Frederick County Public Schools Benefits Guide Plan Year : October 1, 2016 September 30, 2017

Transcription

1 Frederick County Public Schools Benefits Guide Plan Year : October 1, 2016 September 30, 2017 This booklet highlights your benefits. Certain limitations and exclusions apply. Complete benefit details will be defined by the carrier s Certificates of Coverage

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3 Medical Insurance & Pharmacy Provider: ANTHEM Administered by Anthem Blue Cross Blue Shield Benefits Anthem KeyCare 25 Anthem Lumenos HSA Network Provider PPO and Blue Card PPO and Blue Card Office Visit $25 Primary Care $50 Specialist Co-Insurance 80/20% 80/20% Plan Year Deductible Individual - $500 Family - $1,000 Out-of-Pocket Maximum Per Plan Year Individual - $4,000 Family - $8,000 20% after deductible Individual-$1,500 Family $3,000 Individual - $3,425 Family - $6,850 Preventive Care/Wellness Covered at 100% Covered at 100% Inpatient Hospital Services 20% after deductible 20% after deductible Outpatient Surgery 20% after deductible 20% after deductible Emergency Room 20% after deductible 20% after deductible Diagnostic test and x-rays 20% after deductible 20% after deductible Therapy Services (Physical, Occupational, Speech) 30 visits 20% after deductible 20% after deductible Spinal Manipulations (Chiropractor) 30 visits $25 Co-Pay 20% after deductible Out of Network Deductible and Co-Insurance Prescription Drugs Tier 1 (Generic) Tier 2 (Preferred) Tier 3 (Non-Preferred) Tier 4 (Specialty) Mail Order 90 day supply Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred) Tier 4 (Specialty) $750/$1,500deductible 40% up to $5,500/$11,000 $10 Copay $30 Copay $50 Copay 20% up to $200 max $20 Copay $60 Copay $100 Copay Not Available Same as in-network 30% up to $6,000/$12,000 20% after deductible Deductible s, office visits, your 20% co-insurance and prescription drug co-pays all go toward the Out of Pocket Maximum. FCPS Health Savings Account annual contribution is $1,000. 3

4 Dental/Vision Provider: Anthem Anthem Dental Dental coverage is available when you participate in the FCPS health care plan. If elected, network participation is not required for the dental plan, so you can use the dental provider of your choice for services. The following chart is an overview of the benefits provided under the plan. The maximum annual benefit payable for each covered person, exclusive of orthodontia, is $1,000. A Maximum Carryover Provision allows up to $250 of unused benefit dollars to be carried over to the next Coverage Year. (Please see Dental Certificate of Coverage on HR site, pg. 7) Level of Service Example Annual Deductible Coverage Level Preventative Services Basic Restorative Services Major Restorative Services Cleanings; X-rays $ %* Fillings; Root canal therapy; Oral surgery Crowns; Bridges; Dentures $50 per covered individual $50 per covered individual Orthodontia Braces $ % after deductible* 50% after deductible* 50% up to a lifetime maximum benefit per covered child (up to age 19) of $1,000* * This is percentage of the allowed amount. Your dentist may charge more than the allowed amount, and you are responsible for any balance bill. Blue View Vision Level of Service Routine Eye Exam (once every calendar year) In Network Coverage Level $15 co-pay Contact Lens Fitting 100% Standard Eyeglass Lenses (once every calendar year) Eyeglass lens upgrades Eyeglass Frames (once every calendar year) 100% Discounted cost depending on upgrade $130 allowance then 20% off any remaining balance Contact Lenses $130 allowance then 15% off any remaining balance Out of Network See benefit booklet on FCPS HR web site 4

5 Benefit Rates Medical, Dental, Vision, Prescription Monthly Health Insurance Premiums KeyCare25/ Lumenous HSA WITH Dental WITHOUT Dental Total Cost Employee Cost Employee Cost Keycare25 Keycare25 Employee Only $ $92.26 $87.40 Employee Child(ren) $1, $ $ Employee and Spouse $1, $ $ Employee Family $1, $ $ Lumenos HSA Plan Lumenos HSA Plan Employee Only $ $72.42 $67.56 Employee Child(ren) $ $97.58 $86.39 Employee and Spouse $1, $ $ Employee Family $1, $ $ Comprehensive group health insurance is provided through two plans, KeyCare 25 and Lumenos HSA. All plans are administered through Anthem and include medical, dental, vision, and pharmacy coverage although you may elect to waive the dental coverage. Preventive services are paid at 100% when a plan member sees an in-network provider. 5

6 Flexible Spending Accounts (FSA) Provider: WageWorks FSA s provide you with an important tax advantage that can help you pay for health care or dependent care expenses on a pre-tax basis. You save Federal, State and FICA taxes on all the money you set aside into a Flexible Spending Account. By anticipating your family s costs for the next year, you can actually lower your taxable income. Estimate carefully though any funds left in the account at year end are forfeited. You must complete a new form every year to participate in a flexible spending account. This benefit election does not carry from one year to the next. Health Care Expenses (Calendar Year Maximum = $2500)* You will incur expenses as usual, and then submit a claim for reimbursement from your account with tax-free dollars. The following documentation can be submitted with claims,(all receipts must include date of service, description, cost to you, and the provider and patient name): Itemized receipts for co-pays at physicians or pharmacies Receipts and prescriptions for over the counter medications (covered as long as you have a physician s prescription) Copies of Explanation of Benefits (EOBs) from your Medical plan for co-pays, and coinsurance amounts Vision expenses not covered by your vision plan (co-pays or amounts or allowances) Your share of dental and orthodontia expenses not covered by the dental plan Dependent Care Expenses (Calendar Year Maximum = $5,000)** Day care provided by a licensed facility In-home dependent care Before/after school care program Preschool Summer day camp You may be reimbursed for claims incurred from October 1, 2016 September 30, You must submit claims for reimbursement by or no later than December 31, * An employee with a spouse covered by another health care plan with an HSA may not have a medical FSA. ** Both spouses must work or attend school full-time in order to take advantage of the dependent care FSA. They need not work for the same employer. 6

7 HSA Information and Other Important Reminders: Health Savings Account (HSA): (for Lumenos HSA plan participants only) Employees may elect to use their HSA dollars to pay for health, dental, or prescription costs incurred for themselves or their dependents. Contributions may be made to the employee s HSA up to the limits set by the U.S. Treasury and IRS. Employees can make pre-tax contributions to the HSA account and may change contribution levels throughout the year. FCPS contributes $1,000 to each Lumenos HSA participating employee at the beginning of the plan year. Unused dollars are saved and may be retained by the employee if they retire or leave the division. HSA dollars roll from year to year, earn interest, and can be invested after a specified threshold is met. An employee cannot be covered by another insurance plan if he/she elects the Lumenos HSA plan. Health Savings Account Annual Contribution Limits Coverage Level Calendar Year 2016 Calendar Year 2017 Individual $3,350 $3,400 Family $6,750 $6,750 Other Important Information to Remember The benefit plan choices you make when you are first hired can only be changed during the Open Enrollment period. At that time you can make the following benefit changes: you can switch between options, you can enroll yourself in coverage if you previously waived coverage, and you can enroll or drop eligible dependents. Open Enrollment this year is: August 15th - August 26th, Any changes you make will be effective October 1, Medical premium deductions for the new plan year begin from the September pay. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stopped contributing towards your or your dependents' other coverage). However, you must request enrollment within 31 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). 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. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact your benefit specialist in Human Resources at ext

8 Additional Health and Wellness Programs LiveHealth Online - LiveHealth Online App Immediate doctor visits through live video Your choice of U.S. board-certified doctors Help at the same cost as your regular doctor visits Private, secure and convenient online visits Go to to register and get services Anthem Employee Assistance Program (EAP) Telephone Counseling and Referral Services 24/7 Face to Face Counseling Visits Legal and financial referral & consultation Visit the website 24/7 Nurseline /7 Nurseline is there for you and your family 24 hours a day, seven days a week. So the next time you have a health question, ask a nurse! Future Moms Expecting? The goal of Future Moms is to help you have a healthy, full-term pregnancy. Even after you give birth your Future Moms nurse is there to provide post-natal support. Call customer service to enroll. ConditionCare ConditionCare may be just the support you need if you or someone in your Family is dealing with one or more of these conditions: Asthma, Diabetes, COPD, Heart Failure, Hypertension, Hyperlipidemia, Obesity, Metabolic syndrome and Coronary artery disease. You may receive a call from ConditionCare if your claims indicate you may be dealing with one of these conditions. RivalHealth Provides you with a nutrition and fitness plan that is customized according to your current health and lifestyle and your fitness target. Participation is free and revolves around the usage of the RivalHealth web site Visit the website to sign up at Contact HR or your school for a password. 8

9 Virginia Retirement System The Virginia Retirement System is a retirement system for State employees of participating political subdivisions, that is maintained by the General Assembly. The funds of the retirement system shall be deemed separate and independent trust funds, shall be segregated from all other funds of the Commonwealth, and shall be invested and administered solely in the interest of the members and beneficiaries thereof. Approximately 820 employers participate in the VRS, including state agencies, public colleges and universities, local public school divisions, counties, cities, towns, special authorities and commissions. Plan 1 Plan 1 members joined VRS before July 1, 2010, and were vested (completed five years of service) as of January 1, The VRS Plan 1 is a defined benefit plan and provides a monthly benefit during retirement based on the member s age, total service credit, and average final compensation. Average final compensation is the average of the highest 36 consecutive months of compensation as a covered employee. The benefit is funded through member and employer contributions to VRS, which are invested over the employee's career. The member contributes 5 percent of their compensation each month to their own contribution account on a pre-tax salary reduction basis. Plan 2 Plan 2 members joined VRS on or after July 1, 2010, and before January 1, 2014 or before July 1, 2010, but were not vested (completed five years of service) as of January 1, The VRS Plan 2 is a defined benefit plan and provides a monthly benefit during retirement based on age, total service credit and average final compensation. Average final compensation is the average of the highest 60 consecutive months of compensation as a covered employee. The member contributes 5 percent of their compensation each month to their own contribution account on a pre-tax salary reduction basis. Hybrid Plan Hybrid Plan members have membership dates of January 1, 2014, or later. The Hybrid Retirement Plan is a combination of two different types of plans: a defined benefit plan and a defined contribution plan. The defined benefit portion of the retirement is determined by a formula based on age, years of creditable service, and average final compensation at retirement. Average final compensation is the average of the 60 highest consecutive months of creditable compensation as a covered employee. Members contribute a mandatory 4 percent of creditable compensation each month to the member s defined benefit account and a mandatory 1% of creditable compensation each month to the member s defined contribution account. Members may contribute as much as 4% to their defined contribution account. An unreduced retirement is reached at normal social security retirement age with at least 5 years of creditable service with VRS or when a member s age and service equal 90 (Rule of 90). Employer Provided Life Insurance Annual Salary x 2 for natural death at no cost to employee Annual Salary x 4 for accidental death at no cost to employee Supplemental Life Insurance Application and cost information available upon request. 9

10 Important Notice from Frederick County Public Schools About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Anthem Insurance plan and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Frederick County Public Schools has determined that the prescription drug coverage offered by the Anthem Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage. Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th through December 7th. This may mean that you may have to wait to join a Medicare drug plan and that you may pay a higher premium (a penalty) if you join later. You may pay that higher premium (a penalty) as long as you have Medicare prescription drug coverage. However, if you lose creditable prescription drug coverage, through no fault of your own, you will be eligible for a 2 months Special Enrollment Period (SEP) because you lost creditable coverage to join a Part D plan. In addition, if you lose or decide to leave employer/union sponsored coverage; you will be eligible to join a Part D plan at that time using an Employer Group Special Enrollment Period. You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. If you decide to join a Medicare drug plan, your Frederick County Public Schools coverage will be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. If you do decide to join a Medicare drug plan and drop your FCPS prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. You should also know that if you drop or lose your coverage with FCPS and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without prescription drug coverage that s at least as good as Medicare s prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage Contact the person listed below for further information. NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through FCPS changes. You also may request a copy. FCPS CONTACT PERSON- Beverly Grant (540) Ext For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help, Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). 10

11 Medicaid and the Children s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families 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 health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, 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 employer-sponsored 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 called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. If you do not see the state in which you live listed below, you may contact Human Resources for additional information on determining if your state of residence participates in this program. PENNSYLVANIA Medicaid VIRGINIA Medicaid and CHIP WEST VIRGINIA Medicaid Website: Medicaid Website: Website: ingbusiness/ htm Phone: Medicaid Phone: Phone: CHIP Website: CHIP Phone: HIPAA Special Enrollment If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stopped contributing towards your or your dependents' other coverage). However, you must request enrollment within 31 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). 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. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact your benefit specialist in Human Resources at ext Women s Health and Cancer Rights Act of 1998 If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call Beverly Grant at ext: Newborn and Mothers Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 11

12 Who to Contact Medical Anthem Customer Service Telephone Dental Anthem Dental Customer Service Telephone Vision Blue View Vision Customer Service Telephone Employee Assistance Program Anthem EAP Customer Service Telephone Flexible Spending Accounts (FSA) Wage Works Customer Service Telephone Virginia Retirement System VRS Customer Service Telephone Frederick county Public Schools HR Department (Beverly Grant) ext This Guide is only intended to offer an outline of benefits. All detail and contract obligations of plans are stated in the group contract/insurance documents, including any disclosures (whether regarding grandfathering of plans or others) required by the new health reform law, the Patient Protection and Affordable Care Act (PPACA). In the event of conflict between this guide and the group contract/insurance documents, the group contract/insurance documents will prevail. Please contact your Human Resources Department for further information. 12