EMPLOYEE BENEFITS GUIDE
ST. LUCIE COUNTY BOARD OF COUNTY COMMISSIONERS
OPEN ENROLLMENT
Inside you will find information about
Benefits Eligibility | Benefits Enrollment | Medical Benefits | Dental Benefits | Vision Benefits | Disability Benefits | Life Benefits | FSA Benefits
To enroll or change your benefits, visit
www.SLC.HRInTouch.com
www.SLC.HRInTouch.com
Contents Welcome Letter
Benefit Highlights
Our Benefit Goals
Benefits Eligibility & Enrollment
Medical
Health Wellness Center
Medical Flexible Spending Account
Dependent Care Flexible Spending Account
Dental
Medical, Dental, Life & Disability Yanisa Cuevas, On-site Florida Blue Representative 772.462.1549 [emailprotected]
Medical Plan Florida Blue www.floridablue.com 800.352.2583
New Directions Behavioral Health www.ndbh.com 800.528.5763
Prescriptions PRIME Therapeutics 888.849.7865
Health & Wellness Center www.carehere.com 877.423.1330
Dental Plan Florida Combined Life www.floridabluedental.com 888.223.4892
Vision Plan EyeMed Vision Care www.eyemedvisioncare.com 866.723.0596
3 Vision 22-23
4 Life Insurance 24
5 Disability Insurance and AD&D 25
6-7 Employee Assistance Program (EAP) 26
8-12 Glossary of Benefit Terms 27
13-15 Voluntary Benefits 28-39
16-17 FloridaBlue Information 40-45
18 Annual Notices 46
19-21 Benefit Costs Summary 47
Contacts Employee Assistance Program (EAP) Resources for Life (formerly MHNet) www.mylifevalues.com 800.272.3626
Flexible Spending Accounts Healthy Equity www.healthequity.com 866.346.5800
Life & Disability USAble Life 800.370.5856 [emailprotected]
AD&D The Hartford 800.563.1124
Voluntary Benefits US Enrollment Services 800.282.0732
Benefits Enrollment Website Benefitfocus https://slc.hrintouch.com
This booklet provides a summary of plan highlights. Please consult the carrier’s contract for complete information on covered charges, limitations, and exclusions. This is not a binding contract. The carrier’s contract will prevail. If you have questions, please contact the carrier or Relation Insurance Services..
mailto:[emailprotected]
www.healthequity.com
www.mylifevalues.com
www.eyemedvisioncare.com
www.floridabluedental.com
www.carehere.com
www.ndbh.com
www.floridablue.com
mailto:[emailprotected]
Board of CountyCommissioners
Cathy Townsend DISTRICT 5
Chair
Chris Dzadovsky DISTRICT 1
Vice-Chair
Sean Mitchell DISTRICT 2
Linda Bartz DISTRICT 3
Frannie Hutchinson DISTRICT 4
Administration
Howard N. Tipton COUNTY
ADMINISTRATOR
Dan McIntyre COUNTY ATTORNEY
Dear County Team,
2020 has certainly been a trying and uncertain year for all us. The novel Coronavirus has been an unwelcome strain upon our physical and mental wellbeing. The health and wellness of our employees continues to remain St. Lucie County’s highest commitment and priority which is why we are proud to announce our upcoming 2021 Open Enrollment session.
Open Enrollment for 2021, will take place from October 1st – October 31st. This year will be a passive enrollment, which means that any elections you currently have in place will roll over into 2021 – unless you actively change them. If you wish to keep the same medical, dental or vision benefits in 2021, you will not be required to re-enroll. Flexible Spending Accounts (FSA’s) are the only exception. Per IRS regulations, you MUST RE-ENROLL in FSA’s if you wish to continue those elections.
Employees who are currently enrolled in Supplemental Life Insurance who would like to elect a guaranteed $10,000 increase to their current election (up to $150,000) may do so during Open Enrollment. This increase must be elected through the benefits enrollment system.
The 2021 Employee Benefits Guide provides a comprehensive overview of the County’s benefit package. We recommend that you take the time to carefully review the selection of benefits that the County offers so that you may make informed decisions about which benefits best meet the needs of you and your family.
All benefit elections/changes must be made by logging onto the enrollment website: https://slc.hrintouch.com with the username and password you created. If you have forgotten your login information, you can click the link to reset them.
We look forward to continuing to serve you in maintaining your best possible health and wellness in the coming year, no matter the obstacles. If you have any questions about the benefits offered to you, please contact Human Resources at (772) 462-1546 or [emailprotected].
Sincerely,
Douglas Baber Douglas G. Baber, SHRM-CP Human Resources & Risk Management Director
HUMAN RESOURCES DEPARTMENT Douglas G. Baber, SHRM-CP | Director | Human Resources & Risk Management | [emailprotected] 2300 Virginia Avenue | Fort Pierce, FL 34982 (772) 462 - 1546 (772) 462 - 1428 (772) 462 - 2361 www.stlucieco.gov
www.stlucieco.gov
mailto:[emailprotected]
mailto:[emailprotected]
2021 BENEFITS HIGHLIGHTS EFFECTIVE JANUARY 1, 2021 As always, St. Lucie County BOCC is pleased to offer a comprehensive and competitive benefits package to our employees and their families. Overall, the County will continue to pay the majority of your health care premiums, even though health care costs continue to rise. Partner with us to keep costs low - use the information in this brochure to make the right health care choices for you and your family. This will help maximize your benefits and save money.
MEDICAL
Florida Blue will remain our carrier and we will continue to offer two medical plan options. Medical benefit details can be found on pages8 - 12.
FLEXIBLE SPENDING ACCOUNTS (FSA)
Health Equity will remain our vendor. Flexible Spending Accountsfor Medical and Dependent Care require you to re-enroll for 2021.Information regarding your FSA coverage are listed on pages 16 - 18.
DENTAL
Florida Combined Life (FCL) will remain our carrier. Benefits and Co-pays will remain the same for 2021. Information regarding your dental benefits are listed on pages 19 - 21.
VISION
EyeMed will remain our carrier. Benefits and Co-pays will remain the same for 2021. Information regarding your vision benefits are listed on pages 22-23.
LIFE INSURANCE / DISABILITY
USAble is our carrier for Basic and Supplemental Life Insurance and for our Short-Term and Long-Term Disability. The Hartford will remain our carrier for Supplemental Accidental Death & Dismemberment coverage. Premiums will remain the same for 2021. Information regarding your life and disability coverage are listed on pages 24 - 25.
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OUR BENEFIT GOALS We evaluate our benefit programs each year to make sure that we accomplish several goals.
We strive to: u Promote health and wellness among St. Lucie County
employees and their dependents
u Provide employees with affordable access to health benefits
u Provide competitive benefits programs
u Educate employees on the appropriate use of health benefits
u Provide resources to support employees and their dependents as they make important decisions about their health and health care
u Educate employees on all of the benefits and resources available to them
THINGS WORTH NOTING:
u Most types of preventive care continue to be covered at 100% on our health plan, so there is no charge to you when you visit an in-network provider
u Out of pocket maximums include deductibles, coinsurance, and co-pays
u Over-the-counter medicines or drugs (even if purchased without a prescription) and menstrual care products are now eligible for reimbursem*nt under the medical Flexible Spending Account (FSA)
YOUR BENEFITS ARE PAID FOR WITH PRE-TAX DOLLARS
EVERY PENNY IN YOUR PAYCHECK COUNTS.
To help you stretch your income, we established a Flexible Benefit Plan that allows you to pay for most of
your benefits using pre-tax money.
WHAT DOES A CAFETERIA PLAN MEANTO ME?
� You save at least 12% in Federal Tax
� You save 7.65% in FICA Tax
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GROUP COVERAGE ELIGIBILITY THE COUNTY’S GROUP INSURANCE PLAN YEAR IS JANUARY - DECEMBER
WHO IS ELIGIBLE FOR MEDICAL COVERAGE? All full-time employees are eligible to participate in the County’s group coverage.
DEPENDENT ELIGIBILITY Employees may extend any benefits in which they are currently enrolled to their dependents, so long as the dependents meet the elegibility requirements. Coverage will be effective 1/1/2021 for dependents added during Open Enrollment. Dependents added through Life Events will be effective on the date of the event. Dependents added during New Hire Enrollment will be subject to the same waiting period as the employee.
WHAT DEPENDENTS ARE ELIGIBLE TO ENROLL?
u Spouses: Employee’s legally married spouse. Common Law Marriage partners are not recognized by the state of Florida and are not eligible. Former Spouses are not eligible under the plan, regardless of any legal settlement.
u Children (birth to age 26): A natural child, a stepchild, a legally adopted child, Children for whom you or your legal spouse are the legal guardian or have the legal responsibility for providing medical coverage as defined by court order. NOTE: Vision coverge ends at 25.
u Children (Age 26 - 30): Includes a child who is unmarried and has no dependents of their own; a child is a Florida resident or a full-time or part-time student; a child otherwise uninsured; and/ or a child not entitled to benefits under Title XVIII of the Social Security Act unless the child is a handicapped dependent child.
u Disabled Children: Includes children considered to be disabled through Social Security Administration regardless of whether the child receives Social Security Income or not; single and incapable of self-sustaining employment by reason of mental retardation or physical handicap; chiefly dependent upon the employee for support and maintenance provided that the symptoms or causes of the child’s handicap existed prior to the child’s 30th birthday
AM I REQUIRED TO PROVIDE PROOF OF DEPENDENT ELIGIBILITY? Please see “Required Documentation” section the next page for more information.
SEPARATION OF EMPLOYMENT If an employee separates employment from the County, insurance coverage will continue through the end of the month in which the separation occurred. COBRA continuation of coverage may be available as applicable by law.
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QUALIFYING EVENTS AND IRS CODE SECTION 125
IRS CODE SECTION 125 Premiums for medical, dental, vision insurance and contributions to FSA accounts (Health Care and Dependent Care FSAs) are deducted on a pre-tax basis, therefore, your ability to make changes to these benefits is restricted by the IRS. Changes to an employee’s pre-tax benefits can be made ONLY during the Open Enrollment period unless the employee or qualified dependents experience a qualifying event.
Under certain circ*mstances, employees may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse or dependent’s coverage eligibility. An “eligible” qualifying event is determined by the IRS, Section 125. Any requested changes must be consistent with and on account of the qualifying event.
THE MOST COMMON LIFE STATUS CHANGES:
u Marriage or divorce
u Birth or adoption
u Change in your or your spouse’s work status that affects your benefits or an eligible dependent’s benefits
u Change in health coverage due to your spouse’s annual Open Enrollment period
u Change in eligibility for you or a dependent for Medicaid or Medicare
u Receipt of a Qualified Medical Child Support Order, or other court order
TO MAKE BENEFIT CHANGES AS A RESULT OF YOUR LIFE STATUS CHANGE AS ALLOWED UNDER SECTION 125 OF THE IRS CODE, YOU MUST:
u Notify Human Resources within 30 days of the date of the qualifying event (60 days if due to the loss of CHIP or Medicaid),
u Provide proof of your life status event, and
u Complete and submit your online enrollment change request through the website at slc.hrintouch.com
AM I REQUIRED TO PROVIDE PROOF OF DEPENDENT ELIGIBILITY?
For a marriage or divorce, you will need a marriage certificate or divorce decree. To add dependent children, you will need a birth certificate, adoption decree, child support order, proof of legal guardianship, or, for added step-children, a marriage certificate and a birth certificate. For loss of other coverage or gain of other coverage, you will need a letter from the Plan Administrator to support this change. Be sure to review your dependents’ eligibility and data to ensure birth dates and Social Security numbers are up-to-date. Be sure to remove ineligible dependents within 30 days of their change in eligibility status.
Note: Employees will be responsible for any claims incurred on ineligible dependents.
IMPORTANT If you experience a qualifying event, Human Resources must be contacted within 30 days of
Beyond 30 days, requests may be the event to make the appropriate changes to your coverage. denied and you may be responsible both legally and financially for any claim and/or expense incurred. If approved, changes will take place the first of the month following the date of the qualifying event or the BenefitFocus request for change of coverage, with the exception of newborns which are effective the date of birth. Termination of coverage will be processed at the end of the month. Employees will be required to provide valid documentation supporting a change in status or a qualifying event. To make a change to your benefits please visit slc.hrintouch.com
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MEDICAL COVERAGE FLORIDA BLUE
YOU HAVE CHOICES WHEN IT COMES TO THE COST OF YOUR HEALTH CARE. We understand how important it is to provide an equitable and sustainable medical program for our employees and their dependents. One of our goals as your employer is to provide you with the best benefit options available.
In 2021, there will be no modifications to the current plans. There will still be two medical plans offered, providing you the opportunity to choose the best coverage for you and your family’s needs. There are a few crucial facts that you will need to consider before making a decision. Below are a few FAQs to help you with making a decision.
WHAT’S THE DIFFERENCE? No matter which plan you choose, you’ll get the same:
u Access to doctors, specialists and hospitals u Preventive services that are covered in full
WHICH PLAN WILL BE BETTER FOR MY NEEDS? This will depend on your individual and family needs. The benefits summary listed on the next page will clearly lay out how much you will have to pay out of pocket for services. Cost-sharing options vary, so your goal is to narrow down choices based on out-of-pocket costs.
Plan 3766 (A) may work best for you if:
u You regularly take expensive medications that can only be obtained through a retail pharmacy
u You are expecting a baby, or have children under the age of three requiring frequent medical care
u You’ve been recently diagnosed with a chronic condition that cannot be managed through CareHere
Plan 5773 (B) may work best for you if:
u Most of your medications can be obtained through CareHere or at a low cost through a retail pharmacy
u Most of your medical Conditions can be managed through CareHere
u You are in fairly good health
In addition, those enrolled in the medical plan will continue to have access to the St. Lucie CountyEmployee Health and Wellness Centers at NO COST. (Refer to pages 13 - 15 for more information)
2021 MEDICAL BENEFITS COSTS* COVERAGE LEVEL MEDICAL PLAN 3766 (A) MEDICAL PLAN 5773 (B)
Employee Only $74.17 Semi-monthly $23.23 Semi-monthly
Employee + One $161.66 Semi-monthly $47.82 Semi-monthly
Family $238.71 Semi-monthly $80.69 Semi-monthly
*Pre-tax amount 8
SUMMARY OF
MEDICAL BENEFITS
1
St Lucie BOCC SUMMARIES- EFFECTIVE 1/1/2020BlueOptions BlueOptions
COST SHARING Maximums shown are Per Benefit Period (BPM) unless noted
Plan A 03766
Plan B 05773
Deductible (DED) (Per Person/Family Agg) In-Network $500 / $1,500 $2,500 / $5,000 Out-of-Network $1,000 / $3,000 $5,000 / $10,000
Coinsurance (Member Responsibility) In-Network 20% 20% Out-of-Network 50% 50%
Out of Pocket Maximum (Per Person/Family Agg) Includes DED, Coins, Copays and Rx
Includes DED, Coins, Copays and Rx
In-Network $4,000 / $13,200 $6,850 / $13,700 Out-of-Network $8,000 / Unlimited Max per Family $13,700 / Unlimited Max per Family
Lifetime Maximum No Maximum No Maximum PROFESSIONAL PROVIDER SERVICES
Office Services In-Network Family Physician DED + 20% DED + 20% In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
Maternity (Due at Initial Visit only) In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50% E-Office Visit Services
In-Network Family Physician DED + 20% DED + 20% In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
Allergy Injections In-Network Family Physician DED + 20% DED + 20% In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
Provider Services at Hospital and ER In-Network Family Physician / Specialist DED + 20% DED + 20% Out-of-Network In-Ntwk DED + 20% In-Ntwk DED + 20%
Provider Services at Locations other than office, hospital or ER
In-Network Family Physician DED + 20% DED + 20% In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
Radiology, Pathology and Anesthesiology Provider Services at Ambulatory Surgical Center
In-Network Specialist DED + 20% DED + 20% Out-of-Network In-Ntwk DED + 20% In-Ntwk DED + 20%
Advanced Imaging Services in Physician's Office (MRI, MRA, PET, CT, Nuclear Medicine) In-Network Family Physician DED + 20% DED + 20% In-Network Specialist DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
PREVENTIVE CARE Adult Wellness Office Services
In-Network Family Physician $0 $0 In-Network Specialist/Netwk Blue & Traditional Specialist $0 $0 Out-of-Network / Non-Participating Physicians 50% (No DED) 50% (No DED)
Colonoscopies (Routine) Age 50+ then Frequency Schedule Applies
Age 50+ then Frequency Schedule Applies
In-Network $0 $0 Out-of-Network $0 $0
Mammograms (Routine) In-Network $0 $0 Out-of-Network $0 $0
Well Child Office Visits In-Network Family Physician/ Specialist $0 $0 Out-of-Network 50% (No DED) 50% (No DED)
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BlueOptions BlueOptions COST SHARING Maximums shown are Per Benefit Period (BPM) unless noted
Plan A 03766
Plan B 05773
AMBULANCE / URGENT/ CONVENIENT CARE No Maximum
DED + 20% In-Ntwk DED + 20%
Convenient Care Centers (CCC) In-Network DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
Ambulance Maximum (combined ground, air and water - per day)
In-Network Out-of-Network
Urgent Care Centers (UCC) In-Network Out-of-Network
FACILITY SERVICES HOSPITAL /SURGICAL /LAB/ INDEPENDENT DIAGNOSTIC TESTING FACILITY Inpatient Hospitalization (Per Admit)
In-Network –Option 1 In-Network--Option 2 Out-of-Network
Inpatient Rehab Maximum 30 Days 30 Days
Option 1 - DED + 20% Option 2 - DED + 20%
DED + 50% Therapy at Outpatient Hospital
In-Network –Option 1 Option 1 - DED + 20% Option 1 - DED + 20% In-Network--Option 2 Option 2 - DED + 20% Option 2 - DED + 20% Out-of-Network DED + 50% DED + 50%
$250 + DED + 20% $250 + In-Ntwk DED + 20%
Ambulatory Surgical Center In-Network DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
$0 DED + 50%
Independent Diagnostic Testing Facility -Xrays and AIS (Includes Physician Services)
In-Network - Advanced Imaging Services (AIS) DED + 20% DED + 20% In-Network - Other Diagnostic Services DED + 20% DED + 20% Out-of-Network DED + 50% DED + 50%
MENTAL HEALTH AND SUBSTANCE ABUSE
Option 1 - DED + 20% Option 2 - DED + 20%
DED + 50% Outpatient Hospitalization (per visit)
In-Network –Option 1 Option 1 - DED + 20% Option 1 - DED + 20% In-Network--Option 2 Option 2 - DED + 20% Option 2 - DED + 20% Out-of-Network DED + 50% DED + 50%
DED + 20% In-Ntwk DED + 20%
Physician Office Visit In-Network Family Physician or Specialist DED + 20% DED + 20% Out-of-Network Provider DED + 50% DED + 50%
$250 + DED + 20% $250 + In-Ntwk DED + 20%
Provider Services at Locations other than Hospital and ER In-Network Family Physician or Specialist DED + 20% DED + 20% Out-of-Network Provider DED + 50% DED + 50%
OTHER SPECIAL SERVICES AND LOCATIONS
–
Outpatient Hospitalization (Per Visit) In-Network –Option 1 In-Network--Option 2 Out-of-Network
Emergency Room (Per Visit) In-Network Out-of-Network
Independent Clinical Lab In-Network Out-of-Network
Inpatient Hospitalization (per admit) In-Network –Option 1 In-Network--Option 2 Out-of-Network
Provider Services at Hospital and ER In-Network Family Physician or Specialist Out-of-Network Provider
Emergency Room (per visit) In-Network Out-of-Network
Birthing Center In-Network Out-of-Network
DED + 20% Out-of-Ntwk DED + 20%
Option 1 – DED + 20% Option 2 – DED + 20%
DED + 50%
DED + 20% DED + 50%
No Maximum
DED + 20% In-Ntwk DED + 20%
DED + 20% Out-of-Ntwk DED + 20%
Option 1 – DED + 20% Option 2 – DED + 20%
DED + 50%
Option 1 - DED + 20% Option 2 - DED + 20%
DED + 50%
$250 + DED + 20% $250 + In-Ntwk DED + 20%
$0 DED + 50%
Option 1 - DED + 20% Option 2 - DED + 20%
DED + 50%
DED + 20% In-Ntwk DED + 20%
$250 + DED + 20% $250 + In-Ntwk DED + 20%
DED + 20% DED + 50%
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COST SHARING Maximums shown are Per Benefit Period (BPM) unless noted Diabetic Equipment *
In-Network Out-of-Network
Diabetic Supplies ** In-Network Out-of-Network
Durable Medical Equipment, Prosthetics, Orthotics BPM In-Network Out-of-Network Enteral Formula In-Network Out-of-Network
Home Health Care BPM In-Network Out-of-Network
Hospice In-Network Out-of-Network
Outpatient Therapy: Cardiac, Physical, Occupational, Speech and Massage Outpatient Rehab Therapy Center
In-Network Out-of-Network
Spinal Manipulations, Chiropractic Services BPM
Skilled Nursing Facility BPM In-Network Out-of-Network
BlueOptions Plan A 03766
DED + 20% DED + 50%
Rx Coverage 50%
No Maximum DED + 20% DED + 50%
No Maximum DED + 20% DED + 50%
40 Visits DED + 20% DED + 50%
No Maximum DED + 20% DED + 50%
70 Visits (Includes up to 26 Spinal Manipulations)
DED + 20% DED + 50%
26 Visits (Not to exceed therapy maximum) 120 days
DED + 20% DED + 50%
BlueOptions Plan B 05773
DED + 20% DED + 50%
Rx Coverage 50%
No Maximum DED + 20% DED + 50%
No Maximum DED + 20% DED + 50%
40 Visits DED + 20% DED + 50%
No Maximum DED + 20% DED + 50%
70 Visits (Includes up to 26 Spinal Manipulations)
DED + 20% DED + 50%
26 Visits (Not to exceed therapy maximum) 120 days
DED + 20% DED + 50%
PRESCRIPTION DRUGS
Deductible In-Network Retail (30 days)
Generic/Preferred Brand/Non-Preferred Mail Order (90 days)
Generic/Preferred Brand/Non-Preferred Out-of-Network Retail (30 days)
Generic/Preferred Brand/Non-Preferred Mail Order (90 days)
Generic/Preferred Brand/Non-Preferred Medical Pharmacy Monthly In-Network OOP
Maximum (Provider-Administered Rx)* In-Network Out-of-Network
$0
$6 / $50 / $75
$12 / $100 / $150
50% / 50% / 50%
50% / 50% / 50% $200
20% DED + 50%
$0
$10 / $50 / $100
$20 / $100 / $200
50% / 50% / 50%
50% / 50% / 50% $200
20% DED + 50%
* Diabetic Equipment (insulin pumps, tubing) are always covered under the medical benefits.
** Diabetic Supplies (lancets, strips, etc.) are covered under the Rx benefit
This is not an insurance contract or Benefit Booklet. The above Benefit Summary is only a partial description of the many benefits and services covered by Blue Cross and Blue Shield of Florida, Inc., an independent licensee of the Blue Cross and Blue Shield Association. For a complete description of benefits and exclusions, please see Blue Cross and Blue Shield of Florida’s Benefit Booklet and Schedule of Benefits; their terms prevail.
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PRESCRIPTION BENEFIT IMPORTANT INFORMATION ABOUT PRESCRIPTION DRUG BENEFITS
Whenever possible, members should utilize generic medications to receive the highest level of benefits and lowest co-payment. The medical PPO plan includes a 3-tier formulary drug program. If a generic drug isn’t available, or you prefer to purchase the brand medication, you will need to access Florida Blue’s Formulary listing to determine what copayment will apply.
If the medication is listed in the formulary with a drug tier 2, the drug is considered a preferred brand and will be charged a $50 co-payment (or $100 if you obtain a 90-day supply-mail order) on both medical plans. If the drug is listed as a non-preferred brand with a drug tier 3, it is considered non-formulary and is charged at the highest co-payment level of $100 on plan 5773 (30 day supply) or $200 (90 day supply) or $75 on plan 3766 (30 day supply) or $150 (90 day supply). The formulary listing should be checked regularly as it is subject to change on a quarterly basis.
It is important to note that every therapeutic class of medication is represented within the formulary. If your medication is listed as a non-preferred brand and you are interested in reducing your co-payment, speak with your doctor to find out if you can switch to a preferred medication within the formulary to treat your condition.
Formulary Prescription Drug Listing:
Step 1: Go to www.floridablue.com
Step 2: Click on Members
Step 3: Click on Pharmacy benefits (middle of the page)
Step 4: Login
Step 5: Use Drug Comparison Tool
Log in at floridablue.com from a computer or mobile phone. Select Compare Drug Prices:
Step 1: Enter the drug name (or search by alphabet)
Step 2: Select pharmacies based on zip code
Step 3: Compare prices and lower cost options, when available. Plus, see when Step Therapy, Prior Authorization or other requirements may apply
MYBLUE MOBILE APP THE MYBLUE MOBILE APP GIVES YOU A SIMPLE WAY TO PERSONALIZE, ORGANIZE AND ACCESS YOUR IMPORTANT HEALTH INFORMATION – ON THE GO. The app includes many helpful features such as:
u My Coverage - Get a snapshot of your benefits and accumulators such as deductible, out-of-pocket max, and more
u View ID Card - Access and see an image of your FloridaBlue Member ID card from your phone
u Find a Doctor - Find a doctor, hospital or specialist in the provider directory customized to your plan. Get details and map it using your GPS location
u Compare Drug Prices - Save money by comparing drug costs at local pharmacies from wherever you are. Map the closest pharmacy
u Contact Us - Click to call the 24-hour nurse line, call a Care Consultant or get in touch with FloridaBlue whenever you need to
COMPARE COSTS PARTNER WITH US TO BECOME BETTER CONSUMERS OF HEALTH CARE.
You have choices when it comes to the cost of your health care.
u Shop, compare and estimate your medical costs u The quality and price of medical services can vary depending
on where you go for office visits, imaging services, and surgery, including inpatient and outpatient care
u Compare quality and cost before you go, and then decide what’s best for your care
u Cost estimates are based on your plan and where you stand with your deductible. Your costs are lower after your deductible is met
u You could save hundreds of dollars, or more on your health care services!
Three easy ways to compare:
Click - Access www.floridablue.com to log in/ register on MyBlueServiceSelect Estimate Costs for Medical Services
Call - A Care Consultant at 1-888-476-2227
Visit Us- in-person at a Florida Blue center near you. For locations, go to floridablue.com
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www.floridablue.com
www.floridablue.com
HERE BECAUSE WE CARE
Healthcare Services At No Cost To You
• Care for Infections & Colds • Flu & Allergy Treatments • Chronic Disease Management • Health Coaching Services • Well Exams • Sick Visits Ages 3 & Up • Routine Blood Work
HOURS OF OPERATION WALK-IN HOURS AVAILABLE DAILY
2200 VIRGINIA AVE | FORT PIERCE, FL
MON - SAT 7:00 AM - 7:00 PM • Annual Health Screenings • Wound Care • Sports & School Physicals • Adult Immunizations • Generic Prescription Medication Refills • Home Delivery Medications • Wellness Programs • Weight Loss • Tobacco Cessation
1680 SE LYNGATE DRIVE | SUITE 101 PORT ST. LUCIE, FL
SUN - FRI 7:00 AM - 7:00 PM
SCHEDULE ANYWHERE 877.423.1330 | CareHere.com | CareHere App
CareHere abides by all federal HIPAA and confidentiality regulations. © 2020 | Proprietary to CareHere, LLC | All rights reserved
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MEET THE PEOPLE SERVING YOU Richard Morgan, MDDr. Richard Morgan is board certified by the American Board of Surgery and the American Board of Thoracic Surgery. He has a strong background in the treatment of diseases of the heart, lungs, kidneys and blood vessels. Dr. Morgan is a graduate of Harvard Medical School. He completed residencies in General Surgery at the Massachusetts General Hospital and in Cardiovascular and Thoracic Surgery at the Hospital of the University of Pennsylvania. He also served on the faculty at the University of Pennsylvania and at the Medical College of Ohio. He previously served as Chief of Surgery and President of the Medical Staff at Lawnwood Regional Medical Center.
Kathleen Fraga, MDKathleen Fraga is originally from New York where she graduated from Barnard College of Columbia University. She earned her Doctorate in Medicine from Albany Medical College in New York and completed her residency in Emergency Medicine at Stony Brook University Medical Center. She served as primary care and urgent care physician and instructor at US Army Health Clinics in Mannheim and Stuttgart, Germany before settling in Vero Beach, Florida. Dr. Fraga has also practiced Urgent Care Medicine in Florida and New Jersey prior to joining the CareHere team. She looks forward to partnering with each of you to help you reach your personal health and wellness goals. In her spare time, Kathleen enjoys traveling, painting, music and dance.
Robin Pavcik, APRN FNP-BC Robin Pavcik received a Master’s in Nursing from the University of Tennessee in 1996 and is ANCC board certified as a Family Nurse Practitioner. Her professional experience includes internal medicine, family practice, wound care, urgent care, occupational and employee health, and pain management. Her personal interests include the study and practice of health through diet and lifestyle, swimming, travel and spending time with her loved ones.
David Pavcik, APRN FNP-BC David Pavcik earned his Master’s degree in Nursing after getting his Master’s degree in Engineering Management. He also completed military service in the United States Navy. David has cared for critically ill patients in the medical, surgical, and cardiovascular intensive care units. He has been a Family Nurse Practitioner in both urgent care and employee healthcare. David believes in education and promotes self-awareness and empowerment for improved healthcare and wellness.
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Elisabeth Boelman, PA-C Elisabeth Boelman is a board-certified physician assistant with a lifelong passion for the practice of medicine. She is originally from Kalamazoo, Michigan. Elisabeth earned her Bachelor of Science degree from Western Michigan University, where she graduated Magna Cum Laude. Elisabeth also earned her Master of Science in Medicine through Western Michigan University. She has worked with underserved populations and is fluent in both English and Spanish. Prior to joining CareHere, she worked in internal medicine and pediatrics. As a provider, Elisabeth emphasizes preventive medicine and empowers her patients to actively participate in their healthcare. Elisabeth states, “My primary goal with each patient is to develop a trusting relationship that promotes overall healthy living and prevention of chronic illness.” Elisabeth currently resides in Port St. Lucie with her husband, Scott, and their three children. She enjoys running, camping, baking, and reading.
Teresa Martinez, APRN Teresa descends from Cuba and Spain and has been part of the Treasure Coast for the past 15 years. She completed her graduate studies at Florida Atlantic University, where she earned her Master of Science in Nursing degree.Teresa received her Family Nurse Practitioner certification from the American Academy of Nurse Practitioners. Before joining CareHere,Teresa worked as a nurse practitioner for the City of West Palm Beach, and she works locally as an emergency department nurse practitioner at Cleveland Clinic/Martin Health System.Teresa is married with two teenage sons. In her spare time, she enjoys spending time with her family and their three dogs.
Teena White, DNP, APRN Teena White graduated with her Doctorate in Nursing Practice and minor in Public Health from the University of Florida. Her specialty is family practice and community health, which she has worked since 1991. She is a Professor of Nursing at Indian River State College. In her spare time, you can find her volunteering in the community where she serves on several boards.Teena has been a resident of Martin County since 1980, where she resides with her husband, son and rescue dog, Bindy.
CareHere abides by all federal HIPAA and confidentiality regulations. | CareHere.com © 2020 | Proprietary to CareHere, LLC | All rights reserved
Connect with your CareHere Health & Wellness Team with PHONE & VIDEO appointments.
Schedule a TeleVisit for: • Cold • Flu • Follow-ups • Lab Review • Medical Questions • Allergies • Prescription Refill
TELEVISIT FEATURES • Easy appointment scheduling that can sync
with your calendar.
• User-friendly platform with no software download required.
• Avoid unnecessary travel. • HIPAA compliant and secure.
Health & Wellness Center Locations 2200 Virginia Ave 1680 SE Lyngate Drive | Suite 101 Fort Pierce, FL Port St. Lucie, FL 7:00 AM - 7:00 PM 7:00 AM - 7:00 PM Monday - Saturday Sunday - Friday
Look for schedules with TeleVisit Available when making your appointment.
CareHere abides by all federal HIPAA and confidentiality regulations. | Call 877.423.1330 or at CareHere.com
© 2020 | Proprietary to CareHere, LLC | All rights reserved
15 15
FLEXIBLE SPENDING ACCOUNTS A FLEXIBLE SPENDING ACCOUNT (FSA) ALLOWS EMPLOYEES TO USE PRE-TAX MONEY FOR QUALIFIED EXPENSES.
Determine how much you anticipate spending on qualified expenses throughout the year and fund your FSA for that amount through semi-monthly pre-tax payroll deductions. You can then use those funds to pay for eligible expenses using a debit card at the time of service or by submitting a receipt after-the-fact. With Health Equity’s health care FSAs, the entire elected amount is available to you on the first day of the health plan year. You don’t have to wait for your payroll contributions to accumulate before paying expenses with your FSA.
Health Care FSA – Used to pay for qualified medical, dental, and vision expenses incurred by you and your dependents during the plan year. See box for examples of eligible expenses Health Care FSA Eligible Expenses
■ u Medical plan co-pays and deductibles u Annual maximum contribution is $2,750 u Dental and orthodontia expenses u You have access to your full annual contribution at any time during the u Vision care expenses including lasik, glasses and
plan year for qualified expenses incurred during the plan year contact lenses u You cannot change your annual contribution amount during the plan u Over-the-counter medicine or drugs (even if
year, so be conservative in determining the amount you decide purchased without a prescription) to contribute
u Tobacco cessation programs and related drugs u Deadline to incur claims for this plan year is March 15, 2022 with a doctor’s prescription
u Deadline to submit claims is March 31, 2022 u Infertility treatment u Menstrual care products
u Psychologyand psychoanalysis medical expenses
Visit www.irs.gov for a full list of eligibleexpenses and exclusions.
HealthEquity mobile app1
available for FREE at: • Apple® App Store®
• Google PlayTM
16
www.irs.gov
QUALIFIED EXPENSES • Acupuncture • Chiropractor • Oxygen
• Alcoholism (rehab, transportation for • Contact lenses • Stop-smoking programs
• medically advised attendance at AA) Ambulance
• •
Crutches
Dental treatments
• Surgery, other than unnecessary
cosmetic surgery
• Amounts not covered under another • Prescription eyeglasses/eye surgery • Telephone equipment and repair
• •
health plan Annual physical examination
Artificial limbs/teeth
• • •
Hearing aids Long-term care expenses
Medicines (prescribed, not imported
• •
for hearing-impaired
Therapy Transplants
•
•
Birth control pills/prescription
contraceptives Body scans
• •
from other countries) Nursing home medical care
Nursing services
•
•
Weight-loss program (if prescribed
by a physician for a specific disease) Wheelchairs
• Breast reconstruction surgery • Optometrist • Wigs (if prescribed) following masectomy for cancer • Orthodontia
Visit: HealthEquity.com/QME
NON-QUALIFIED EXPENSES • Concierge services • Future medical care
• Dancing lessons • Hair transplants • Diaper service • Health club dues • Elective cosmetic surgery • Insurance premiums other • Electrolysis or hair removal than those explicitly included • Funeral expenses • International medicines
Over-the-counter medicine (OTC) Over-the-counter medicine or drugs and menstrual care products are now eligible for reimbursem*nt under the medical Flexible Spending Account FSA.
• Nutritional supplements, unless
recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician
• Teeth whitening
©20
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DEPENDENT CARE FLEXIBLE SPENDING ACCOUNTS Dependent Care FSA Dependent Care FSA is used to pay for qualified dependent child care or elder care expenses incurred during the plan year, to allow you (and/or your spouse if married) to work or go to school full-time.
u Annual maximum contribution is $5,000 u You ONLY have access to funds that have
been withheld from your paycheck. If yousubmit receipts for a higher amount, you willbe automatically reimbursed as future payrolldeductions are deposited into your account
u Deadline to incur claims for this plan year isDecember 31, 2021
Dependent Care FSA Expenses u Care at a licensed nursery school or day care
facility u Before and after school care for children
12 and under u Day Camps
u Nannies and Au Pairs u Elder Care Expenses
Dependent Care Ineligible Expenses
u Services provided by a dependent(son, daughter, or spouse)
u Overnight camp expenses
u Baby-sitting expenses for time when you arenot working or at school
u Late payment fees u Tuition expenses for school
Important Rules Regarding FSAs
u Accounts are separate and you cannot co-mingle funds
u Accounts are subject to the USE IT OR LOSEIT provision; unused balances do not carryover and cannot be refunded
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- - - - - -
SUMMARY OF
DENTAL BENEFITS
COST SHARING
Deductible (Basic & Major Services Only) Per Person Per Plan Year Per Family Per Plan Year In-Network deductible credits apply to Out-of-Network deductible and Out-of-Network deductible credits apply to In-Network deductible.
In Network
$50 $150
Low Option Out of Network
$50 $150
BlueDental High Option
In Network Out of Network
$50 $150
$50 $150
Coinsurance *
PREVENTIVE **
BASIC **
MAJOR **
We Pay You Pay
100% 0%
100% 0%
50% 50%
We Pay You Pay
90% 10%
70% 30%
40% 60%
We Pay You Pay
100% 0%
80% 20%
50% 50%
We Pay You Pay
90% 10%
70% 30%
40% 60%
SERVICE HIGHLIGHTS Oral Evaluations (Exams) Bitewing X-ray Prophylaxis (Cleanings) 4 per benefit yr. – Adult/Child Fluoride Treatment (Child Only) Office Visits X-rays – Intraoral/Complete Series/Panoramic Sealants Amalgam Restorations (Silver Fillings) Resin-Based Restorations (Anterior and Posterior) Extractions
Preventive
Basic
Major
None
NONE $1,000
COVERED YES
Preventive
Basic
Major
Adult and Child $500 50% None NONE $1,500
COVERED YES
Surgical Extractions Root Canal Therapy Periodontal Treatment Crowns Osseous Surgery Partial Dentures Fixed Partial Dentures (Bridges) Surgical Placement of Implant Body: Endosteal Implant Implant Supported Porcelain Fused to Metal Crown (titanium, high noble metal) Orthodontia Services Orthodontia Lifetime Maximum BlueDental Pays Benefit Waiting Period
WAITING PERIOD: (MAJOR SERVICES) CALENDAR YEAR MAXIMUM PER PERSON PROCEDURES PERFORMED BY SPECIALIST DENTAL ROLLOVER
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DENTAL COVERAGE It’s About More Than a Pretty Smile Our oral health affects our ability to speak, smell, taste, chew, and swallow. However, oral diseases, which can range from cavities to oral cancer, cause pain and disability for millions of people each year. Plan members can take advantage of discounts by using a network provider.
Visit Your Dentist Regularly Regular preventive visits to your dentist can help protect your health, and we are talking about more than just your mouth. As long as you utilize an in-network provider, our plan covers preventive services at 100% in-network, with no deductible. Members can visit a provider four times a year for a cleaning and the plan will pay 100%.
HELPFUL TIP If you choose to use an out-of-network provider, services may not be paid at 100%, and you may be balance billed the difference between the charge and the allowed amount.
2021 DENTAL BENEFITS COSTS*
COVERAGE LEVEL LOW PLAN HIGH PLAN
Employee Only $17.83 Semi-monthly $19.99 Semi--monthly
Employee + One $35.55 Semi-monthly $39.82 Semi--monthly
Family $58.96 Semi-monthly $66.07 Semi--monthly
*Pre-tax amount
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BlueDental Maximum Rollover
Maximum Rollover for BlueDental ChoiceSM Plan Members
the dentist. There are no fees for Maximum Rollover and no paperwork to complete. Whenever you use less than the yearly threshold amount, you’ll receive Rollover dollars for the following year. What if you could use your Rollover dollars for unexpected visits the next year? Or wouldn’t those extra dollars come in handy when you have to pay out-of-pocket for expensive dental work in the following year? See the chart below for some examples. Any available Rollover dollars will be added to your Rollover account approximately 60 days after the end of your plan year. It’s that easy.
Maximum Rollover* is applied to your BlueDental Choice, BlueDental Choice Plus SM or BlueDental Choice CopaymentSM plan automatically as long as you:
• Receive at least one covered service during your plan year • Are an active member of the plan on the last day of the plan year • Don’t exceed the claim payment threshold in your plan year
Use the chart below to see what your Maximum Rollover dollars could add up to. 1. Look in the first column to find your plan option.
3. Check the third column for the maximum amount of dollars you qualify for next year. 4. The last column provides the maximum amount of rollover dollars that you can accumulate.
1. Plan Option 2. Yearly Threshold Amount
3. Maximum Rollover you’ll receive next year
4. Maximum Rollover you can accumulate
Low Option $500 $350 $1,000
High Option $700 $500 $1,250
Questions? Want to learn more about Maximum Rollover or any of our other products and services? Our BlueDental Customer Service Representatives can help. Just call 1-888-223-4892 at FloridaBlueDental.com.
*Maximum Rollover is not available for our BlueDental CareSM plans.
Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. BlueDental plans are offered through
Florida Combined Life Insurance Company, Inc., D/B/A Florida Combined
21
- - -
SUMMARY OF
VISION BENEFITS
VISION COVERAGE Besides helping you see better, routine eye exams can detect a number of serious health conditions, such as glaucoma, cataracts, diabetes and even cancer. Plus, eye exams for kids can detect problems that can impact learning and development.
As an EyeMed Vision Care member, you can improve your health by taking care of your vision and having routine eye exams, while saving money on all of your eye care needs.
A dependent child living in your household, primarily dependent on you for support or is a full-time or part-time student may be covered though the calendar year in which the child turns 25.
2021 VISION BENEFITS COSTS* COVERAGE
LEVEL LOW PLAN HIGH PLAN
Employee Only $1.03 Semi-monthly $2.78 Semi-monthly
Employee + One $1.91 Semi-monthly $5.28 Semi-monthly
Family $2.78 Semi-monthly $5.56 Semi-monthly
*Pre-tax amount
EyeMed Option 1 In Network
Member Cost Out of Network Reimbursem*nt
Exam with Dilation as Necessary $10 Copay Up to $35
Frames 35% off retail price N/A
Standard Plastic Lenses Single Vision Bifocal Trifocal
$50 Copay $70 Copay $105 Copay
N/A N/A N/A
Lens Options (paid by the member and added to the base price of the lens)
UV Treatment Tint (Solid and Gradient) Standard Plastic Scratch Coating Standard Polycarbonate Standard Anti-Reflective Coating Standard Progressive Lens (Add-on to Bifocal) Other Add-Ons and Services
$15 $15 $15 $40 $45 $65
20% off retail price
N/A N/A N/A N/A N/A N/A N/A N/A
Contact Lenses (discount applied to materials only) Conventional 15% off retail price N/A
Laser Vision Correction
LASIK or PRK from U.S. Laser Network 15% off retail price or 5% off promotional price
N/A
Frequency Examination Once every 12 months Lenses or Contact Lenses Unlimited
Frame Unlimited
*Frame, lens, & Lens Option discount applies only when purchasing a complete pair of eyeglasses 22
EyeMed Option 2 In-Network
Member Cost Out-of-Network Reimbursem*nt
Exam With Dilation as Necessary $10 Copay Up to $35
Frames $0 Copay, $100 Allowance; 20% off balance over $100
Up to $40
Standard Plastic Lenses Single Vision Bifocal Trifocal Standard Progressive Lens Premium Progressive Lens
$25 Copay $25 Copay $25 Copay
$90 $90, 80% of charge less $120
Allowance
Up to $25 Up to $40 Up to $60 Up to $40 Up to $40
Lens Options (paid by the member and added to the base price of the lens)
UV Treatment Tint (Solid and Gradient) Standard Plastic Scratch Coating Standard Polycarbonate Standard Anti-Reflective Coating Other Add-Ons and Services
$15 $15 $15 $40 $45
20% off retail price
N/A N/A N/A N/A N/A N/A N/A
Contact Lens Fit and Follow-up Standard Contact Lens Fit & Follow-up Up to $55 N/A Premium Contact Lens Fit & Follow-up 10% off retail N/A
Contact Lenses (discount applied to materials only)
Conventional $0 Copay, $115 Allowance; 15% off balance over $115 Up to $81
Disposable $0 Copay, $115 Allowance; plus balance over $115 Up to $81
Laser Vision Correction
LASIK or PRK from U.S. Laser Network 15% off retail price or 5% off promotional price N/A
Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months
Frame Once every 24 months
Questions? Visit EyeSiteOnWellness.com
23
USAble LIFE INSURANCE COVERAGE Life Insurance and AD&D St. Lucie County provides all full-time employees with a basic life insurance benefit equal to one times basic annual earnings, rounded to the next highest $1,000, up to a maximum of $200,000. The County also provides Accidental Death and Dismemberment, which pays an additional benefit equal to the basic life benefit if a death is due to an accident. These benefits are provided at NO COST to the employees
Supplemental Life Insurance In addition to the insurance provided free by the County, you can purchase additional life insurance in increments of $10,000 up to $300,000 for yourself, and up to 50% of the employee benefit for your spouse in $10,000 increments up to $150,000, and $10,000 for a child(ren). Eligible children include:
u Unmarried, less than age 30
u Living in your household or a full- or part-time student u Depends on you for more than 50% of his/her support u A handicapped child age 30 or over, who was insured
under this policy before reaching age 30
Evidence of Insurability Evidence of Insurability requires you to complete a medical questionnaire, obtain a physical (at the carrier’s request), and receive carrier approval before your insurance takes effect.
Life enrollment time frames are limited as detailed below:
u New Hires – You may apply for coverage up to the amount requiring Evidence of Insurability through the normal enrollment process.
u Marriage, Adoption or Birth – If you are already enrolled in employee life, you can enroll new dependents as long as you follow normal event deadlines. If you wish to increase your employee life amount, you must complete the Evidence of Insurability Form and submit it within the normal life event deadlines.
u Annual Election to Increase Supplemental Life byOne Increment – Each year at open enrollment, the life insurance carrier allows employees currently enrolled in the Supplemental Life Insurance coverage to increase their Life Volume by one plan increment of $10,000 up to the $150,000 guarantee issue maximum without the need for evidence of insurability. Only employees currently enrolled may participate in this feature (spouses and dependent children are not eligible). Enrollment and Evidence of Insurability forms must be submitted and approved to increase employee coverage over $10,000 or any increase in spouse and dependent child coverage.
Why buy life insurance? Life insurance provides a lump sum cash benefit to surviving dependents to cover immediate expenses such as funeral expenses or ongoing living expenses. Life insurance benefits often help survivors adjust to the loss of income related to the death of a wage earner or provide funds for college or retirement for the survivors.
Benefit Reduction Your benefits will reduce to 65% at age 70.
24
USAble DISABILITY COVERAGE Short-Term Disability (STD) insurance provides income continuation if you are ever unable to work due to a non-work related accident or illness. Long Term Disability (LTD) insurance provides income continuation for both non-work and work-related accidents or illnesses. The County pays the full cost of both STD and LTD for full-time employees.
Short-Term Disability (STD) STD begins on the later of the 15th day, or the end of accumulated sick leave/vacation (whichever is greater) after a qualifying accident or illness. STD lasts for 13 weeks and pays a weekly benefit equal to 60% of your basic weekly earnings to a maximum of $1,900 per week.
Long Term Disability (LTD) LTD begins on the 91st day after a qualifying accident or illness and pays a monthly benefit equal to 60% of your monthly income up to $8,000 per month. The maximum benefit period is to age 65 Reducing Benefit Duration.
THE HARTFORD ACCIDENTAL DEATH & DISMEMBERMENT Accidental Death & Dismemberment benefits offered through CNA Hartford provide a specific benefit for loss of life, limbs, speech, hearing or sight as defined in the policy. If enrolled, benefits under this policy are separate from, and pay in addition to, the Life & AD&D benefits available through the County’s Group Life policy. Losses caused by medical or surgical treatment of sickness or disease are not covered.
You can enroll the following dependents:
u Your Legal Spouse as indicated by Florida Law
u Your Dependent Child who is 18 years of age or younger and who is chiefly dependent upon you for support and maintenance or who is living in your household
u Your Dependent child who is 19 through the calendar year in which the child reaches 25, provided such child is attending an accredited school on a full or part time basis, is dependent upon you for support and maintenance or is living in your household
Principal Sums
Age Reduction(applies to Employee & Spouse coverage)
Age 69 or younger 100%
70-74 65%
75-79 45%
80-84 30%
85 and older 15%
u Employee: $10,000 to $250,000 in increments of $10,000. Principal sums in excess of $150,000 may not exceed 10 times your basic annual salary
u Spouse: 50% of your original principal sum if there are no insured dependent children covered at the time of accident; or 40% of your original principal sum if there are insured dependent children covered at the time of the accident
u Children: 15% of your original principal sum if there is no spouse at the time of accident; or 10% of your original principal sum if there is an insured spouse at the time of the accident
25
EMPLOYEE ASSISTANCE PROGRAM (EAP) Our EAP Benefit is being enhanced this year. Life presents challenges to each and every one of us. Sometimes we need a little extra help. St. Lucie County provides a comprehensive and 100% confidential employee assistance program through Resources for Living . These EAP benefits are available for all full-time employees, and all members of your household and your adult children up to the age of 26, regardless of your medical insurance coverage. Services are confidential and are available 24 hours a day, 7 days a week. You are automatically enrolled with no ID required.
Counseling and Relationship Support
u Unlimited, toll-free telephonic access to EAP dedicated staff, 24 hours per day
u Telephonic access to licensed behavioral health professionals
u Support, consultation and resources for stress, family relationship issues, anger management, substance abuse, and helping you balance work and home life
u Eight (8) face to face counseling sessions per issue per year, with licensed network professionals, at no cost to you; i.e., no copays or deductibles (previously, only 6 visits were covered).
CALL YOUR EAP AT
1-800-272-3626 or visit us online at www.mylifevalues.com
Username: stlucieco | Password: 8002723626
Online Services Online information and provider search features for locating resources that families need, such as:
u Child care - Convenience/personal services - Adoption u Parenting - Pet care - Temporary back-up care u Special needs - Elder care - School/college planning u Urgent/daily living needs - Caregiver support - Consumer information u Summer care - Care for people with disabilities u On-line Discounts on brand-name products and services, including categories such as computers & electronics, theme
parks, movie tickets, local attractions, travel, gifts, apparel, child and elder care, flowers, jewelry, fitness centers and more
Legal Services Half- hour free consultation with a participating attorney for each new legal topic (each plan year) related to:
u General Law (excluding employment law) - Special Needs, including emergency matters u Mediation Services - Document Preparation u A discount of 25% off the hourly rate charged by the participating attorney for any legal services not covered and/or
beyond the 1/2 hour initial consultations referenced above u All services must be for legal matters related to the employee and eligible household members
Financial Support Half- hour free consultation on new financial counseling topics each plan year
u Topics include Budgeting, Credit, Debt, Retirement, College Funding, Buying vs. Leasing, Mortgages/Refinancing, Financial Planning, Tax Questions & Preparation, IRS Matters, Tax Levies & Garnishments, Consumer Credit Counseling, CommunityServices
u A discount of 25% off the tax preparation services u All services must be for financial matters related to the employee and eligible household members
Other Services Identity Theft Services--One hour telephonic fraud resolution consultation as well as coaching and direction on prevention and restoring credit for victims of ID Theft, and a free Identity Theft, Emergency Response Kit for victims of ID Theft.
26
GLOSSARY OF BENEFIT TERMS
In order to obtain a complete understanding of your health plan benefits and spend your health care dollars the best way possible, you should be familiar with the following terms:
Coinsurance Your share of health care expenses for covered services. After your deductible requirement is met, a percentage of the allowed amount will be paid by the plan. The remaining percentage is your patient responsibility.
Balance Bill You may receive a bill from an out of network provider for the difference between the actual charges and the plan’s allowed amount. In-network providers will not balance bill anything above and beyond the deductible, co-payment and coinsurance as indicated by the plan.
Co-payment A fixed dollar amount that you are responsible to pay for a specified service.
Deductible An amount you are responsible to pay for certain services before the plan begins to pay its share of the eligible expenses. The deductible is a requirement each calendar year. Please refer to the Evidence of Coverage document for a full listing of services subject to the deductible.
Dependent Care Spending Account Lets you set aside pre-tax dollars to pay for eligible childcare expenses. Because the reimbursem*nt account contributions are not taxed, you decrease your taxable income while increasing your available cash. Funds do not roll over year to year, are not portable and do not accrue.
Explanation of Benefits (EOB) Explains how a health benefits claim was paid. A fixed dollar amount that you are responsible to pay for a specified service.
Flexible Medical Spending Account A tax-advantaged account that can be used to pay for medical expenses. Contributions to the FSA are made by the employee. Funds can only be used to pay for claims in the year they are accrued. Unused funds are forfeited. Funds are not portable and do not accrue interest.
Out of Pocket Maximum The maximum amount that you will pay towards deductible, coinsurance, and co-payment during a given calendar year. Once the stated out of pocket maximum has been satisfied, benefits will be paid for eligible expenses at 100%.
Pre-certification / Authorization Requirements Please remember that there are certain services that require a pre-certification or authorization. Failure to follow these guidelines may result in a reduction or denial of benefits.
Pre-Existing Condition Effective January 1, 2014, all pre-existing condition exclusions were removed from the plan.
27
VOLUNTARY BENEFITS The Voluntary programs sponsored by St. Lucie County are individual policies offered through convenient payroll deductions, which are portable should you change employment. That means you can take the coverage with you. County employees and family members have preferred underwriting with most enrollment requiring no medical questions or exams. Below is a brief overview of these plan offerings:
Trustmark Accident 24 Hour Protection Plan This plan covers you for both on and off-the-job accidental injuries. You can go to any facility in the country and receive benefits. It is great for families with children in sports.
u Policy pays cash benefits directly to you, over-and-above any other coverage and protects you 24 hours a day and provides benefits for injuries that occur either on or off-the-job
u Benefits include: ER, Hospital admissions, ambulance, fractures, dislocations, burns, lacerations, follow-up visits, emergency dental, Accidental Death Benefit
u $100 Wellness Benefit is payable up to two visits per person, per year. Wellness Benefit includes routine physicals, immunizations and health screen tests
Benefit Amount Benefit Amount
Initial Care
Hospital Benefits Admission Benefit (per admission) $3,200 Confinement Benefit (per day up to 365 days) $500 ICU Benefit (per day up to 15 days) $1,000
Emergency Room Treatment $150 Ambulance Ground $600 Air $2,500
Initial Doctor’s Office Visit $200 Lodging (per night up to 30 days per accident) $200 Surgery Benefit Open, abdominal, thoracic $2,000 Exploratory $200
Blood, Plasma and Platelets $600 Emergency Dental Benefit Extraction $150 Crown $450
Follow-Up Care
Accident Follow-Up Treatment $200 Physical Therapy Up to six visits per person per accident $100
Appliance $250 Transportation 100+ miles, up to three trips $600
Prosthetic Device or Artificial Limb More than one $2,000 One $1,000
Skin Grafts 25% of burn benefit
Injuries
Fractures Open reduction up to $15,000Closed reduction up to $7,500 Chips 25% of closed amount
Dislocations Open reduction up to $12,000 Closed reduction up to $6,000
Laceration $50-$1,000 Burns Flat amount for: Third-degree 35 or more sq. in. $25,000 Third-degree 9-34 sq. in. $4,000 Second-degree for 36% or more of body $2,000
Concussion $200 Eye Injury Requires surgery or removal of foreign body $400
Ruptured Disc $1,000 Loss of Finger, Toe, Hand, Foot or Sight Loss of both hands, feet, sight of both eyes or any combination of two or more losses $40,000 Loss of one hand, foot or sight of one eye $20,000 Loss of two or more fingers, toes or any combination of two or more losses $4,000 Loss of one finger or one toe $2,000
Tendon/Ligament/Rotator Cuff Injury Repair of more than one $1,500 Repair of one $1,000 Exploratory surgery without repair $200
Torn Knee Cartilage $1,250 Exploratory surgery $250
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 28
VOLUNTARY BENEFITS Trustmark Universal Life with Long Term Care Policy This program lets you provide a lifetime of coverage by locking in your rate at today’s age. It gives peace of mind that comes with knowing there are funds available when they are needed most.
u Guaranteed Issue for Newly Hired employees age 65 and under and contingent guaranteed issue for New Hires age 66–70 and all spouses and children if you enroll when initially eligible
u Spouses can apply even if employee elects to waive coverage u Guaranteed premiums for life and guaranteed death benefits for life u Guaranteed cash values as long as you pay the premiums
Universal Life Insurance 65+ Trustmark Universal LifeEvents insurance is permanent life insurance that helps shield your family from financial hardship if you or your spouse is suddenly out of the picture. It:
u Helps provide permanent financial protection u Is a financial tool that helps you manage life at every stage from supporting a family to sending your children to college
to the need for long-term care u Builds cash value over time that you can access for life’s challenges and life’s opportunities u Benefits can be paid as a Death Benefit, as Living Benefits, or as a combination of both. What’s covered?
The LifeEvents Advantage LifeEvents is designed to match your needs throughout your lifetime. It pays a:
u Higher death benefit during working years when expenses are high and your family needs maximum protection. Then, at age 70 when financial needs are typically lower, the death benefit reduces to one-third
u Consistent Level of Living Benefits throughout retirement when you are most likely to need long-term care services
Living Benefits Long-Term Care Benefit (LTC)pays a monthly benefit equal to 4% of your death benefit for up to 25 months. The LTC benefit accelerates the death benefit and proportionately reduces it.
Benefit Restoration Restores the death benefit that is reduced to pay for LTC, so your family receives the full death benefit amount when they need it most.
Additional Benefits
u Children’s Term Life Insurance – Covers newborns to age 23 and is convertible to Universal Life
insurance Optional benefit
u Waiver of Premium – Waives policy payments ifyour doctor determines you are totally disabled
u Accidental Death Benefit – Doubles the death benefit if death occurs by accident prior to age 75
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 29
VOLUNTARY BENEFITS Trustmark Critical Illness Coverage If you are diagnosed with a Critical Illness, where does the money come from to cover the deductibles, coinsurance, and out-of-pocket expenses? This plan pays cash benefits directly to you, over-and-above any other benefits that you may be eligible to receive.
u Pays a tax-free lump sum that you choose between $10,000 - $100,000 of coverage upon the diagnosis of a covered critical illness. Does not require any treatment or hospitalization to trigger a claim, only certain diagnostic criteria of the condition
u Covered conditions include: Heart Attack, Stroke, Internal Cancer, Organ Transplant, Renal (Kidney) Failure, Paralysis, and Coma. Partial payments for: Coronary Artery Bypass Surgery, Carcinoma in Situ
u An annual $50 wellness benefit is payable per insured for any preventive screening, chest x-ray, certain blood tests
Critical Illness insurance Trustmark Critical Illness Insurance pays benefits upon the first diagnosis of a covered critical illness. It provides a cash payment for expenses and treatments not covered by most medical plans, and it pays before most high-deductible health plan benefits begin. A health screening benefit identifies and reduces health risks, making it easier for you and your covered family members to stay healthy.
Covered Conditions Invasive cancer • Heart attack • Stroke • Renal (kidney) failure • Blindness • ALS (Lou Gehrig’s disease) • Major organ transplant • Paralysis of at least two limbs • Coronary artery bypass
surgery (25% benefit)• Carcinoma in situ (25% benefit)
Benefits you’ll appreciate
u Lump-sum benefit – Paid directly to you, regardless of any other coverage you have
u Subsequent condition benefit Pays a lump-sum cash payment when you are diagnosed with any covered condition included in your policy. There are no limits to the number of payouts for each insured family member and no reduction in payouts for later-diagnosed conditions
u Best Doctors® medical advice when you need it most. Receive one-on-one support in connecting you to the medical information you may need for covered conditions
u Health Screening Benefit – To help you stay well, the Health Screening Benefit pays the cost of one screening test per calendar year ($50 maximum). Some of the many screening tests covered include: • Low dose mammography • Chest X-ray • Pap smear (women over 18) • Bone marrow • Serum cholesterol • Colonoscopy • Prostate specific antigen • Stress test
Optional benefit
u EZ Value automatic increases u Waiver of Premium – Waives premium payments if your doctor determines you
are totally disabled
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 30
VOLUNTARY BENEFITS Aflac Hospital Confinement Indemnity Insurance How would your family carry on if you were unexpectedly hospitalized? This program lets you create a more comprehensive medical plan with options to cover the following:
BENEFIT DESCRIPTION
HOSPITAL CONFINEMENT Pays $500; $1,000; $1,500; or $2,000. You choose the benefit amount at the time of application. Payable once per calendar year, per covered person.
REHABILITATION FACILITY Pays $100 per day; limited to 15 days per confinement. Limited to 30 days per calendar year, per covered person.
HOSPITAL EMERGENCY ROOM Pays $100 for treatment in a hospital emergency room. Limited to 2 payments per calendar year, per covered person.
HOSPITAL SHORT-STAY Pays $100 for hospital stays of less than 23 hours. Limited to 2 payments per calendar year, per policy.
WAIVER OF PREMIUM Yes
Choose the Policy Riders that Best Fit Your Needs Below
OPTIONAL RIDERS DESCRIPTION
EXTENDED BENEFITS RIDER Physician Visit Benefit: Pays $25 for visits (including telemedicine) to a physician, psychologist or urgent care center. Individual Coverage: Limited to 3 visits per calendar year, per policy.
Insured/Spouse & Family Coverage: Limited to 6 visits per calendar year, per policy.
Laboratory Test and X-Ray Benefit: Pays $35; limited to 2 payments per covered person, per calendar year.
Medical Diagnostic and Imaging Exams Benefit: Pays $150 for a covered exam, limited to 2 exams per covered person, per calendar year. Benefits payable for a variety of medical diagnostic and imaging exams, including sleep studies.
Ambulance Benefit: Pays $200 (ground) or $2,000 (air) for transportation to or from a hospital. The benefit is limited to two
trips, per calendar year, per covered person.
HOSPITAL STAY AND SURGICAL Initial Assistance Benefit: Pays $100 once per calendar year, per CARE RIDER rider, when a covered person requires a hospital admission.
Surgery Benefit: Pays $50-$1,000 for a covered surgery. Limited to
one payment per 24-hour period, per covered person.
Invasive Diagnostic Exams Benefit: Pays $100 for one covered
exam, per covered person, per 24-hour period.
Hospital Intensive Care Unit Confinement Benefit: Pays $500 per day, per covered person, for up to 30 days.
Daily Hospital Confinement Benefit: Pays $100 per day, per covered person, for up to 365 days.
Second Surgical Opinion Benefit: Pays $50 once per covered
person, per calendar year.
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 31
VOLUNTARY BENEFITS Aflac Cancer Protection Policy Why Cancer Insurance? The costs to fight the disease have escalated beyond the means of most individuals and have become the target of limitations and restrictions within many medical policies. It gives peace of mind that comes with knowing there are funds available during treatment. A cancer insurance policy can also help protect your income and savings from expenses that aren’t covered by your major medical health insurance policy, including:
u Hospitalization Benefits
u Continuing Care Benefits
u Experimental cancer treatment
u Travel and lodging when treatment is far away from home
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 32 32
AflAC Cancer Protection CANCERINDEMNITYINsuRANCE
Added Protection for You and Your Family Chances are you know someone who’s been affected, directly or indirectly, by
cancer. You also know the toll it’s taken on them—physically, emotionally, and
financially. That’s why we’ve developed the Aflac Cancer insurance policy. The plan
pays a cash benefit upon initial diagnosis of a covered cancer, with a variety of other
benefits payable throughout cancer treatment. You can use these cash benefits to
help pay out-of-pocket medical expenses, the rent or mortgage, groceries, or utility
bills—the choice is yours.
And while you can’t always predict the future, here at Aflac we believe it’s good to be
prepared. The Aflac Cancer plan is here to help you and your family better cope
financially—and emotionally—if a positive diagnosis of cancer ever occurs. That way
you can worry less about what may be ahead.
how IT woRks
brochure is for illustrative purposes only. Refer to the policy for complete benefit details, definitions, limitations and exclusions.
AFLAC CANCER
PROTECTION coverage isselected.
Policyholder suffers from
frequent infections & high fevers.
Physician visit & bone marrow biopsy reveals diagnosis of leukemia.
AFLAC CANCER
PROTECTION
insurance policyprovides the
following:
$23,575 ToTAl BENEfITs
The above example is based on a scenario for Aflac Cancer Protection Assurance – Option 2 that includes the following benefit conditions: Bone Marrow Biopsy (Cancer Screening Benefit) of $75, Initial Diagnosis Benefit of $4,000, IV Chemotherapy for 3 months (Physician-Administered Radiation Therapy, Chemotherapy, Immunotherapy, or Experimental Chemotherapy Benefit) of $3,600, Immunotherapy (Physician-Administered Radiation Therapy, Chemotherapy, Immunotherapy, or Experimental Chemotherapy Benefit) for 6 months of $7,200, Antinausea Benefit (9 months) of $900, Stem Cell Transplant Benefit of $7,000, Hospital Confinement Benefit (4 days) of $800.
Benefits and/or premiums may vary based on state and benefit option selected. Riders are available for an additional premium. The policy has limitations, exclusions, and pre-existing condition limitations that may affect benefits payable. The policy may contain a waiting period. This
FA C T N O . 0 1 FA C T N O . 0 2
IN THE UNITED STATES, MEN HAvE SLIgHTLY LESS THAN A IN THE UNITED STATES, WOMEN HAvE SLIgHTLY MORE THAN A
1-in-2 1-in-3 LIFETIME RISK OF DEvELOPINg CANCER.1 LIFETIME RISK OF DEvELOPINg CANCER.1
1Cancer Facts & Figures 2012, American Cancer Society.
The policy has limitations and exclusions that may affect benefts payable. For costs and complete details of the coverage, contact your Afac insurance agent/producer. This brochure is for illustrative purposes only. Refer to the policy for beneft details, defnitions, limitations, and exclusions.
Afac herein means American Family Life Assurance Company of Columbus.
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 33
25% Discount on Medical Services- No Claim Forms, No Deductibles!
24/7 Lost Pet Recovery Included!
All Pets are Eligible! Covers Pre-Existing Conditions!
Single Pet: $4.00 semi-monthly
Unlimited Pets: $5.50 semi-monthly
Website for in-network providers: www.petbenefits.com/search
To enroll in these voluntary benefits. call US Enrollment Services at 800.282.0732 34
www.petbenefits.com/search
Save up to 50% on Your Pet’s Prescriptions, Preventatives, Food,
Toys & More!! All Dogs and cats are eligible for PetPlus,
regardless of their age or breed. PetPlus even covers pets with pre-existing conditions.
Free shipping on all orders!
Pickup medications at Caremark Pharmacies including Walgreens, Target, CVS, and others!
Easy-to-use App, Prescription verification at your veterinarian!
Only $1.88 semi-monthly for Single Pet
Only $3.75 semi-monthly for Unlimited Pets
To enroll in these voluntary benefits. call US Enrollment Services at 800.282.0732 35
with Legal Insurance Legal Insurance Plan proudly offered to St. Lucie County Employees
Protect your family’s future with LegalEASE.
to shield your family and savings from unexpected personal legal issues.
What you get with a LegalEASE plan: •
to your personal legal matter • Access to a national network
of attorneys with exceptional experience that are matched to meet your needs
• In and out-of-network coverage • Concierge help navigating common
individual or family legal issues
Enroll now in the LegalEASE Insurance Plan. To learn more: Call: 1(800) 248-9000 Visit: legaleaseplan.com/stlucie Member Services: 1(888) 416-4313
SM
36
A legal insurance plan can ease the biggest stresses - finding and paying for legal expertise when you need it most. LegalEASE offers an insurance plan that provides support and protection from unexpected personal legal issues.
Plan Details:
$8.94 semi-monthly*, Who’s via payroll deduction covered:
Employees Spouse Dependent ChildrenUp to age 19; Age 19-26 enrolled full-time at an accredited university
*Based on a 24 pay-period deduction schedule
The value of a LegalEASE insurance plan. Being a member saves costly legal fees and provides coverage for:
HOME & RESIDENTIAL AUTO & TRAFFIC Serious Traffic Matters (Resulting in Suspension
Vacation or Investment Home, Tenant Dispute, Purchase, Sale, Refinancing of Primary Residence/
or Revocation of License), License Suspension Tenant Security Deposit Dispute, Landlord Dispute (Administrative Proceeding), Traffic Ticket, with Tenant, Security Deposit Dispute with Tenant, First-Time Vehicle Buyer Construction Defect Dispute, Neighbor Dispute, Noise Reduction Dispute, Foreclosure
FINANCIAL & CONSUMER FAMILY Debt Collection Defense, Bankruptcy, Tax Audit, Separation, Divorce, Name Change, Student Loan Refinancing/Collection Defense, Guardianship/Conservatorship, Adoptions, Document Preparation, Consumer Dispute, Small Juvenile Court Proceedings, Prenuptial Agreement Claims Court, Mail Order/Internet Purchase Dispute, Bank Fee Dispute, Cell Phone Contract Dispute, Warranty Dispute, Financial Advisor, Identity Theft Defense
GENERALESTATE PLANNING & WILLS Civil Litigation Defense, Initial Law Office
of Attorney, Probate of Small Estate, Living Trust Will or Codicil, Living Will or Health Care Power
Consultation, Review of Simple Documents, Document Mediation, Misdemeanor Defense, Incompetency
Defense, Identity Theft Assistance, Discounted Contingency Fees
Limitations apply. Please visit https://www.legaleaseplan.com/stlucie for specific plan benefits.
For more information, visit: https://www.legaleaseplan.com/stlucie
SM
To learn more, call: 1(800) 248-9000, and reference “St. Lucie County” Member Services: 1(888) 416-4313
Limitations and exclusions apply. This benefit summary is intended only to highlight benefits and should not be relied upon to fully determine coverage. More complete descriptions of benefits and the terms under which they are provided are received upon enrolling in the plan. If this benefit summary conflicts in any way with the Policy issued, the policy shall prevail. Group legal plans are administered by Legal Access Plans, L.L.C. or LegalEASE Home Office: 5151 San Felipe, Suite 2300, Houston, TX. This legal plan may not be regulated as insurance in some states. Product available in all states. Underwritten by Nationwide Mutual Insurance Company and affiliated companies in all states except HI, ID, NH, NC, OH, PA, SC, TX, and WY, where underwriting is not required. © 2019 Nationwide Mutual Insurance Company. SHR-0159M1_ NW_INS_Enroll_1PG_StLucieCounty_2019-09
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 37
TOGETHER.
with Benefit Plans
Screen modified for demonstration purposes. Features may differ depending on plan.
TOGETHER. LifeLock Identity Theft Protection and Norton Device Security are redefining what it means to be safer in the digital world. Everyday activities like online shopping, banking, and even browsing can expose your personal information, making you more vulnerable to cybercriminals. LifeLock with Norton Benefit Plans combine leading identity theft protection and device security against online threats, viruses, ransomware and malware, at home and on-the-go. Let us help protect your identity, your devices and your online privacy, in an always connected world.
ELECT YOUR PLAN DURING BENEFITS ENROLLMENT.
38
Benefit Pricing - Semi Monthly Rates with Benefit Essential with Benefit Premier
Employee Only (18+ Years Old) $3.75 $6.00
Employee + Family∆ $7.49 $11.99
∆ The LifeLock Benefit Junior plan is for minors under the age of 18. LifeLock enrollment is limited to employees and their eligible dependents. Eligible dependents must live within the employee’s household, or be financially dependent on employee. LifeLock services will only be provided after receipt and applicable verification of certain information about you and each family member. Please refer to employer group for the required information under your plan. In the event you do not complete the enrollment process for any family member, those individuals will not receive LifeLock services, but you will continue to be charged the full amount of the monthly membership selected until you cancel or modify your plan at your employer’s next open enrollment period, which may be annually. Please note that we will NOT refund or credit you for any period of time during which we are unable to provide LifeLock services to any family member on your plan after your benefit effective date due to your failure to submit the information necessary to complete enrollment. If you do not complete the enrollment process for each family member, you may continue to pay more for LifeLock services than you otherwise would if you had selected a lower tier plan.
LIFE
LOCK
IDEN
TITY
TH
EFT
PRO
TECT
ION
LifeLock Identity Alert™ System†
• Payday - Online Lending Alerts†
• Credit Alerts & Social Security Alerts†
LifeLock Mobile App (Android™ & iOS)**
Downloading the app does not provide protection.
Dark Web Monitoring**
LifeLock Privacy Monitor™
USPS Address Change Verification
Lost Wallet Protection
Reduced Pre-Approved Credit Card Offers
Fictitious Identity Monitoring
Data Breach Notifications
Credit, Checking & Savings Account Activity Alerts†**
Checking & Savings Account Application Alerts†**
Bank Account Takeover Alerts†**
401K & Investment Account Activity Alerts†**
File Sharing Network Searches
Sex Offender Registry Reports
Online Account Monitoring**
Expected availability 2020, subject to change.
Prior Identity Theft Remediation∂
This feature is separate from our Million Dollar Protection™ Package and does not provide coverage for lawyers and experts, reimbursem*nt of stolen funds or compensation for personal expenses for events occurring during the 12 months prior to enrollment. See disclaimer for details.
U.S.-based Identity Restoration Specialists
24/7 Live Member Support∆
Million Dollar Protection™ Package†††
• Stolen Funds Reimbursem*nt • Personal Expense Compensation • Coverage for Lawyers and Experts
Up to $1 Million each Up to $1 Million each
Credit Application Alerts2** One-Bureau One-Bureau
Credit Monitoring1** One-Bureau Three-Bureau
Annual Credit Report & Credit Score1**
The credit scores provided are VantageScore 3.0 credit scores based on data from Equifax, Experian and TransUnion respectively. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.
Three-Bureau
Monthly Credit Score Tracking1**
The credit score provided is a VantageScore 3.0 credit score based on Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.
One-Bureau
NO
RTO
N D
EVIC
E SE
CURI
TY Secures PCs, Macs, Smartphones/Tablets** Up to 3 devices
(Family gets 6 devices) Up to 5 devices
(Family gets 10 devices)
Online Threat Protection**
Password Manager **
Parental Controls3**
Smart Firewall**
Cloud Backup3** 10 GB 50 GB
ON
LIN
EPR
IVAC
Y
SafeCam3**
1 If your plan includes credit reports, scores, and/or credit monitoring features (“Credit Features”), two requirements must be met to receive said features: (i) your identity must be successfully verified with Equifax; and (ii) Equifax must be able to locate your credit file and it must contain sufficient credit history information. IF EITHER OF THE FOREGOING REQUIREMENTS ARE NOT MET YOU WILL NOT RECEIVE CREDIT FEATURES FROM ANY BUREAU. If your plan also includes Credit Features from Experian and/or TransUnion, the above verification process must also be successfully completed with Experian and/or TransUnion, as applicable. If verification is successfully completed with Equifax, but not with Experian and/or TransUnion, as applicable, you will not receive Credit Features from such bureau(s) until the verification process is successfully completed and until then you will only receive Credit Features from Equifax. Any credit monitoring from Experian and TransUnion will take several days to begin after your successful plan enrollment. Please note that in order to enjoy all features in your chosen plan, such as bank account alerts, credit monitoring, and credit reports, it may require additional action from you and may not be available until completion.
2 If your plan includes One Bureau Credit Application Alerts, two requirements must be met to receive said features: (i) your identity must be successfully verified with TransUnion; and (ii) TransUnion must be able to locate your credit file and it must contain sufficient credit history information. IF EITHER OF THE FOREGOING REQUIREMENTS ARE NOT MET YOU WILL NOT RECEIVE ONE BUREAU CREDIT APPLICATION ALERTS. One Bureau Credit Application Alerts will take several days to begin after your successful LifeLock plan enrollment.
3 Not all features are available on all platforms. Norton Family Parental Controls, Norton Cloud Backup, and PC SafeCam are presently not supported on Mac OS.
† LifeLock does not monitor all transactions at all businesses
†††Reimbursem*nt and Expense Compensation, each with limits of up to $1 million for LifeLock with Norton Benefit Essential and LifeLock with Norton Benefit Premier and up to $25,000 for Benefit Junior, and up to $1 million for coverage for lawyers and experts if needed, for all plans. Benefits under the Master Policy are issued and covered by United Specialty Insurance Company (State National Insurance Company, Inc. for NY State members). Policy terms, conditions and exclusions at: LifeLock.com/legal.
** These features are not enabled upon enrollment. Member must take action to activate this protection. ∂ Subject to eligibility requirements defined in Terms & Conditions at https://www.lifelock.com/legal/prior-id-theft-remediation. Symantec reserves the right
to change and/or cease services at any time. ∆ English only. No one can prevent all identity theft or cybercrime. LifeLock and Norton by Symantec are now Norton LifeLock. Copyright © 2019 Symantec Corporation. All rights reserved. Symantec, the Symantec Logo, the Checkmark Logo, Norton, Norton by Symantec, LifeLock, and the LockMan Logo are trademarks or registered trademarks of Symantec Corporation or its affiliates in the U.S. and other countries. Other names may be trademarks of their respective owners. Norton LifeLock is the Consumer Division of Symantec.
GPPM8558
To enroll in these voluntary benefits call US Enrollment Services at 800.282.0732 39
The Florida Blue Care Team works hand-in-hand with your physician. Together we put you at the center of all we do. Your dedicated care team includes doctors, nurses, pharmacists, social workers, dietitians and others.
Your Florida Blue plan includes these services at no extra cost:
A clinical care team who makes your best health their top priority
Dedicated nurses who focus on simplifying health care and helping you reach your health care goals
Programs and classes to support your journey to better health
Access to community resources that help with transportation,food,financesandmore.
It doesn’t matter what Florida Blue plan you have.
To find out if this program is for you, read Bill’s story on the next page or call us at 1-800-955-5692 and select Option 3.
Florida Blue CaresWorried about how to manage your ongoing health condition?
Feeling overwhelmed with all you need to remember about your medical condition? Have peace of mind knowing Florida Blue Cares.
The Florida Blue Care Team works hand-in-hand with your physician. Together we put you at the center of all we do. Your dedicated care team includes doctors, nurses, pharmacists, social workers, dietitians and others.
Your Florida Blue plan includes these services at no extra cost:
A clinical care team who makes your best health their top priority
Dedicated nurses who focus on simplifying health care and helping you reach your health care goals
Programs and classes to support your journey to better health
Access to community resources that help with transportation,food,financesandmore.
It doesn’t matter what Florida Blue plan you have.
To find out if this program is for you, read Bill’s story on the next page or call us at 1-800-955-5692 and select Option 3.
Florida Blue CaresWorried about how to manage your ongoing health condition?
Feeling overwhelmed with all you need to remember about your medical condition? Have peace of mind knowing Florida Blue Cares.
The Florida Blue Care Team works hand-in-hand with your physician. Together we put you at the center of all we do. Your dedicated care team includes doctors, nurses, pharmacists, social workers, dietitians and others.
Your Florida Blue plan includes these services at no extra cost:
A clinical care team who makes your best health their top priority
Dedicated nurses who focus on simplifying health care and helping you reach your health care goals
Programs and classes to support your journey to better health
Access to community resources that help with transportation,food,financesandmore.
It doesn’t matter what Florida Blue plan you have.
To find out if this program is for you, read Bill’s story on the next page or call us at 1-800-955-5692 and select Option 3.
Florida Blue CaresWorried about how to manage your ongoing health condition?
Feeling overwhelmed with all you need to remember about your medical condition? Have peace of mind knowing Florida Blue Cares.
40
Florida Blue nurse Jennifer realized Bill needed help controlling his blood sugar. She called him to offer her help. As she listened to Bill, Jennifer learned:
• Bill wasn’t taking his insulin exactly the way his doctor said he should. Bill explained he can’t afford the cost of his insulin.
• He also stopped testing his blood sugar because he ran out of supplies.
• And he stopped exercising because he’s had a blister on his foot that wasn’t healing. Bill is worried about possible foot amputation.
JennifertalkedtoBillabouthowtofeelmoreincontrolofhisdiabetes.ShehelpedBillfindwherehecouldget diabetic testing supplies and what they cost. She also helped Bill understand that getting his supplies from an out-of-network provider may cost more. She also called Bill’s doctor, who prescribed a different type of insulin that Bill can afford. Bill’s doctor also suggested that a nurse practitioner visit Bill at home.
After meeting Bill in his home, the nurse referred Bill to an endocrinologist. This type of specialist often treats people living with diabetes. The endocrinologist told Bill he needed to get important screenings for his A1C level and kidneys. The endocrinologist also helped Bill get new inserts for his shoes. And she also helped Bill make an appointment with a registered dietitian. The dietitian helped Bill learn about healthy food choices to help lower his blood sugar.
Now Bill’s blood sugar is under control. By working with Jennifer, Bill knew Florida Blue Cares. That’s the power of having a clinical care expert who partners with you. It’s a relief trusting someone else to handle the details so you can focus on feeling your best.
See How Your Florida Blue Care Team Makes a DifferenceBill* lives with diabetes.
*Member’s name changed for privacy. Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or gender. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770). ©2019 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserved.95327 0319
Florida Blue nurse Jennifer realized Bill needed help controlling his blood sugar. She called him to offer her help. As she listened to Bill, Jennifer learned:
• Bill wasn’t taking his insulin exactly the way his doctor said he should. Bill explained he can’t afford the cost of his insulin.
• He also stopped testing his blood sugar because he ran out of supplies.
• And he stopped exercising because he’s had a blister on his foot that wasn’t healing. Bill is worried about possible foot amputation.
JennifertalkedtoBillabouthowtofeelmoreincontrolofhisdiabetes.ShehelpedBillfindwherehecouldget diabetic testing supplies and what they cost. She also helped Bill understand that getting his supplies from an out-of-network provider may cost more. She also called Bill’s doctor, who prescribed a different type of insulin that Bill can afford. Bill’s doctor also suggested that a nurse practitioner visit Bill at home.
After meeting Bill in his home, the nurse referred Bill to an endocrinologist. This type of specialist often treats people living with diabetes. The endocrinologist told Bill he needed to get important screenings for his A1C level and kidneys. The endocrinologist also helped Bill get new inserts for his shoes. And she also helped Bill make an appointment with a registered dietitian. The dietitian helped Bill learn about healthy food choices to help lower his blood sugar.
Now Bill’s blood sugar is under control. By working with Jennifer, Bill knew Florida Blue Cares. That’s the power of having a clinical care expert who partners with you. It’s a relief trusting someone else to handle the details so you can focus on feeling your best.
See How Your Florida Blue Care Team Makes a DifferenceBill* lives with diabetes.
*Member’s name changed for privacy. Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or gender. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770). ©2019 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserved.95327 0319
Florida Blue nurse Jennifer realized Bill needed help controlling his blood sugar. She called him to offer her help. As she listened to Bill, Jennifer learned:
• Bill wasn’t taking his insulin exactly the way his doctor said he should. Bill explained he can’t afford the cost of his insulin.
• He also stopped testing his blood sugar because he ran out of supplies.
• And he stopped exercising because he’s had a blister on his foot that wasn’t healing. Bill is worried about possible foot amputation.
JennifertalkedtoBillabouthowtofeelmoreincontrolofhisdiabetes.ShehelpedBillfindwherehecouldget diabetic testing supplies and what they cost. She also helped Bill understand that getting his supplies from an out-of-network provider may cost more. She also called Bill’s doctor, who prescribed a different type of insulin that Bill can afford. Bill’s doctor also suggested that a nurse practitioner visit Bill at home.
After meeting Bill in his home, the nurse referred Bill to an endocrinologist. This type of specialist often treats people living with diabetes. The endocrinologist told Bill he needed to get important screenings for his A1C level and kidneys. The endocrinologist also helped Bill get new inserts for his shoes. And she also helped Bill make an appointment with a registered dietitian. The dietitian helped Bill learn about healthy food choices to help lower his blood sugar.
Now Bill’s blood sugar is under control. By working with Jennifer, Bill knew Florida Blue Cares. That’s the power of having a clinical care expert who partners with you. It’s a relief trusting someone else to handle the details so you can focus on feeling your best.
See How Your Florida Blue Care Team Makes a DifferenceBill* lives with diabetes.
*Member’s name changed for privacy. Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or gender. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770). ©2019 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserved.95327 0319 41
42
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New User Sign Up (continued)
4.
3.
6.
5.
Step 3: Choose and type in a User ID (click on User ID suggestion for help on User IDs).
Step 4: Choose and type in a Password. The Password must be typed in twice for security purposes. Click Next.
If you opt-in for electronic communications, a screen for email address will also appear on this screen. If so, enter your email address twice, and click Next. (not applicable for everyone)
Note: Write down your User ID and Password in case you forget them later.
Step 5: Type three different security questions and type an answer to each. Click Next.
Note: The security questions will be used if you forget your User ID or Password.
Step 6: Click Continue, and you’ll be taken to the member website homepage.
Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. HMO coverage is offered by Health Options, Inc., DBA Florida Blue HMO, an affiliate of Florida Blue. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1- 800-352-2583 (TTY: 1-800-955-8770). 44
Don’t pay more than you should.
can compare quality and cost—
Don’t pay more than you should.
Know Before You Go Quality and cost are important factors when making health care decisions. As a member, you
before you receive medical care or buy prescriptions. Get cost estimates based on your plan benefits, and see treatment options that may save you money. Costs vary depending on where you go for treatment. And prescription prices vary based on the brand you buy— and where you buy them.
Price and Compare Online Log in at floridablue.com. Make the drug pricing and medical services cost estimator tools work for you.
Talk with a Care Consultant Our Care Consultants are experts when it comes to explaining quality care and treatment options, that can help save you money. Call 1-888-476-2227 or stop in a Florida Blue Center. Visit floridablue.com for locations.
Cost Comparison Examples MRI of the Knee
Facility A $1,569.00
Facility B $689.00
Savings $880.00
30 Cholesterol Pills Brand Name $115.00
Generic $5.65
Savings $109.35
The savings to you is based on your plan benefits.
Download the Florida Blue mobile app! Compare drug prices on the spot and map the nearest pharmacy.
Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association. 45
ANNUAL NOTICES WOMAN’S HEALTH AND CANCER RIGHTS ACT OF 1988 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:
u All stages of reconstruction of the breast on which the mastectomy was performed;
u Surgery and reconstruction of the other breast to produce a symmetrical appearance;
u Prostheses; and u 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 your Plan Administrator.
NEWBORNS’ 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 vagin*l 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) after delivery. 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).
NOTICE OF SPECIAL ENROLLMENT RIGHTS Special enrollment events allow you and your eligible dependents to enroll for health coverage outside the Open Enrollment period under certain circ*mstances if you lose eligibility for other coverage, become eligible for state premium assistance under Medicaid or the State Children’s Health Insurance Program (S-CHIP), or acquire newly eligible dependents. This is required under the Health Insurance Portability and Accountability Act (HIPAA).
If you decline enrollment in the Medical and Dental plans for you or your dependents (including your spouse) because of other health insurance coverage, you or your dependents may be able to enroll in the Medical and Dental plans without waiting for the next Open Enrollment period if you:
u Lose other coverage: You must request enrollment within 31 days after the loss of other coverage
u Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption: You must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption
u Lose Medicaid or Children’s Health Insurance Program (S-CHIP) coverage because you are no longer eligible: You must request enrollment within 60 days after the loss of such coverage
In addition, you may enroll in the Medical and Dental plans if you become eligible for a state premium assistance program under Medicaid or S-CHIP. You must request enrollment within 60 days after you gain such coverage. To request special enrollment or obtain more information, contact Kate Hartman, Benefits and Wellness Coordinator, 772.462.1613.
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SUMMARY OF
BENEFITS COSTS
PRE-TAX BENEFIT DEDUCTION AMOUNT
MONTHLY DEDUCTION AMOUNT EMPLOYEE ONLY EMPLOYEE + ONE FAMILY
MEDICAL 3766 $148.34 $323.32 $477.42 MEDICAL 5773 $46.46 $95.64 $161.38
DENTAL - LOW OPTION $35.66 $71.10 $117.92 DENTAL - HIGH OPTION $39.98 $79.64 $132.14
VISION - OPTION 1 $2.06 $3.82 $5.56
VISION - OPTION 2 $5.56 $10.56 $15.52
PER PAY DEDUCTION AMOUNTT
EMPLOYEE ONLY EMPLOYEE + ONE FAMILY MEDICAL 3766 $74.17 $161.66 $238.71 MEDICAL 5773 $23.23 $47.82 $80.69
DENTAL - LOW OPTION $17.83 $35.55 $58.96 DENTAL - HIGH OPTION $19.99 $39.82 $66.07
VISION - OPTION 1 $1.03 $1.91 $2.78 VISION - OPTION 2 $2.78 $5.28 $7.76
EMPLOYEE SUPPLEMENTAL LIFE POST-TAX MONTHLY BENEFIT EMPLOYEE SUPPLEMENTAL LIFE RATES SPOUSE SUPPLEMENTAL LIFE RATES
AGE RATE PER $1,000 AGE RATE PER $1,000 UNDER 30 $0.09 UNDER 30 $0.07
30 - 39 $0.11 30 - 39 $0.09 40 - 44 $0.17 40 - 44 $0.15 45 - 49 $0.29 45 - 49 $0.27 50 - 54 $0.43 50 - 54 $0.41 55 - 59 $0.70 55 - 59 $0.68 60 - 64 $0.79 60 - 64 $0.77 65 - 69 $1.37 65 - 69 $1.35 70 - 74 $2.23 70 - 74 $2.21
75+ $3.83 75+ $3.81 $5,000 Supplemental Life Insurance - Child(ren) $1.00 $10,000 Supplemental Life Insurance - Child(ren) $2.00
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) EMPLOYEE $0.034 PER $1,000 FAMILY $0.050 PER $1,000
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To enroll or change your benefits, visit
www.SLC.HRInTouch.com
Kate Hartman Benefits & Wellness Coordinator SLC BOCC HUMAN RESOURCES (772) 462-1613
For More Information
Contact