2016 based tier of coverage. HDHP Base or Out-of-Network Plan: Answer the following questions to determine which reimbursement account you are eligible for: Are you enrolled in Medicare Part A or B or Tri-Care? No Go to next question You re not eligible for a HSA and will automatically be in the HRA. Are you enrolled under another non-hdhp Plan? No Go to next question - You are not eligible for a HSA and will automatically be in the HRA. Can you be claimed as a dependent (child or qualifying relative) on someone else s tax return? No Go to next question You are not eligible for a HSA and will automatically be in the HRA. If you answered YES to any of the questions above, you are not eligible to enroll in a HSA per IRS rules and will automatically be enrolled in the HRA. Do not go any further. If you answered NO to all of the questions above, you are eligible for an HSA or can choose to remain in your current HRA, if you have a balance. Continue to the next section. Answer the questions below to determine which reimbursement account is best for you: Do you have money left in your current HRA? No You will be enrolled in the HSA these are your options: Freeze your HRA balance and start fresh with the HSA. a. County will automatically vest your HRA account and transfer the balance to a Retirement Health Savings Account with ICMA in You may use this account for eligible health expenses and premiums when you retire or separate from County employment and are age 55+. Note: This special vesting benefit is only for employees who move from a CDH plan to a HDHP plan effective 1/1/2016. b. You will have a 90-day runout period (through March 31, 2016) to submit any outstanding 2015 health, Rx, dental or vision claims to PayFlex for reimbursement. c. HSA does not require documentation for expenses, you must save your documentation/receipts in case you are audited by the IRS. d. Must file HSA info on your income tax. HSA information will be included on your W-2. For more information please go to Broward.org/Benefits or call Continue with your HRA (subject to all current HRA rules). 1. County will fund your HRA with the special one-year HDHP incentivized amount. 2. HRA remains subject all current HRA rules: a. Subject to current vesting rules: Retirement: HRA balance prorated based on consecutive years enrolled in a CDH plan with the County. Separation from County Employment: Must have 6 full calendar years of CDH plan enrollment with the County. If less than 6 calendar years, balance in HRA forfeits back to County. Vested balance at retirement/separation from County employment will be transferred to a Retirement Health Savings Account with ICMA and will be accessible starting at age 55. Maximum amount that can be accrued in account is $20,000. HRA expenses subject to IRS rules, must provide PayFlex itemized documentation for all dental, vision, hearing expenses, and for all health expenses that are not for one of our set copays under the CDH plans. 12