DeSoto County Board of County Commissioners

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1 DeSoto County Board of County Commissioners Benefits at a Glance Booklet Plan Year: October 1, 2015 September 30, 2016

2 Introduction The DeSoto County Board of County Commissioners is committed to providing its employees with a comprehensive benefits program to help you stay healthy and feel secure. This booklet will describe those benefits which include medical, dental, vision, life and AD&D insurance. Full time employees are eligible for benefits on the 1st day of the month following 30 days of full time employment. The County pays 100% of the employee premium and 50% of the dependent premium for medical coverage. The County also pays 100% of the premium for basic life and AD&D insurance. Employees may purchase dental, vision, and voluntary life insurance for themselves and their dependents through payroll deduction. In order to get the most out of your plans you should seek care at an in network provider. These providers have agreed to discount their prices, so you will pay less out of pocket. You can locate an in network provider by accessing the carrier s website listed in the back of this booklet. The Benefit at a Glance Booklet is a high level overview of the County s employee benefits program. For a detailed description of benefits, exclusions, and limitations please refer to the applicable Certificates of Coverage. 2

3 Dependent Eligibility Overage dependents will automatically terminate on the plan, and no further action is required on the employee s part. If your overage dependents meets the extended eligibility requirements, please provide supporting documentation to Human Resources. If you have an overage dependent that is disabled, and you would like to continue coverage with the plan, please contact Human Resources for the additional information. Medical To age 26 with no eligibility requirements 26 to the end of the calendar year in which they turn 30 if they are: Unmarried with no dependents Not enrolled in any other health plan Florida resident or a full time student Dental Through the end of the calendar year in which they turn 25 Vision Through the end of the calendar year in which they turn 26 Life To age 20 (24 if a full time student) Qualifying Events The premiums you pay toward yours and your dependents coverage may be deducted from your pay check pre-tax through an IRS Section 125 Plan. Pre-tax coverage elections made at Open Enrollment cannot be changed until the next annual Open Enrollment period. The only exception to this IRS Section 125 Rule is if you experience a Qualifying Event. A Qualifying Event allows you to make a change to your benefit elections within 30 days of the Event. Examples of Qualifying Events include: Marriage Birth, adoption, or legal custody of a dependent child Divorce or legal separation Involuntary loss of other group coverage Death ***If you experience a Qualifying Event, you must contact Human Resources within 30 days to change your benefit elections. 3

4 Affordable Care Act Update Starting in 2016 you will receive 2 additional employee statements along with your W-2 form: The first statement is a 1095-B and will be provided by the insurance carrier. This statement will be used by you when preparing your own individual tax return to confirm you are enrolled in minimum essential coverage and therefore, will not be subject to the individual mandate penalty under the Affordable Care Act. The second statement is a 1095-C and will be provided by the employer. This statement will advise whether you were offered group health coverage that was affordable (generally costing not more than 9.5% of your pay for single employee medical coverage) and of minimum value (covering at least 60% of your benefits), and whether you enrolled in coverage. The second statement is used to determine if you are eligible for a premium tax credit for coverage on the exchange (the Marketplace) in the event you would choose to get coverage there rather than through your employer. 4

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6 Medical Insurance Healthcare Service Choice Plus Traditional Plan OLG In Network Out of Network Deductible $500 / $1,500 Family $750 / $2,250 Family Coinsurance (Member Responsibility) 20% 40% Out of Pocket Max $2,500 / $5,000 Family $3,000 / $9,000 Family Primary Care Visit $15 40% after Ded. Specialist Visit $15 40% after Ded. Wellness Visits $0 Certain services are covered when using a non-network provider. Please see certificate of coverage for more information. Lab work (LABCORP) $0 40% after Ded. X-Ray $0 40% after Ded. MRI, CAT, PET Scan (at Diagnostic Testing Facility) $50 40% after Ded. Urgent Care $35 40% after Ded. Emergency Room $100 $100 Inpatient Hospital 20% after Ded. 40% after Ded. Outpatient Surgery 20% after Ded. 40% after Ded. Durable Medical Equipment 20% after Ded. 40% after Ded. Prescription 30 day Retail $7 / $25 / $40 $7 / $25 / $40 Prescription 90 day Mail Order $17.50 / $62.50 / $100 Not Covered Medical Monthly Cost Employer Cost Per Month Employee Cost Per Month Employee Cost Per Week Employee Only $ $ $0 $0 Employee + Spouse $1, $ $ $72.82 Employee + Child(ren) $1, $ $ $65.91 Family $1, $1, $ $

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13 HEY! Did you know Feel good about $4 generics*!!! Hundreds are available. Walmart offers a wide range of generics to help treat a variety of health related concerns. They are just as effective as their brand-name equivalents, but are available at a much lower cost just $4 for a 30-day supply, or $10 for 90 days. Find your generic today by contacting or visiting your local Walmart pharmacy. You can also visit their websites at Free Prescriptions! By bringing your prescription for one of the oral antibiotics listed below to your neighborhood Publix Pharmacy you can receive the below medications for FREE! 14-day supply of: Amoxicillin *Ciprofloxacin Ampicillin Penicillin VK Sulfamethoxazole/Trimethoprim (SMZ-TMP) 30-day supply of: *Amlodipine (up to mg or 5-mg tablets, or mg tablets) *Lisinopril *Metformin ( mg tables, or 90 tablets of 850-mg or 1000-mg ) *Some restrictions and/or exclusions may apply 13

14 Dental Insurance Dental Low Plan Monthly Cost Weekly Cost Employee Only $24.44 $6.11 Employee + Spouse $50.52 $12.63 Employee + Child(ren) $65.72 $16.43 Family $91.68 $

15 Dental Insurance Dental High Plan Monthly Cost Weekly Cost Employee Only $30.00 $7.50 Employee + Spouse $62.00 $15.50 Employee + Child(ren) $83.28 $20.82 Family $ $

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17 Vision Plan Monthly Cost Weekly Cost Employee Only $4.70 $1.18 Employee + Spouse $8.92 $2.23 Employee + Child(ren) $9.39 $2.35 Family $13.80 $

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19 Life and AD&D Basic Life and AD&D The DeSoto County Board of County Commissioners pays 100% of the premium for your Basic Life and Accident Death and Dismemberment coverage. Your Basic Life coverage amount is 1 times your annual earnings to a maximum of $200,000. For a covered accidental loss of life, your Basic AD&D coverage amount is equal to your Basic Life coverage amount (1 times your annual salary). For other covered losses a percentage of this benefit will be payable. Please see your certificate of coverage for more information. Age Reductions: Basic Life and AD&D insurance coverage amounts reduce by 35% at age 65, by 50% at age 70, and by 65% at age 75. You can update your beneficiary information in benefits.plansource.com Voluntary Additional Life Insurance Employee Life Coverage: You may elect Additional Life insurance units of $10,000 up to a maximum of $300,000. If you wish to become insured for an amount of Additional Life in excess of $100,000, the excess will be subject to medical underwriting approval. Employee s Age (as of October 1) Employee / Spouse Rate (per $1,000) Under 29 $0.05 Age $0.08 Age $0.12 Age $0.15 Age $0.26 Age $0.45 Age $0.81 Age $1.08 Age $1.97 Age $3.27 Age 75 + $12.85 Spouse Life Coverage: This coverage is available in units of $5,000 to a maximum of $150,000, but not to exceed 100% of your additional life coverage. If you elect an amount for your spouse that is greater than $50,000, the excess will be subject to medical underwriting approval. Age Reductions for Employee/Spouse: Voluntary Life insurance coverage amounts reduce by 35% at age 65, by 60% at age 70, and by 75% at age 75. Child Life Coverage: You may elect $10,000 of Dependents Life insurance for your eligible children. **If you waive voluntary life during the initial enrollment period or decide to increase coverage in the future, you will need to provide evidence of good health to The Standard so that they can determine if you will be approved or denied for this coverage. 19

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26 Important Notices for Plan Participants HIPAA Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including you spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children s Health Insurance Program Reauthorization Act (CHIPRA) of If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states. Medicaid and the Children s Health Insurance Program - If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their premiums. If you or your dependents are already enrolled in Medicaid or CHIP, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employersponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer s health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employer s plan. This is a called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. Annual Disclosures 26

27 Important Notices for Plan Participants Michelle s Law The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child's physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. Section 111 Effective January 1, 2009 Group Health Plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extension of 2007 s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claim assignments. In other words, it will help establish who pays first. The mandate requires Group Health Plans to collect additional information, more specifically Social Security Numbers for all enrollees, including dependents six months of age or older. Please be prepared to provide this information on your Benefit Enrollment Form when enrolling into benefits. Women s Health and Cancer Rights Act of 1998 The medical plans provide benefits for mastectomyrelated services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prosthesis, and complications resulting from a mastectomy, including lymph edema. Important Notice About Your Prescription Drug Coverage and Medicare This notice has information about current prescription drug coverage with DeSoto County Board of County Commissioners, and about options under Medicare s Part D prescription drug coverage. The information can help individuals eligible for Part D decide whether or not to join a Medicare drug plan. Prior to November 15th, a Medicare Part D Notice will be provided to you. Annual Disclosures 27

28 Key Contact Information Please refer to this list when you need to contact one of your benefits vendors. For general information, contact your Human Resources Department. Company Name Customer Service Website Address Francene Marra (386) Robin Riley (386) Medical Dental Life EyeMed Vision eyemedvisioncare.com This Benefits at a Glance handbook is designed to provide basic information to employees on employee benefit plans and programs available October 1, 2015 September 30, 2016 for the employees of DeSoto County Board of County Commissioners. It does not detail all of the provisions, restrictions and exclusions of the various benefit programs documented in the carrier contract or the Summary Plan Description (SPD). This booklet does not constitute a SPD or Plan Document as defined by the Employee Retirement Income Security Act. 28