HomeMy WebLinkAboutHandouts_Broker of Record_Tab 02_12/11/2008VILLAGE OF
TEQUESTA
Presentation Questions
Broker of Record for
Employee Benefits
RFP #: HR3-2008
Thursday, December 11, 2008
Submitted by:
GEHRING GROUP
PROFESSIONAL SERVICES
11505 Fairchild Gardens Avenue, Suite 202
Palm Beach Gardens, Florida 33410
(561) 626-6797
(800) 244-3696 / (561) 626-6970 -Fax
www. ge hringgro up. c o m
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1. Is your company financially solvent -How has the market affected your staffing, financials,
etc.?
The downturn in the economy has allowed the Gehring Group to see a significant
increase in our business and hiring of additional staff. Many of our clients are
seeking alternative resources and outsourcing opportunities due to their own
resources being downsized.
Incorporated in 1992, Gehring Group, Inc. is organized as a Florida Subchapter S
corporation, of which Kurt Gehring is the sole owner. As anon-public company,
Gehring Group does not prepare or file audited financial statements for public
distribution or file with the Securities and Exchange Commission. Under the
direction of Kate Grangard, CFO, a Certified Public Accountant, Gehring Group
employs a conservative fiscal approach and prudent decision making. The
predominant portion of Gehring Group's revenue is received from monthly employee
benefits commissions and consulting fees and has enjoyed continuous operating
profitability. Gehring Group maintains a positive capital balance and reinvests its
profits into the development of client service oriented technology. In addition,
Gehring Group maintains a strong banking relationship, reference to which is
available upon request.
2. What's the number of employees that you have in office who will help service our
employees' problems and questions?
Gehring Group's 24 staff members operate under the philosophy of a team approach.
Our employees are working managers and professionals who are cross trained and
educated on all accounts. Each client is assigned a primary Account Manager and
Analyst. Account Managers maintain frequent, year round, contact with their
assigned clients. Depending on the complexity and needs of the client, contact is
made as often as every other day, but not less frequently than monthly depending on
the client's specific service needs. Gehring Group's proactive approach includes
establishing a calendar of expectations with clients to outline their insurance
program expectations in order to assure that Gehring Group is aware of their risk
management schedule and requested attendance. In addition, each Account
Manager and Analyst is supported by other Gehring Group staff members to ensure
that our clients always have access to someone during their time of need. Gehring
Group is adequately staffed to fulfill the needs of Village of Tequesta, with current
available capacity in each of its departments, due to our commitment to the hiring of
experienced knowledgeable personnel, and recent staff additions in accordance with
this commitment.
3. What's your history with governmental clients and unions?
95`% of the Gehring Group's client base consists of public entities of which over
twenty-five are in Palm Beach and Martin Counties alone; therefore, our firm is
uniquely qualified in its understanding of public entity issues. We understand the
bid process and public record laws while maintaining familiarity with the constantly
changing and complex Statutes that apply to governmental organizations. This
specialized knowledge is especially vital when negotiating renewals and program
changes with insurance carriers and health insurance consortiums. The experience
we offer guarantees that no piece of the puzzle will be missing when a benefit
change is implemented.
4. What's your history with HSAs?
Gehring Group public sector clients are among the first in Florida to implement
some of the cutting edge types of insurance and funding products recently made
available through the various legislative updates such as Health Reimbursement
Accounts (HRA) and Health Savings Accounts (HSA) in an attempt to maximize
their shrinking benefits budget with great success.
Several of our clients have utilized tax advantaged funding arrangements while
others have taken advantage of progressive types of health programs recently made
available by the various insurance carriers. The Children's Services Council of Palm
Beach County (CSC) is one such example. In late 2005, Gehring Group was
appointed to investigate and implement a cost efficient plan alternative to their
current fully insured HMO option. Gehring Group issued an RFP to accomplish this
goal and provided a detailed analysis to the group upon completion. Upon review of
the various options outlined, CSC elected to implement a high deductible health plan
(HDHP) alongside a Health Savings Account (HSA).
The cost savings of the HDHP in comparison to the #ofRespondentsWho
Claimed HSA Reimbursement
renewal proposal of the in force HMO was significant
enough to allow the employer to fund 75°/, of the
deductible in each employee's HSA. In addition, the ~.,,~
group still realized a total annual cost savings of over ,-''gqO '.
9.5°/~ for the 2006 plan year. s1%
During the first year of the program, Gehring Group
conducted a survey of the group's employees with ; ~ Yes .~ No
approximately 50`% of the participants responding. The
results revealed widespread utilization of the HSA fiords (91`%. of respondents).
These results indicated that employees had successfully tackled the learning curve
associated with this fairly new concept.
The savings associated with the decision to implement a HSA plan carried over to
the 2007 plan year resulting in a total cost for the group medical plan including the
employer funding of the HSA at a rate less than that of the 2005 plan year.
5. Can your company administer an HSA, HRA account, or would you defer it to a third party
to administer?
Gehring Group is not a third parry administrator, and therefore does not administer
pre-tax flexible spending program in-house. However, we provide this service
through a third party administrator and/or insurance carrier either via competitive
bid process or by utilizing one of the TPA's and/or insurance carriers with whom
Gehring Group has apre-negotiated relationship. Although Gehring Group clients
utilize a number of HSA/HRA/FSA vendors due to our independent role as agent,
eve offer free services through the following preferred vendors:
• Benefits Workshop
• 1~Iangrove Administrators
• Ceridian
• Eagles Benefits by Design
• Various insurance carriers
With the increased adoption of the debit card "smart technology," more and more of
the various pharmacy and retail chains are becoming known as "no receipt retailers."
This technological advancement has made debit card utilization increasingly more
convenient. In addition, employees would no longer have to "front" the cost of
HRA/FSA qualified expenses at those vendors who accept the card, and wait for a
reimbursement check. The debit card service would also be included as part of
Gehring Group's AOR fee.
6. Can you provide an HSr, that will run concurrent with our fiscal year? If not, how would
you propose to bridge the difference between October and January?
Yes, a qualified HSA high-deductible health plan can run concurrent with the
Village's fiscal year. Most insurance companies are now offering plan year
deductibles versus calendar year deductibles; therefore, a bridge behveen October
and January should not be necessary.
Based upon our experience, many groups have transitioned their benefits to a
January 1y` effective date in order for their employees to take a full year of the tax
advantages of HSA plans due to the IRS maintain a calendar year tax system. If a
bridge is necessary, dual funding of the deductible and education may be a
requirement in order not to position the employee and their dependents with a
double deductible. Once the plan year is complete, the membership will not feel the
bridge issues again.
7. Can we get all prices in by July?
Yes, a ,group of the Village's size should expect their renewal premiums and new
quote premiums within 90 days of the effective date.
8. Can the Village of Tequesta band together with other organizations for the specific purpose
of gaining insurance?
Due to our reputation and current portfolio in the public sector, eve are one of the
only brokers with access to the various insurance trusts, insurance pools, and
consortiums in the State that allow municipalities to band together with other
organization for the purpose of gaining insurance. For example, the Village
purchases its property & casualty and workers' compensation insurance from the
Florida Municipal Insurance Trust -which insures over 50% of municipalities in the
State.
9. Describe the current medical plan in place in your organization; tell us how it has benefited
you, and how it compares to a POS plan, as is currently in place in Tequesta.
As an employer under 50, the Gehring Group is limited to filed rates and products
known as "manual rated". Our rates are established by our demographics, such as
age and gender, not our claims experience.
The Gehring Group had maintained a traditional POS benefits program up until last
year, when we received a 60`%. reduction in our premium rates from B1ueCross
B1ueShield of Florida to transition to a HSA plan with a $1,500 single deductible and
$3,000 family deductible. Once the deductible has been satisfied all medical and
pharmacy benefits are paid at 100'%,. Due to the substantial rate reduction, the
Gehring Group was able to fund 100`%~ of the deductible for each employee in a HRA
account. At this funding level, a 20`% savings was still realized. In fact, Gehring
Group has just received our renewal and we are still 10% lower in our premium
payments than two years ago.
10. Would dual option plans be beneficial to an organization of our size?
While there is no significant disadvantage to offering a dual option plan in a group of
the Village's size there are some options to consider. What is the philosophy of your
organization? Are you bound by Union contracts? Ho~v would employee morale be
impacted?
There are certain efficiencies by offering one plan (i.e. administration and
communication). There are advantages especially in the terms of employee morale
by offering a dual option plan because you are giving the employees options to
choose benefits that meet their personal and familial needs.
More and more of Gehring Group clientele are implementing high deductible health
plans and are typically maintaining their traditional health plan alongside the new
high deductible health plan while creating contribution and account strategies in
order to change behavior and drive enrollment to specific plans. We have identified
that most employees are happier with being given the option to choose their
coverage.
11. Summarize President Elect Obama's health care proposal and give us an idea of how it may
benefit the Village of Tequesta, especially in terms of cost containment.
The Obama health care proposal would create a National Health Insurance
Exchange featuring a new public plan and approved private plan options. According
to advance studies health plans would save approximately $2,500 per employee per
year or approximately $210,000 in the Village's case.
Key elements of the program include:
• Enrollment would be available to individuals who do not have access to
employer health coverage or current public plans, as well as to individuals
who want new health coverage.
• The new public plan would offer a benefit package similar to the Federal
Employees Health Benefits Program (FEHBP), and all approved private
plans would be required to offer a package that is at least as generous as the
public plan.
• Individuals would be guaranteed eligibility for all available plans, with no
preexisting exclusions, and the coverage would be portable.
• Income-based, sliding-scale tax credits would be available for those who
don't qualify for Medicaid or the State Children's Health Insurance Program
(SCHIP).
• Employer-sponsored health plans would be reimbursed for a portion of
catastrophic costs incurred above an unspecified threshold amount, as long as
the savings are used to reduce employee premiums.
• Tighter controls on pharmaceutical manufacturers in order to release
prescription drugs more quickly to the generic marketplace.
• Maintain and provide for federally purchases malpractice insurance for
providers and organizations.
• Create and update electronic health records in order to prevent inefficiencies
and replications in providing health services.
The Obama health care proposal anticipates that employers will continue to play a
role as a key source of health insurance coverage. The proposal also would retain the
current uncapped employee income tax exclusion on the value of employer-provided
health coverage, although it's likely that Congress wrill consider imposing some kind
of cap.
The proposal is silent on the fate of tax-favored health savings accounts and high-
deductible health plans -central elements in the consumer driven health care
strategies of many companies.
Most important are other elements that could bring major changes in the employer-
sponsored health care system, beginning with apay-or-play mandate. This provision
would require large companies to provide "meaningful coverage" or make a
"meaningful contribution" to the cost of health coverage for their employees.
Companies that fail to do so would be required to contribute a percentage of payroll
toward the cost of the new public plan. Small employers would be exempt from the
mandate, but the dividing line between large and small employers is not defined.
Notably, the proposed pay-or-play mandate lacks clarity regarding what would be
considered meaningful coverage or a meaningful contribution. It also offers no
specificity regarding the percentage of payroll assessment that would apply to
employers who choose to "pay" instead of "play."
Since none of these critical financial benchmarks have been defined, it is difficult for
organizations to estimate at this time how their current health care programs would
be affected. Specifically, it's not clear to what extent employers would have to
continue bearing the burden of health care coverage costs for their employees in
order to avoid paying into the public plan.
Until further details emerge, some employers may decide to evaluate their plans by
relying on certain assumptions regarding the likely form that the pay-or-play
requirements may take. A group might ultimately determine that it would need to
top up plan design, expand eligibility or increase the subsidy toward the cost of
health care to meet the "play" requirements, or do all three.
From a strategic standpoint, the Obama proposals raise the prospect that some
employers may ultimately choose to sponsor richer coverage than would be available
through the government or individual market options. Doing so could serve as a
device to attract and retain talent. For virtually all employers, some broad
reassessment of their health care strategies, and a consideration of alternative
approaches, would be in order.
12. The Village's current group insurance benefits include medical, dental and life. In your
experience, are there any other product(s) that you we could benefit from? If so, are there
any creative ways would you go about getting us those product(s) as part of a package deal
with minor effect on our overall group insurance budget?
The Village may want to consider evaluating these other employer-paid and/or
employee-paid (voluntary) coverages to its employee benefits package:
• Short term disability and long term disability
• Vision insurance
• Employee assistance programs
• Legal expense insurance
• Pet insurance
• Cancer insurance
• Accident insurance
• Specified disease /dread disease insurance
• Hospital indemnity insurance
In addition, many insurance companies are offering premium reductions by aligning
products with one carrier. This allows the carrier to monitor claims activity
concurrently (i.e. medical, dental & disability) as ~~ell a reducing administrative cost.
In addition to premium reductions, etc. merging benefits with fewer insurance
carriers, greatly reduces Village staff time from multiple administration of different
insurance plans.
13. What are the value-added services and programs that you currently offer your customers that
set you apart from the competition?
Gehring Group takes pride in being recognized for providing a significant number of
"value-added" services to our clients. The following outlines several additional
services that Gehring Group ~~ill provide to the Village inclusive within the agent of
record appointment:
Continuous Plan Analysis
When appointed as Agent of Record, Gehring Group's first task involves interviewing
staff regarding what they deem to be the positive aspects of their program as well as
any areas of particular concern. We discuss you future goals and collect all relevant
plan documents and benefit summaries in order to become familiar with the details
of each policy. In addition, Gehring Group performs a continuous review of your
claims information, if available, premium rates and all other information in order to
evaluate your current program and determine a timetable for the release of any RFPs
that may be necessary.
As part of our continuous service, Gehring Group staff also conducts detailed
reviews, analysis and projection sessions with decision makers at key points
throughout the year. We consistently track the available claims utilization data of
your program throughout the plan year in order to more effectively prepare for the
renewal process. We review available claims utilization reports to determine whether
your programs are running favorably and utilize this claims data to forecast renewal
projections and negotiate with vendors.
Consistent Client Contact
Upon appointment as Agent of Record, Gehring Group and the client determine a
convenient schedule to meet. These meetings can take place quarterly, semi-
annually or as needed. Gehring Group strives to be available to our clients whenever
the need arises. As always, there is never any additional cost associated for Gehring
Group staff to attend meetings on-site.
Development of Requests for Proposals/ uotes
Gehring Group would conduct all phases of the procurement process for those lines
of insurance deemed suitable for bidding. Our involvement in this process is very
comprehensive. We feel it is our job to educate you on any new products in the
industry that may reduce administrative burden or aid in the reduction of health care
costs.
Plan & Proposal Evaluation
Gehring Group will consistently provide thorough examination of all proposals
received during a bid process. We will compare all proposals to the in-force program
and illustrate the program differences to include the advantages and disadvantages
of each. This will include a detailed cost comparison which outlines the total cost of
the program in addition to breaking down the costs related to employer and
employee contributions in an easy to understand format. During this process, eve
will also compare provider networks to determine which proposers may be
considered viable options.
Plan Renewals & Effective Negotiations
In addition to bidding your employee benefits program, Gehring Group will also
negotiate renewals with your current carriers. As previously stated, our block of
business provides us with the credibility to negotiate with insurance carriers more
effectively. We get results. Our highly trained staff is able to negotiate more
effectively due to the high quality of our own analysis.
Program Implementation
Gehring Group provides extensive assistance during program implementation and
the open enrollment process. After the RFP and evaluation process, Gehring Group
staff remains involved in:
Coordinating implementation process with all selected carriers.
Assisting with employee meetings at all sites as determined by client.
~ Developing education materials and employee benefit booklets based on new
programs and updates in current plans.
~ Aiding in cancellation or renewal of current insurer upon written acceptance from
the client.
Ongoing Service
In addition to the processes above, your Gehring Group Account Manager will
maintain continuous communication throughout the plan year to provide support to
staff with administrative, legislative, enrollment and billing questions. Gehring
Group is available to assist our clients' staff with the resolution of claim problems
and other issues such as policy interpretation.
On-site Service
Gehring Group staff is always available to provide on-site assistance with new-hire
orientations and employee benefits fairs.
Employee Surveys
One of the most effective ways to acquire employee feedback regarding their benefits
program, or any other topic of interest, is through an employee survey. Gehring
Group has the ability to accomplish this via paper survey form, or electronically, via
the internet. These surveys have proven to generate effective results that aid in
future decision making.
Displacement Anal,~sis
As part of the procurement process for each medical insurance bid conducted by the
Gehring Group, we perform a provider disruption analysis in order for our clients to
make an informed decision regarding viability of the plan alternative. Therefore, it is
our recommendation to conduct this disruption analysis within the time frame of the
bid process with the carriers who actually submit a bid response in order to have the
most up to date provider network information from which to make an informed
decision.
Employee Benefits Handbook
At the beginning of each new plan year we have the ability to compile all of the
information regarding your insurance coverages and summarize it in an employee
friendly benefit booklet. This booklet has proven to be a valuable resource to our
client's employees and has reduced the number of inquiries received by our client's
HR and Benefits staff. This service is offered at no additional cost. We will provide
you with enough copies for open enrollment and as needed for new-hire orientations
throughout the plan year.
In-House Graphics Department -Professional Employee Communications
Gehring Group employs an in-house Graphics Department. This enables us to assist
our clients with employee communication materials. As part of our services, w~e draft
and produce employee communication pieces such as payroll stuffers, department
posters, mass employee mailings, etc. This allows our clients to better communicate
its employee benefit offerings and keep their employees well educated with regard to
their employee benefit options and responsibilities. All of the communication
materials such as posters, education materials and employee benefit handbooks,
were compiled and produced in-house.
Legislative Compliance & Updates
Gehring Group provides you with updates regarding any changes in applicable laws
and how they might affect your benefits program. We are also available to revie~~
your processes and procedures to make recommendations with regard to compliance
issues, HIPAA, FMLA, COBRA, etc. Gehring Group makes a special effort to
remain knowledgeable on industry trends, new legislation and new types of health
insurance programs being presented by insurance companies and third-party
administrators. Staff members consistently attend conferences and educational
seminars in order to stay ahead of the curve.
Produce Formal Proposals /Make Presentations
Gehring Group is available to make presentations to all staff groups or employee
committees as needed.
14. Why should we choose your company over the other applicant(s)?
As Insurance Broker and Consultant or Agent of Record for a large number of
municipalities and public entities throughout the State of Florida and here in Palm
Beach County, ~~e are confident that our firm would save the Village time and money
based on our negotiation clout and unparalleled level of service provided to staff.
Due to Gehring Group's close proximity to the Village and knowledge of the local
insurance market, we feel we are best suited to serve the Village in the capacity of
Agent of Record.
Gehring Group has proven to be an asset in assisting our clients in controlling
benefit costs through various means. Whether it is assisting employees with claim
issues, ensuring that our clients are up to date and informed on the latest market
trends, or developing our own technological solutions, we are in constant contact
with our clients to determine how to best meet their needs.
We thank you for giving us the opportunity to meet with you to discuss our proposal,
introduce our team and we invite the Village of Tequesta to allow us the opportunity
to exceed your expectations.
Presented by:
Kurt Gehring
Christian Bergstrom
Ellen Jones
Anna Maria Studley
q
RFP# HR3-2008
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RFP# HR3-2008
Page 1
Broker of Record for Employee Benefits
~' Page 2
GEHRING,~GROUP
11505 Fairchild Gardens Avenue, Suite 202
Palm Beach Gardens, FL 33410
Telephone: (561) 626-6797
Fax: (561)626-6970
www.gehringgroup. com
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This sample employee benefit highlights booklet was created exclusively
_ 4 in response to RFP# HR3-2008. Further reproduction of this booklet's
contents, including logos, is strictly prohibited.
This sample employee benefit highlights booklet contains actual Gehring Group client
inserts from those public sector entities represented below.
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Health Care District
PALM BEACH COUNTY
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Children's
Services Council
PALM BEACH COUNT Y
Benefits At-A-Glance
V1(.y .~ `iir
Benefit Employee Eligibility Initial Enrollment Eligibility
COBRA
'Regular & Supplemental, Full-time Upon occurrence of a COBRA
qualifying event
Deferred Compensation Plan i Regular & Supplemental, Full- & Part-time
457(b) with MetLife & ICMA :Upon employment
Employee Assistance Program (EAP) :Regular & Supplemental, Full-time 1yt of the month following 90 days of
employment
Employee /Family Health, Dental,
Vision, Life, Long & Short Term
Disability, Health Reimbursement :Regular & Supplemental, Full-time 1st of the month following 90 days of
Accounts, Flexible Spending employment
Accounts and Optional Cancer,
Heart/Stroke or ICU Coverage
Family Medical Leave :All Employees
Upon occurrence (must meet FMLA
criteria)
Florida Retirement Plan Regular & Supplemental, Full- & Part-time Upon employment
Paid Bereavement Leave
Regular & Supplemental, Full-time
;Upon occurrence following 90 days
of employment
i Upon occurrence of the Village
Paid Holiday(s) :Regular & Supplemental, Full- & Part-time :observed holidays. Regular part-
time employees shall accrue holiday
time on a prorated basis.
Paid Jury Duty Leave Regular & Supplemental, Full-time Upon occurrence
Paid Major Illness Leave :Regular & Supplemental, Full-time :Following 90 days of employment
Paid Military Leave Regular & Supplemental, Full- & Part-time As specified by applicable law
Regular, Full-time
Paid Time Off PTO
( ) Regular, Part-time (prorated)
:Supplemental, Full-time
Following 90 days of employment
Supplemental, Part-time (prorated)
Paid Witness Duty Leave ;Regular & Supplemental, Full-time :Upon occurrence
Safety Shoes :Designated positions Upon employment/assignment to
Regular & Supplemental, Full- & Part-time :designated position
Seminars & Continuing Education :All Employees As specified by management
Upon occurrence for travel
Travel Reimbursement ;All Employees :authorized in advance by the
department director
Designated Positions
Uniforms
:Regular & Supplemental, Full- & Part-time Upon employment/assignment to
Temporary designated position
Workers' Compensation 'All Employees ;Upon employment
Receipt of benefits under these programs is subject to applicable terms, conditions, and laws related to each individual program.
All benefits covered in this bondlrt m e subject to change. This is an Employee Benefit Highlight Summan/ and not a rontrart. All benefits are subject to the provisions and exclusions of the master contract
~Grou Insurance Eli lblllt
p g Y
The Children's Services Council's group insurance plan year is January 151 through December 31s~. For new hires eligible to
participate in the CSC's group insurance plans, coverage will be effective on the 915 day of employment. Questions regard-
ing group insurance eligibility may be directed to the Human Resources Department.
Dependent Coverage
Employees may elect to provide health, dental, and additional voluntary life insurance coverages for eligible dependents.
A dependent is defined as the participant's legal spouse /registered domestic partner and / or an unmarried dependent
child of the participant. Dependent children may be covered through the end of the calendar year in which the child
reaches the age 19. The term "child" includes:
• A natural child
• A stepchild
• A legally adopted child
• A foster child
• A child for whom legal guardianship has been awarded to the participant or the participant's spouse
Dependents Over the Age of 19
Health Insurance: Coverage may continue to the end of the calendar year in which the dependent reaches the age of 25 if:
/ The child is dependent upon the policyholder for support, and
/ The child is living in the household of the policyholder, OR
/ The child is a full-time or part-time student.
State law mandates new dependent eligibility age requirements become effective January 1, 2009 for eligible
dependents age 25-30. Coverage may continue past the age of 25 to the end of the calendar year in which the
dependent reaches the age of 30, if:
/ The child is unmarried with no dependents, and
/ The child is a resident of Florida or a full-time or part-time student, and
/ The child is otherwise uninsured and not entitled to Medicare.
Employees who previously dropped health insurance coverage for a dependent because that dependent exceeded the previous age
requirement (age 19 or 25) may elect to reinstate that dependent if he/she currently meets the new age requirement as outlined above.
You have until April 1, 2009, to make a written election to reinstate coverage, without proof of insurability.
Dental Insurance: Coverage may continue to the end of the calendar year in which the dependent reaches the age of 25 if:
/ The child is dependent upon the policyholder for support, and
/ The child is living in the household of the policyholder, OR
/ The child is a full-time or part-time student.
• Additional Voluntary Life Insurance: Coverage may continue to the end of the calendar year in which the dependent
reaches the age of 25 if:
/ The child is dependent upon the policyholder for support, and
/ The child is a full-time student.
Disabled Dependents
Health Insurance Only: Coverage for an unmarried dependent child may be continued beyond the aQe of 25 if:
/ The dependent is physically or mentally disabled (proof of disability will be required upon request), and
/ Coverage began prior to age 19, and
/ The dependent has continuously been insured.
Domestic Partners
Domestic partners may be eligible to participate in certain group coverages if the partnership is officially registered with
the Clerk & Comptroller's Office. Contact Human Resources regarding domestic partner eligibility criteria.
2 All benefits covered in thrs booklet are subject to change. T/vis is an Emplm~ee Benefit Highlight Sum~nnru ~~!~a r r ~ ; .~~ na ~- ail I~<n ~iits arr>ubi~ ri h~ ihr,~r~~~~i~iana and errlusions of the master contract.
' Group Insurance Premiums
The Village subsidizes a portion of your insurance premium for certain group coverages explained in this booklet based on the
following schedule:
• Health Insurance: 80% of the premium for either the CIGNA Open Access Plus Base Plan or CIGNA Health Savings Open
Access Plus Plan;
• Dental Insurance: 80% of the premium for the DMO Plan or a credit equaling that same dollar amount to offset the Indemnity
Plan premium;
For employees who enroll in the CIGNA Health Savings Plan, the Village will also contribute to your Health Savings Account as
follows: $1,000 for employees with Employee Only coverage or $2,000 for employees who also cover dependents. In addition, the
Village provides a rebate to benefit eligible employees who waive all coverages, only cover themselves, or elect Dental Insurance
only. A premium schedule for all coverages can be obtained from the Human Resources Department.
~'r : Default Benefits
,.~.
New employees who do not make timely elections for health, dental, vision and group term life benefits within 31 days of
their date of hire will be assigned the following Default Benefits:
• United Healthcare HMO employee-only health coverage • Humana / CompBenefits employee-only vision coverage
• DeltaCare DMO employee-only dental coverage • Standard Insurance basic group term life insurance benefits
If assigned, Default Benefits will be effective first of the month following 90 days of employment. Changes to Default
Benefits will not be permitted until the next applicable Open Enrollment period unless the employee can demonstrate a
qualified family status change (qualifying event) as explained on the previous page.
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~~44 Qualifying Events
Under certain circumstances, you may be allowed to make changes to your benefits elections during the plan year, such as
additions, deletions and cancellations, depending on whether or not you experience an eligible qualifying event as
determined by the Internal Revenue Service (IRS) Code, Section 125. You may change a benefit election upon the
occurrence of a valid qualifying event only if the event affects your own, your spouse's or your dependent's coverage
eligibility.
If you experience a qualifying event, you must report the qualifying event to the Human Resources Department within 31
days of the event. Beyond 31 days, additions will be denied and the employee may be responsible both legally and
financially for any claims and/or expenses incurred as a result of any dependent who continues to be enrolled but no
longer meet the City's eligibility requirements.
If approved, most election changes will be effective on the date of the qualifying event for additions; cancellations will be
processed at the end of the month in which the event occurred.
Examples of Qualifying Events Include:
• The birth /adoption /legal custody of a child • A spouse or dependent child dies
• A marriage
• A divorce
• A covered dependent is no longer eligible for coverage
• A dependent returns to full-time student status
• An increase in your work hours from part-time to full-time
• A decrease in your work hours
• A spouse obtains employment
• A child gains or loses coverage with an ex-spouse
All benefits covered in this booklet are subject to d~ange. This is an Employee Benefit Nigliliglrt Summon! and not a contract. All benefits are subject to the provisions and exclusions of the master contract. 3
Health Insurance: HMO & PPO Plan Options
CIGNA Healthcare
Customer Service: (800) 244-6224
www.cigna.com
Health Maintenance Organization (HMO)
The Town of Jupiter offers an HMO health insurance plan option through CIGNA Healthcare. The HMO is a
"Gatekeeper" plan that requires you to first select and coordinate your care through a Primary Care Physician (PCP) and
pay an established copayment amount. Your PCP selection is at your discretion and can be changed at any time
throughout the plan year. All medical services you receive must be from a provider or facility that participates in the
CIGNA HMO network. The HMO does not provide coverage for services received out-of-network. The network of
participating providers that the HMO plan utilizes is called "Network HMO". To obtain a listing of providers that
participate in the Network HMO, contact CIGNA customer service or visit CIGNA online at www.cigna.com.
2009 Plan Year HMO Plan Premiums -Per Pay Deduction
Coverage Tier Employee Cost :Town of Jupiter Total Premium
Employee Only $0.00 $224.57 $224.57
Employee + 1 Dependent I $76.53 $373.63 $450.16
Employee + Family $114.88 $560.89 $675.77
Preferred Provider Organization (PPO)
The Town of Jupiter also offers a PPO health insurance plan option through CIGNA Healthcare. The PPO plan offers the
convenience of referral-free access to doctors and the option to select a personal Primary Care Physician as your source for
routine care and guidance. As your needs change, so may your choice of doctors and that is why you can change your
PCP for any reason. The network of participating providers for the PPO plan is the "PPO network". To obtain a listing of
providers that participate in the PPO network, contact CIGNA customer service or visit CIGNA's website at
www.cigna.com.
The PPO Plan also provides benefits for services received from out-of-network providers (providers that do not participate
in the PPO network). Once you satisfy your out-of-network deductible, you are then responsible for a percentage of the
charges (coinsurance) based on CIGNA's discounted fee (the allowable amount). In addition to your coinsurance, out-of-
network providers may also "balance bill" which is the difference above CIGNA's allowable amount and the out-of-
network provider's own fee for any particular service. Therefore, you have the potential to maximize your benefits when
services are received by in-network providers.
2009 Plan Year PPO Plan Premiums -Per Pay Deduction
Coverage Tier Employee Cost :Town of Jupiter Total Premium
Employee Only $37.59 $304.10 $341.69
Employee + 1 Dependent $150.47 $533.48 $683.95
Emplovee + Family $225.77 $800.44 $1,026.21
4 All benefits covered in this hooAlet are subject to change. This is an Employee Benefit Highlight Summon/ and not a contract. All benefits are subject to the provisions and exclusions of the master contract.
Health Insurance: HMO & PPO Plan Options
Summary of Benefits HMO Plan PPO Plan
Calendar Year Deductible (CYD) In-Network Only In-Network Out-of-Network
Individual No Deductible No Deductible $500
Family No Deductible No Deductible $1,500
Calendar Year Out-of-Pocket Max. In-Network Only In-Network Out-of-Network
Individual $500 $1,500 $2,500 +CYD
Family $1,000 $3,000 $5,000 +CYD
Physician Services In-Network Only In-Network Out-of-Network
Primary Care Office Visit $10 Per Visit $15 Per Visit 40% After CYD
Specialist Office Visit $20 Per Visit $25 Per Visit 40% After CYD
Allergy Treatment /Injections I No Charge After Copay I No Charge After Copay 40% After CYD
Chiropractic Visits (CYM) See Outpatient Rehab. See Outpatient Rehab. See Outpatient Rehab.
Laboratory & Radiology Services In-Network Only In-Network Out-of-Network
MRI, CAT Scan, PET Scan, etc. No Charge 20% 40% After CYD
Other Outpatient Facility I $75 per Visit I 20% 40% After CYD
Lab and/or X-ray No Charge 20% ', 40% After CYD
Laboratory Provider Quest &LabCorp Quest &LabCorp Not Available
Hospital Services In-Network Only In-Network Out-of-Network
Inpatient $250 per Admission $250 per Admission + 20% 40% After CYD
Outpatient I $75 per Visit I 20% 40% After CYD
Physician Services at Facility No Charge 20% 40% After CYD
Emergency Room $100 per Visit $100 Per Visit $100 Per Visit
Urgent Care Center $50 per Visit $50 Per Visit $50 Per Visit
Ambulance No Charge 20% 20%
Prescription Drugs In-Network Only In-Network Out-of-Network
Generic $10 Copay $15 Copay Not Covered When Filled
Preferred Brand Name $20 Copay $35 Copay at a Out-of-Network
Non-Preferred Brand Name $40 Copay $50 Copay Pharmacy
Mail Order (90 Day Supply) 2Xs Retail Copay 2Xs Retail Copay Not Available
Outpatient Rehabilitation* In-Network Only In-Network Out-of-Network
Facility Charge $20 Per Visit $25 Per Visit 40% After CYD
Annual Maximum Visits 60 Days Combined Unlimited Unlimited
Durable Medical Equipment In-Network Only In-Network Out-of-Network
Charge /Annual Benefit Max. No Charge /Unlimited 20°~0 /Unlimited 40% After CYD
Lifetime Benefit Maximum In-Network Only In-Network Out-of-Network
Per Covered Member Unlimited $1 Million $1 Million
* Rehabilitation Services Include: Physical, Speech, Occupational, f~ Chiropractic
This summary has been provided as a convenient reference. For details regarding all the plan's coverage, exclusions,
and stipulations, contact Customer Service or visit CIGNA online at www.cigna.com.
All benefits covered in this booAlet are subject to change. This is an Emploilee Benefit Highlight Si~mman/ and not a contract. AU benefits are subject to the provisions and exdustons of thz master contract.
Health Insurance: HSA &HRA Plan Options
CIGNA Healthcare
Customer Service: (800) 244-6224
www.cigna.com
Choice Fund Health Savings (HSA) Plan
CIGNA's Choice Fund HSA Plan is an open access plan that requires you to
first satisfy a deductible whether services are received in-or out-of-network.
Once you satisfy your in-network deductible, the plan then pays 100% of all
eligible charges thereafter with the exception of prescription drugs. The
deductible is waived and there is no charge for Preventative Services when
received in-network. When utilizing out-of-network providers, your
coinsurance responsibility is 30% of the allowable amount and you can also
be subject to balance billing.
2009 HSA Funding Amounts
Employee Only I $500.00
Employee + Dependent(s) $1,000.00
The CIGNA Choice Fund HSA is a High Deductible Health Plan (HCHP) that complies with the Internal Revenue Service
(IRS) requirements and qualifies enrollees to open a Health Savings Account (HSA). An HSA is an interest-bearing account
where funds can be used to help pay your deductible, coinsurance and any medical expenses not covered by the plan. For
the 2009 plan year, the Town will fund each HSA with an initial funding of $500 for individual employees and $1,000 for
employees with dependent health insurance coverage in a JP Morgan Chase bank account. Employees may opt to
additionally fund their HSA with tax-free dollars up to $2,500 (individual coverage) or $4,950 (dependent coverage)
through evenly disbursed payroll deductions or a one lump sum payroll deduction; this decision must be made during
open enrollment only. Guidelines regarding the HSAs are established by the IRS so be sure to thoroughly review your
enrollment materials before deciding if an HSA is right for you.
2009 Plan Year HSA Plan Premiums -Per Pay Deduction
Coverage Tier Employee Cost :Town of Jupiter Total Premium
Employee Only $0.00 $196.14 $196.14
Employee + 1 Dependent I $60.29 $332.83 $393.12
Employee + Family $90.51 $480.35 $570.86
Open Access Plus Health Reimbursement Account Plan (OAP HRA)
The Town is offering its employees the OAP HRA Plan as a new plan option
for the 2009 Plan Year. This plan provides benefits for services when 2009 HRA Funding Amounts
received in-network only. Services received by providers and facilities that
participate in the Open Access Plus (OAP) network will only be subject to Employee Only I $300.00
the copays as listed in the Summary of Benefits table on the following page.
Employees who enroll in the OAP HRA plan will be provided with a Health Employee + Dependent(s) $600.00
Reimbursement Account (HRA) funded completely by the Town. Funds in
the HRA may be used to offset deductibles and copayments associated with the OAP HRA medical plan. Funding is based
on your tier of coverage: $300 for individual employees and $600 for employees with dependent health insurance
coverage. The HRA is administered by Benefits Workshop and details regarding the HRA are provided on pages 7 and 8.
2009 Plan Year HRA Plan Premiums -Per Pay Deduction
6
Coverage Tier Employee Cost ; Town of Jupiter Total Premium
Employee Only $0.00 $223.10 $223.10
Employee + 1 Dependent I $72.02 $371.92 $443.94
Employee + Family $108.74 $555.83 $664.57
All benzfits rovered in U~is booklet are subject to diange. This is an Emplmlee Benefit Highlight Sunnnan~ and not n rontract. All benefits nre subject fo the provisions and esdusions of the mnsfer contract.
Health Insurance: HSA &HRA Plan Options
Summary of Benefits HSA Plan HRA Plan
HSA /HRA HSA Town Funding Amount HRA Town Funding Amount
Individual $500 $300
Family $1,000 $600
Calendar Year Deductible (CYD) In-Network Accrued Collectively Out-of-Network In-Network
Individual $1,500 $3,000 No Deductible
Family $3,000 $6,000 No Deductible
Calendar Year Out-of-Pocket Max. In-Network Accrued Collectively Out-of-Network In-Network
Individual $1,500 $3,000 $2,000
Family $3,000 $6,000 $4,000
Physician Services In-Network Out-of-Network In-Network
Primary Care Office Visit 0% After CYD 30% After CYD $30 Per Visit
Specialist Office Visit I 0% After CYD 30% After CYD I $50 Per Visit
Allergy Treatment /Injections I 0% After CYD 30% After CYD No Charge After Copay
Chiropractic Visits (CYM) See Outpatient Rehab. See Outpatient Rehab. See Outpatient Rehab.
Laboratory & Radiology Services In-Network Out-of-Network In-Network
MRI, CAT Scan, PET Scan, etc. 0% After CYD 30% After CYD $150 Per Service
Other Outpatient Facility 0% After CYD 30% After CYD I $150 Per Service
Lab and/or X-ray 0% After CYD 30% After CYD I No Charge
Laboratory Provider Quest &LabCorp Not Available Quest &LabCorp
Hospital Services In-Network Out-of-Network In-Network
Inpatient 0% After CYD 30% After CYD $250 Per Day
Outpatient 0% After CYD 30% After CYD I $150 Per Service
Physician Services at Facility 0% After CYD 30% After CYD I No Charge
Emergency Room 0% After CYD 30% After CYD I $150 Per Visit
Urgent Care Center I 0% After CYD 30% After CYD $75 Per Visit
Ambulance 0% After CYD 30% After CYD No Charge
Prescription Drugs In-Network Out-of-Network In-Network
Generic 0% After CYD Not Covered $20 Copay
Preferred Brand Name 0% After CYD When Filled at a $40 Copay
Out-of-Network
Non-Preferred Brand Name I 0% After CYD Pharmacy $60 Copay
Mail Order (90 Day Supply) 0% After CYD Not Available 2Xs Retail Copay
Outpatient Rehabilitation* In-Network Out-of-Network In-Network
Facility Charge 0% After CYD 30% After CYD $50 Per Visit
Annual Maximum Visits 20 Days Combined 20 Days Combined
Durable Medical Equipment In-Network Out-of-Network In-Network
C1large /Annual Benefit Max. 0% After CYD / $700 No Charge / $2,000
Lifetime Benefit Maximum In-Network Out-of-Network In-Network
Per Covered Member $5 Million $1 Million $5 Million
* Rehabilitation Services Include: Physical, Speech, Occupational, & Chiropractic
This summary has been provided as a convenient reference. For details regarding all the plan's coverage, exclusions,
and stipulations, contact Customer Service or visit CIGNA online at www.cigna.com.
All benefits covered in this booklet are subject to change. This is an Emplmlee Benefit Highlight Summanl and not a contract. All benefits are subject to the provisions and exclusions of the master contract
Health Insurance: Plan At-A-Glance
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Att benefits covered rn this booklet are subject to change. This is an Emyloyee Benefit Higlilight Summm~l and not a contract. All benefits are subject to the provisions and exclusions of the master eontraet.
Health Insurance -BCBS Programs
Coverage when Traveling
When traveling within the United States, you are covered whether you need care in urban or rural areas. Outside of the
United States, you have access to doctors and hospitals in more than 200 territories around the world through the
B1ueCard Program. Visit www.bcbsfl.com to access the B1ueCard Doctor and Hospital Finder or call B1ueCard Access at
1-800-810-BLUE (2583) for the names and addresses of doctors and hospitals in the area where you or a covered
dependent need care.
Blue Service
Blue Service provides 24 hour online access to review your benefits and coverage, view claims status, search for providers
in your network, download forms, search FAQ's, and learn about BCBS's discount programs, etc. Log onto
www.bcbsfl.com for more information.
Blue Complements
Blue Complements is a FREE discount program on products and services available to all members such as:
• 25% or more discounts on acupuncture or massage therapy with BCBS contracted providers
• 15%-45% on vitamins, smoking cessation, health related books, tapes and videos
• 20%-60% off retail rates at more than 1,500 participating Global Fit network fitness clubs
• 40%-50% off retail for bicycle helmets for members and families through Safe-Tech
• 20%-50% off various Jenny Craig Weight Loss programs
Examples of Blue Complements programs include:
/ EyeMed: Discounts on Vision Care: Receive comprehensive vision care with significant savings on eye exams and
eyewear. Members pay $40 for eye exams and receive up to 40% off retail prices for frames and lenses. This program is
offered through EyeMed. Visit participating optical departments at Sears, JC Penney Optical, Pearle Vision Centers and
other independent vision care centers throughout Florida. To locate participating providers, please call EyeMed's
toll-free number at (800) 793-8622 or visit EyeMed online at www.enrollwitheyemed.com/select.
/ HEARx: Discounts on Hearing Products: BCBS members receive free hearing examinations and a savings of 25% off
the retail price of any hearing aid purchased at HEARx centers, or special promotional prices that provide even greater
savings. Since this is a discount program through HEARx, it is not a benefit of your health care plan. Call HEARx
toll-free at (800) 731-3277.
/ TruVision: Lasik Vision Correction Services: Discount services include 15% off retail prices or 5% off the promotional
price. For more information, call TruVision toll-free at (877) 747-2020 for a location near you and for the discount
authorization.
/ TruVision: Contact Lens Mail Order Service: Prices on average are 15% lower than other national contact lens
mail-order programs. For more information or to place an order, call toll-free (877) 793-8622.
/ TruHearing: Discounts on Hearing Care and Products
TruHearing offers discounted hearing aids to BCBSF plan members. The free hearing exams are performed by a
trained hearing consultant using the latest diagnostic equipment. For more information, call toll-free (866) 814-4327.
Health Dialog
Health Dialog is a FREE program that provides information and support through:
• Health Coaches -speak privately with experienced, licensed health care professionals, including Registered Nurses,
dieticians and respiratory therapists, 24 hours a day, 7 days a week.
• Web-based information tools, operated and maintained by Health Dialog' -with over 27,000 pages of up-to-date, easy
to understand, in-depth information on more than 1,900 clinical topics including medical tests and medications.
• Free audio, video and printed information on specific health conditions to help you weigh the risks and advantages of
treatment options.
All hene(its covered in this booklet are subject to change. This is an Emplrn~ee Benefit Highlight Summanl and not a contract. All benefits are subject to the provlsrons and ezrlusions of the master mntrart. 9
Dental Insurance
Cigna Dental
Customer Service: (800) 244-6224
Website: www.cigna.com
The Authority offers two dental coverage options through Cigna. The Authority pays 100% of the employee's premium.
Premiums for dependent dental coverage are included in your health insurance premium.
Dental Health Maintenance Organization (DHMO)
Cigna's managed dental plan, the DHMO, requires you to select a primary dental provider within the Cigna network to
coordinate your care. The costs for dental services you receive, including orthodontia, are set by a predetermined fee
schedule. There are no deductibles to satisfy with the DHMO and your benefits will not max out during the plan year. A
variety of dental services and their procedure codes have been provided below along side of the DHMO's corresponding
Copay for each service. The DHMO schedule of benefits is also available through Employee Relations.
Sample Procedures Procedure
Code DHMO
Copay
Sample Procedures Procedure
Code DHMO
Copay
Office Visit D9430 $0 Repairs (cont.)
Periodic Evaluation D0120 $0 I Repair Broken Denture I D5510 $55
Comprehensive Evaluation I D0150 $0 I Peridontic Therapy
Cleaning I D1110 $0 I Periodontal Evaluation D0180 $40
Full Mouth X-rays D0210 $0 I Root Planning (1/4) I D4341 $90
Sealant per Tooth I D1351 $15 Gingivectomy (1/4) D4210 $185
Oral Surgery I I Crown & Bridge
Single Tooth D7111 $10 I Inlay, Metallic - 1 Surface I D2510 $350
Partial Impaction I D7230 $105 Onlay, Metallic - 2 Surface I D2542 $410
Boney Impaction I D7240 $155 Porcelain Fused to Metal D2750 $400
Fillings I Full High Noble Metal I D2790 $400
Amalgam - 1 surface I D2140 $5 Porcelain/Ceramic I D6740 $435
Resin -1 surface I D2330 $5 Dentures
Sedative D2940 $10 I Full Upper Denture I D5110 $460
Root Canal Therapy I I Full Lower Denture I D5120 $460
Anterior I D3310 $230 Partial Upper Denture D5213 $535
Bicuspid D3320 $270 I Partial Lower Denture D5214 $535
Molar D3330 $370 I Denture Reline (Chair Side) I D5730 $95
Removal of Impacted Tooth I Orthodontic Treatment
Soft Tissue D7220 $55 Pre-Ortho Treatment Visit D8660 $55
Anesthesia/IV Sedation I Comprehensive Banding I D8070 $425
Anesthesia 1st 30 Min. D9220 $145 Children (Up to age 19):
IV Sedation 1st 30 Min. I D9241 $145 24 Month Treatment Fee I D8670 $1,900
Repairs Charge per Month (24) $79.17
Recement Inlay D2910 $10 I Adults:
Recement Crown D2920 $10 I 24 Month Treatment Fee D8670 $2,500
Recement Partial Denture D6930 $10 Charge per Month (24) $104.17
10 All benefits covered in this booklet are subject to change. This is an Employee Benefit Highlight Summan/ and not a contract. All benefits are subject to the provisions and exclusions of the master con-
Dental Insurance
Preferred Provider Organization (PPO)
Cigna's PPO dental plan allows you to receive dental services within an established network and also provides out-of-
network benefits. Preventive and diagnostic care are not subject to a deductible. For other services, once you have
satisfied your deductible, the PPO dental plan pays a percentage of the charge. Out-of-network dental services are
processed as an indemnity plan with no orthodontia benefit. A partial summary of benefits under the PPO plan are
provided below. The PPO schedule of benefits is also available through Employee Relations.
/ It is important to note that services received out-of-network are subject to "balance billing." Balancing billing is the difference
above the reasonable and customary charge for any service received and the out-of-network provider's retail charge. You are
responsible for any balance billing that occurs when an out-of-network provider is utilized.
Summary of Benefits PPO Dental Plan
Calendar Year Benefit Maximum In-Network Out-of-Network
Per Covered Member $1,500
Calendar Year Deductible (CYD) In-Network Out-of-Network
Per Covered Member $25
Per Family I $75
Waived for Preventative Services? Yes
Preventative Services In-Network Out-of-Network
Oral Exams
Cleanings
Fluoride
100%, No Deductible 100%, No Deductible
Sealants
X-rays (Bitewing /Full Mouth /Panoramic)
Space Maintainers
Basic Services In-Network Out-of-Network
Fillings
Oral Surgery
Periodontics
Root Canal Therapy
Surgical Extraction of Impacted Teeth 100% After CYD 80% After CYD
Anesthetics
Relines, Rebases, and Adjustments
Repairs: Bridges, Crowns, Inlays
Repairs: Dentures
Major Services In-Network Out-of-Network
Crowns
Dentures 60% After CYD 50% After CYD
Bridges
Orthodontia (Children & Adults) In-Network Out-of-Network
Coinsurance 50% After CYD Not Covered
Lifetime Orthodontia Benefit Maximum $1,500 Out-of-Network
41l benefits roz~ered in this ~ookletnre ~uhir~I ~ n^ Emplnuee BenrfiF Highlight Summon/and not a rnnhacP. All benefits are subject to Nye Provisions and exclusions o(Nae master contract. 11
Vision Discount Plan
CIGNA Healthy Rewards
Customer Service: (800) 870-3470
www.mycigna.com
District employees and their family members who are enrolled in any CIGNA health or dental insurance plan are
automatically eligible to participate in CIGNA's Healthy Rewards vision discount plan. CIGNA's vision discount plan is
administered by EyeMed Vision Care and offers discounts on exams, frames, lenses, contacts, and accessories at thousands
of eye care locations nationwide including LensCrafters, Sears, JC Penney, Pearle and Target.
Healthy Rewards vision discounts apply only when services are received by participating EyeMed Select network
providers. To locate an EyeMed Select participating provider, contact Customer Service or visit CIGNA online at
www.mycigna.com. You have no claims to file, your discount applies the minute you pay for services. Simply use your
CIGNA ID card to identify yourself and pay the discounted amount directly to the EyeMed provider at the time you receive
your services.
Healthy Rewards Discount Vision Plan Benefits
Vision Services EyeMed Select Network
$10 Off Contact Lens Exam
Exam with Dilation as Necessary $5 Off Routine Eye Exam
Complete Pair Glasses Purchase**: Frame, Lenses, & Lens Op tions Purchased in Same Transaction
Standard Plastic Lenses*:
Single Vision $50
Bifocal $70
Trifocal $105
Frames"'*:
Any Frame Available at Provider Location 35% Off Retail Price
Lens Options:
UV Coating $15
Tint (Solid and Gradient) $15
Standard Scratch-Resistant $15
Standard Polycarbonate $40
Standard Progressive (Add-on to Bifocal) $65
Standard Anti-Reflective Coating $45
Other Add-ons & Services 20% Discount
Contact Lenses (Materials Only):
Conventional (Non-disposable) 15% Off Retail Price
Disposable 0% Off Retail Price
Laser Vision Correction:
LASIK or PRK 15% Off Retail Price or 5% Off Promotional Price
Frequency:
Exam, Frame, Lenses, & Contact Lenses Unlimited
_~ _ :~,~ ,.«w„
* Items purchased separately will be discounted 20% off the retail price, however, the discoum may nuc ue w„~~„~ru ~~_~_. ~=.y ~~~~-
discounts or promotional offers, and the discount does not apply to EyeMed provider's professional services, or disposable contact lenses.
** The 35% discount is only available when a complete pair of glasses is purchased. Select frames may not be available for discount.
This benefits summary has been provided as a convenient reference. For details regarding all the plan's
coverages, exclusions, and stipulations, contact Customer Service or visit CIGNA online at www.mycigna.com.
12, All henefi'ts covered in this booklet are subject to change. This is an Employee Benefit Highlight Summand and not a contract. All benefits are subject to the pravisions and exclusions of the master con-
Vision Indemnity Plan
CIGNA
Customer Service: (800) 244-6224
www.mycigna.com
District employees and their family members who are enrolled in any CIGNA health insurance plan are automatically
eligible to participate in CIGNA's vision indemnity plan. The vision indemnity plan is a type of insurance plan that
reimburses you up to certain dollar limits (allowances) based on the type of vision services your receive. Note: an allowance
is not the same as a copay. You may receive services from any
licensed eye care provider you wish. Once you pay for the
services you receive, simply submit your receipt along with a
claim form to CIGNA. CIGNA will then send you a
reimbursement check up to the allowed amount based on the
schedule provided in the table below to the right.
Benefits include:
• Eye exam by a Optometrist or Ophthalmologist.
• Lenses to correct vision.
• Eyeglass frames.
• Expenses incurred for charges made for the purchase of
eyeglasses and contact lenses up to the allowed amount.
Benefits are payable every 12 months for exams, lenses /contact
lenses and every 24 months for frames.
Filing a Claim
Claim forms may be obtained by contacting Customer
Service, at www.mycigna.com, or by logging on to https://
hcdpbc.myebconline.com. To file a claim, you must submit
your completed claim form and include a copy of the receipt
as proof of the expense. Receipts must include:
/ Your Name / Provider Name / Date of Service
/ Patient Name / Provider Address / Diagnosis
/ Type of Service / Provider Tax ID Number / Charge for Service
Indemnity Vision Plan
Vision Services Reimbursement Schedule
Exams: $30 Allowance
Lenses:
Single Vision $25 Retail Allowance
Bifocal $50 Retail Allowance
Trifocal $70 Retail Allowance
Lenticular $90 Retail Allowance
Progressive Not Covered
Contact Lenses:
Therapeutic $120 Retail Allowance
Elective $50 Retail Allowance
Frames: $25 Retail Allowance
Once you have gathered the required documentation,
file your claim by mail to:
CIGNA Healthcare
P.O. Box 182223
Chattanooga, TN 37422-7223
Understanding Your Vision Plans: Q&As
Do I need to enroll in these plans?
• No. You are automatically eligible to participate if:
/ Vision Discount Plan: you are already enrolled in any CIGNA health or dental insurance plan.
/ Vision Indemnity Plan: you are already enrolled in any CIGNA health insurance plan.
Do I have to pay additional premiums to be eligible to participate in these plans?
• No. The vision discount plan is part of CIGNA's Healthy Rewards program and the vision indemnity plan is an
extension of your CIGNA health insurance plan.
Can I use both plans to receive benefits for the same vision service?
• Yes. Example: suppose you receive a routine vision exam at a cost of $60. If you utilize an EyeMed Select network
provider, you receive a $5 discount through CIGNA's Healthy Rewards program. You may also submit a claim to the
vision indemnity plan for a reimbursement of $30. By maximizing the benefits of both plans, you save $35!
This benefits summary has been provided as a convenient reference. For details regarding all the plan's
coverages, exclusions, and stipulations, contact Customer Service or visit CIGNA online at www.mycigna.com.
All benefits covered in this booklet are subjert to change. This is an Employee Benefit Highlight Summand and not a contract. All benefits are subject to the provisions and exclusions of the master contrart. 13
L4„f
of 4
"~<<o.,o.=Flexible Spending Accounts
Benefits Workshop
Customer Service: (888) 537-3539
www. benefitsworkshop.com
The City offers Flexible Spending Accounts (FBAs) as administered by Benefits Workshop. Most of the money you spend
on routine medical expenses comes from your after-tax income. This means you earn money, then pay taxes, and spend
what is left. If you have predictable medical expenses for yourself or your family, such as deductibles and copays or any
work-related day care expenses, FBAs may be right for you.
FSAs allow you to set aside money for reimbursement of medical and day care expenses you regularly pay. The amount
you set aside is not taxed and is automatically deducted from your paycheck and deposited into the FBA. During the year,
you have access to this account for reimbursement of some expenses that are not covered by insurance. An FSA not only
results in a substantial tax savings, it also increases your spending power. There are two types of FBAs:
Health Care
Reimbursement Account
The money you elect to contribute into a Health Care FSA
during annual open enrollment will not be taxable income
to you and can be used to offset the cost of a wide variety of
health-related expenses incurred by you or your qualified
dependents under medical or dental insurance plans.
Examples of these expenses include copays for physician
office visits, inpatient hospital stays, prescription drugs,
over the counter drugs and other expenses not covered by
insurance that generate an out-of-pocket cost to the
employee.
Employees can also receive reimbursement for expenses
related to dental and vision care (that are not classified as
cosmetic). Other common expenses that qualify for
reimbursement are: doctor visits, deductibles, copays,
prescription drugs, mental healthcare, dental services and
orthodontics, Lasik surgery, eye exams, glasses and
contacts.
*NOTE: The entire Health Care FSA election is available
to you on the first day coverage is effective.
Dependent Care
Reimbursement Account
The money you elect to contribute into a Dependent Care
FSA reimburses you for day care expenses up to an annual
maximum of $5,000 ($2,500 if you file a separate tax return)
for eligible children and adults. Qualified expenses include
adult and child day care centers, preschool, and before/after
school care.
Please note that if your family's annual income is over
$20,000, this reimbursement option will most likely save you
more money than the dependent care tax credit you take on
your tax return. To qualify, your dependent must be:
a child under the age of 13 or,
a child, spouse or other dependent that is physically or
mentally incapable of self-care and spends at least 8
hours a day in your household.
*NOTE: Unlike the Health Care FSA, you will only be
reimbursed up to the amount that has been deducted from
your paycheck for Dependent Care expenses.
You may elect to participate in either one FSA or both simultaneously. To calculate your per pay contribution, simply take
your total plan year FSA election(s) amount and divide that by the number of benefit payroll deductions (24) as illustrated on
the following page. However, be conservative when estimating your medical and/or dependent care expenses. IRS
regulations state that any unused funds which remain in your FSA after a plan year ends and all claims have been filed
can not be returned to you nor carried forward to the next plan year. This is known as the "use it or lose it" rule.
A sample list of qualified expenses eligible for reimbursement include, but are not limited to, the following:
• Acupuncture • Diagnostic tests health screenings • Guide dogs • Orthodontic fees
• Ambulance service • Doctor fees • Hearing aids and exams •Over-the-counter items
• Birth control pills • Drug addiction/alcoholism treatment .Injections and vaccinations .Surgery
• Chiropractic care • Prescription drugs • In vitro fertilization • Wheelchairs
• Contact lenses (corrective) • Experimental medical treatment • Nursing services • X-rays
• Dental fees • Eyeglasses • Optometrist fees
14 All benefits covered in this booklet are subject to change. This is an Emplmtee Benefit Highlight Summant and not a contract. All benefits are subject to tlaeprovisions and exclusions o(the master ean-
4'tf
~` ~oRlo. =Flexible Spending Accounts
When considering your Health Care FSA election amount,
you need to first understand what your insurance plans
will pay. The FSA will not reimburse you for expenses
paid by insurance.
The worksheet on the right may help you estimate your
annual contributions to cover certain medical expenses for
yourself and any dependents. You may want to talk to
your doctor, dentist, or other providers as well as your
qualified dependents to help you estimate your expenses.
The entire Health Care FSA election amount balance is
available on the 1st day of the plan year; however, if the
entire balance is used, your Health Care FSA contribution
per pay period will still remain the same.
Health Care FSA Worksheet
Deductible
Copays
Coinsurance
Contact Lenses
Dental Care
Eyeglasses/Contacts
Prescription drugs
Surgery
Other
This is the amount to consider
contributing to the Health Care FSA
Dependent Care FSA expenses are somewhat more
predictable. You just figure out what you spend on a
per paycheck basis for preschool, after-school or care
for older dependents that is necessary for you to work.
If you are married, the same applies for both you and
your spouse to work.
The day care can be provided in a licensed day care
center or by an individual in your home or the day care
provider's home. Day camps are also eligible if the
services are used in lieu of regular day care.
The other major difference between a Health Care FSA
and a Dependent Care FSA is that you may obtain
reimbursement for dependent care expenses only up to
the amount you have contributed. If you have
contributed $100 and you request $150 in
reimbursements for eligible expenses, you will only
receive $100 until future contributions are received (in
the same plan year).
Divide by the Number of Pay Periods Divide by 24
Health Care FSA Contribution
Per Pay Period
Dependent Care FSA Worksheet
Child Day Care Expenses
Preschool Expenses
Summer Day Camp Expenses
Adult Day Care Expenses
Other
This is the amount to consider
contributing to the Dependent Care FSA
Divide by the Number of Pay Periods Divide by 24
Dependent Care FSA Contribution
Per Pay Period
4t
O~ F~L
- =Section 125 Plan
~ORIOr
Payroll deducted premiums for health, dental, and vision coverages and contributions made into your flexible spending
accounts are deducted from your gross income before your income is taxed. The City's plan is known as a Cafeteria Benefit
Plan and is governed by IRS Code, Section 125. This pre-tax benefit means you pay less tax on a per-pay and annual basis.
Allowable enrollment changes as determined by Section 125 of the IRS Code are previously explained under the Qualifying
Events section on page 2.
~~ All benefrts cowered in this booklet m~e a.I~i:~:f rr :ir~~~~,~;r i his i. ail Employee Bene~tt Nrghlight Summand and not a conhact. All benefits are subject to the provisions and exclusions of the master contract. 15
~ V 1 A,~,y
~~~~ Basic and AD&D Life Insurance
`Zuan`'
The Hartford
Customer Service: (888) 563-1124
www.thehartfordatwork.com
Basic Term Life
The City provides basic term life insurance through The Hartford. Your benefit amount is determined by your eligibility
classification as described below. Your enrollment is automatic but you are required to designate a beneficiary. Beneficiary
designations can be made online at https://wpb.mybentek.com. A beneficiary confirmation statement can also be printed and
retained for your records.
Eligibility Classifications
Class 1 ?Active Full-time Employees of Management Class 1.
Class 2 :Active Full-time Employees of Management Class 2 other than members of Professional Managers Supervisors Association (PMSA).
Class 3 :Active Full-time Employees of Management Class 2 who are members of the PMSA.
Class 4 Active Full-time Employees or Elected Officials other than Members of the PMSA, Firefighters and Police Department employees.
Class 5 Active Full-time Employees who are members of the PMSA who are not in Management Classes 1 or 2, other than Firefighters and
Police Department employees.
Class 6 'Active Full-time Employees of the Police Department who are not in Management Classes 1 or 2.
Class 7 :Active Full-time Employees of the Fire Department who are not in Management Classes 1 or 2.
Class 8 :Retired employees who retired prior to October 1, 1998 other than employees of the Police and Fire Department.
Class 9 :Retired Employees who retired on or after October 1, 1998 other than employees of the Police and Fire Department.
Class 10 ;Retired Employees of the Police Department.
Class 11 Retired Employees of the Fire Department.
Benefit Classifications
Class 1 1 times annual earnings plus $100,000, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 2 ' 1 times annual earnings plus $50,000, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 3 1 times annual earnings plus $75,000, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 4 1 times annual earnings, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 5 ' 1 times annual earnings plus $25,000, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 6 1 times annual earnings, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 7 '.: 1 times annual earnings, rounded to the next higher multiple of $1,000, to a maximum of $250,000.
Class 8 Flat $7,500.
Class 9 :Flat $10,000.
Class 10 Flat $25,000.
Class 11 ;Flat $25,000.
Accidental Death & Dismemberment
For Eligibilih~f Classes 1 - 7, the City also provides accidental death F~ dismemberment (ADf~D) life insurance which pays in addition to the
basic benefit when death occurs as a result of an accident. The AD£~D benefit prays ifa addition to and in an amount equal to the basic benefit
amount. For example, if you are a Class 4 employee earning $35,000 annually and death occurs ns an accident, the death benefit would be
$35,000 (basic) + $35,000 (ADfaD) for a total benefit of $70,000. A partial AD£~D benefit is also payable based on the schedule below.
The Entire Benefit will be Paid for the loss of: One half the Benefit will be Paid for the loss of.•
• Life (accidental); or • One hand; or
• Both hands or Both feet; or • One foot; or
• Sight of both eyes; or • Sight of one eye; or
• Any 2 or more: 1 fool, 1 hand, or the sight of 1 eye. • Thumb and index finger of the same hand.
For Classes 1- 7, the Basic Life / AD&D benefit amount reduces starting at age 70. For details regarding all the plan's coverages,
exclusions, and stipulations, contact Customer Service or visit The Hartford online at www.thehartfordatwork.com.
16 All benef~'ts covered in this booklet are subject fo chawge. This is an Employee Benefit Highlight Sunnnan~ and not a ronfract. All benefits are subject to the provisions and esdusions of the master con-
~~.I P.fI,4
~~~ Supplemental Employee & Dependent Lif e Insurance
The Hartford
Customer Service: (888) 563-1124
www.thehartfordatwork. com
Supplemental Employee Life
The City offers basic term life insurance through The Hartford. Enrollment is voluntary and 100% employee paid. A summary of
the plan's benefit provisions is provided below followed by a premium calculation. Beneficiary designations can be made online at
https://wpb.mybentek.com. A beneficiary confirmation statement can also be printed and retained for your records.
Supplemental Employee Life Plan Summary
Eligibility :All Active Full-time Employees.
Benefit Options 1,2 or 3 times your basic annual earnings to a maximum of $300,000.
Cost to You :This benefit is 100% employee paid.
$250,000 for all first-time eligible employees. Employees who do not enroll when first eligible and later want
Guaranteed Issue to add this coverage, or employees who want to increase their current election must submit medical evidence
to Hartford Life. Coverage will not be effective unless, and until, Hartford approves your application.
Portability You can take this coverage with you if you terminate employment prior to Normal Retirement Age. Rates will
be similar but not identical.
Age Reduction :Your benefit reduces starting at age 70.
Supplemental Employee Life Monthly Premium Calculation
$1,000 x 10 x $0.35 = $
Monthly Rate
Elected Benefit Amount _~_ Q, nnn _c ci ._._~ a__ .r.~ Your Monthly Cost
Supplemental Dependent Life
The City offers basic term life insurance through The Hartford. Enrollment is voluntary and 100% employee paid. A summary of
the plan's benefit provisions is provided below followed by a premium calculation. Beneficiary designations can be made online at
https://wpb.mybentek.com. A beneficiary confirmation statement can also be printed and retained for your records.
Supplemental Dependent Life Plan Summary
Benefit Options Spouse: Flat $10,000.
Child(ren): Flat $5,000.
Dependent elections cannot exceed 50% of the employee's inforce life benefit. You may not elect coverage for
Dependent Spouse ;your spouse if your spouse is covered as an employee under this policy. If both you and your spouse are
employees of the City, only one of you may elect coverage for your child(ren).
Dependent Child(ren) :Children from live birth to age 21 are covered, and may remain in the plan to age 25 if a full-time student.
Cost to You :This benefit is 100% employee paid.
Spouse $10,000 is the guaranteed issue amount for spouses who are newly eligible for coverage. Employees who have
Guaranteed Issue 'previously declined spouse coverage must submit medical evidence for their spouses to Hartford Life.
Coverage will not be effective unless, and until, Hartford Life approves your application.
Child(ren)
All amounts are guaranteed issue, even if enrolling late.
Guaranteed Issue
Age Reduction ;None.
Supplemental Dependent Spouse Monthly Premium Calculation
$10,000 _ $1,000 x 10 x $0.35 = $3.50
Elected Benefit Amount Monthly Rate
per $1,000 of Elected Benefit Your Monthly Cost
For details regarding all the plan's coverages, exclusions, and stipulations, contact Customer Service or visit
The Hartford online at www.thehartfordatwork.com.
All bene(~7s covereA in this booklet are subject to change. This is an Employee Bznefrt Highlight Summary anA not a contract. All benefits are subject to the provisions and exclusions of the master contract. 1 ~]
1 ~ Short Term Disability Insurance
Principal Financial Group
Customer Service: (800) 986-3343
www.principal.com
At no cost to the employee, the Tax Collector provides Short Term Disability (STD) insurance for all eligible employees
through the Principal Financial Group. STD provides you with weekly income if you are unable to work or have a reduced
income due to an illness or injury unrelated to your occupation. Eligible employees are automatically enrolled. An STD
"Q&A" is provided below that answers commonly asked questions regarding the benefit your STD plan provides.
You qualify as disabled if you are:
• Totally disabled due to sickness or injury, you are not working, and cannot perform
Do I qualify as disabled? the duties of your normal occupation;
• Working part-time or on a limited basis due to disability. You will qualify as
residually disabled if you are working but cannot perform the duties of your
normal occupation, and you experience a 20% or greater income loss.
When does the STD benefit The STD benefit begins on the latter of the 16th day of disability or exhaustion of
begin? available PTO or critical leave benefits.
What is the STD benefit? The STD benefit equals 60% of your weekly predisability earnings, up to a maximum
of $1,000 per week. This benefit may be reduced by other income (answered later).
What is the STD benefit if I am If you are disabled and working on a limited or part-time basis, the "Work Incentive
disabled but working? Benefit" is equal to the total disability benefit as long as the sum does not exceed your
weekly predisability pay.
How long does the STD
benefit last? To a maximum of 26 weeks as long as you qualify as disabled.
• PTO or critical leave;
What other income may • Retirement payments or disability payments from Social Security or other
reduce the STD benefit?
government agencies;
• Payments from pension plans;
• Workers' Compensation.
Benefits end when your disability ends or you:
• Reach the maximum benefit payment period;
• Fail to provide any proof of disability;
What would cause the STD • Die;
benefit to terminate? • Cease to be under the care of a physician;
• Fail to report income from other sources;
• Fail to pursue Social Security Disability Income (SSI) benefits (when appropriate);
• Fail to submit to required medical exams.
The STD benefit does not pay a benefit for disabilities resulting from:
• Willful self-injury;
• War or act of war;
What disabilities does • Participation in an assault or felony:
the STD plan exclude? • A sickness or injury covered by Workers' Compensation or arising out of or in the
course of employment for wage or profit;
• A new or continuing disability after the benefit payment period ends and the
insured has not returned to active work.
For further clarification regarding your STD coverage, exclusions,
and stipulations, contact The Principal's Customer Service.
18 All benefits covered in this booklet are subject to dtange. This is an Emplen~ee Bznefit Highlig{tt Summan/ and not a contrai t. All bznefifs arz subject m Nie provisions and exclusions of the master con-
1 =Long Term Disability Insurance
Principal Financial Group
Customer Service: (800) 986-3343
www.principal.com
At no cost to the employee, the Tax Collector provides Long Term Disability (LTD) insurance for all eligible employees
through the Principal Financial Group. LTD is designed to replace a portion of your income when you cannot work on a
full-time basis because of injury or illness. Eligible employees are automatically enrolled. An LTD "Q&A" is provided
below that answers commonly asked questions regarding the benefit your LTD plan provides.
You qualify as disabled for the first 2 years of disability if:
• You are not working and cannot perform the duties of your normal occupation due
to injury or illness; or
• You are working part-time or on a limited basis due to injury or illness and you have
lost at least 20% of your of the income you earned before you were disabled.
Do I qualify as disabled?
Thereafter, you qualify as disabled if:
• You are not working and cannot perform any occupation you are reasonably
qualified to perform based on your background, training, or education;
• You are working part-time or on a limited basis due to injury or illness and you
have lost at least 20% of your of the income you earned before you were disabled.
When does the LTD benefit begin? The LTD benefit begins after you have been disabled for 6 months.
What is the LTD benefit? The LTD benefit equals 60% of your monthly predisability earnings, up to a maximum
of $6,000 per month. This benefit may be reduced by other income (answered later).
What is the LTD benefit if I am If you are disabled and working on a limited or part-time basis, the "Work Incentive
disabled but working? Benefit" is equal to the total disability benefit as long as the sum does not exceed your
weekly predisability pay.
How long does the LTD benefit last? To a maximum of your Social Security Normal Retirement Age.
• PTO or critical leave;
What other income may reduce the • Retirement payments or disability payments from Social Security or other
LTD benefit? government agencies;
• Payments from pension plans;
Benefits end when your disability ends or you:
• Reach the maximum benefit payment period;
• Fail to provide any proof of disability;
What would cause the LTD benefit • Die;
to terminate? • Cease to be under the care of a physician;
• Fail to report income from other sources;
• Fail to pursue Social Security Disability Income (SSI) benefits (when appropriate);
• Fail to submit to required medical exams.
The LTD benefit does not pay a benefit for disabilities resulting from:
• Willful self-injury;
• War or act of war;
What disabilities does the LTD • Participation in an assault or felony:
plan exclude? • A sickness or injury covered by Workers' Compensation or arising out of or in the
course of employment for wage or profit;
• A new or continuing disability after the benefit payment period ends and the
insured has not returned to active work.
For further clarification regarding your LTD coverage, exclusions,
and stipulations, contact The Principal's Customer Service.
All benefits covered in dais booklet are su(+ject to change. This is nn Enaplrn/ee Benefit Highlight Summanl and not a contract. All benefits are subject to the provisions and exclusions o(the master contract. 19
Employee Assistance Program
Center for Family Services
24-hour Crisis Line: (800) 404-7960
Provided by the Town at no cost to you, a comprehensive Employee Assistance Program (EAP) is available to all eligible
full-time employees and each member of the employee's family through the Center of Family Services located in West Palm
Beach. The EAP offers access to state licensed professionals with master or doctorate degrees in social work, mental health,
family counseling, marriage therapy and certified addictions professionals with offices are located conveniently throughout the
community. Even though the EAP is employer paid, EAP providers must follow strict confidentiality guidelines protected by
both federal and state laws. This information cannot be legally disclosed unless you sign a release of information document
The EAP program is available to help you gain a better understanding of problems that affect you, locate the best professional
help for your particular problem, and decide upon a plan of action. A qualified representative can be contacted 24 hours a day,
7 days a week. Examples of the issues addressed by the EAP include:
• Critical incident stress debriefing • Marital counseling • Employee wellness
• Childcare/eldercare consultation • Legal consultation • Mental health assessment and counseling
~~ \~~ Le al Insurance
~~.,.~ g
Preferred Legal Plan
Customer Service: (888) 577-3476
www.preferredlegal.com smithppl@fdn.com
City employees have the opportunity to enroll in a voluntary pre-paid legal program through Preferred Legal Plan. By enrolling
in this plan, a participant will have 24-hour direct access to attorneys who will provide legal assistance for a variety of situations
such as those examples provided below.
The cost to the employee to participate in this legal plan is $4.60 per pay period. This cost is the same for all employees
regardless of the number of eligible dependents enrolled in the plan. All premiums will be payroll deducted on a post-tax basis
for your convenience.
Preferred Legal Plan
• Free unlimited legal advice via phone consultation.
• Free face-to-face consultations with attorneys.
• Free review of legal documents (real estate contracts, lease agreements, simple Wills, etc.) and notary services.
• Free letters and phone calls on your behalf.
• Free Identity Theft information and restoration.
• Free access to legal forms.
Additional services may also be provided at discounted rates.
20 All benefits covered in this booklet are subject to change. This is an Employee Benefit Highlight Summand and not a contract. All benefits are subject to the provisions and exclusions of the master con-
Supplemental Insurance - AFLAC
American Family Life Assurance Company of Columbus (AFLAC)
The American Family Life Assurance Company of Columbus, better known as AFLAC, will continue offering several
insurance policies for you to purchase if you desire. These are individual policies which may provide additional insurance
coverage that you need depending on your personal situation. Participation in the AFLAC policies is voluntary and
premiums are payroll deducted for your convenience. In addition, these are individual policies which are portable should
you ever leave employment at MCSD.
WHAT ARE MY POLICY OPTIONS?
AFLAC offers the following policies to eligible MCSD employees:
• Personal Sickness Indemnity Plan
Illness, whether "routine" childhood occurrences or serious diseases, can require doctors' visits, hospital stays
(including maternity), testing, surgeries, ambulance, etc. This usually entails time out of work, co-pays and
deductibles and that mean money out of your pocket. AFLAC can help with the extra expenses that an illness can cost
your family
• Specified Health Event Protection
Insuring your quality of life while you are recuperating from a serious health condition. About every 29 seconds an
American will suffer a coronary event. Coronary Bypass Surgery is performed 49% of the time on people under age 65.
On average someone in the United States suffers a stroke every 53 seconds. Recover financially from serious illness
with First Occurrence, Reoccurrence, Hospital Confinement, Travel, Lodging and many, many more benefits.
• Personal Accident Indemnity Plan (off the job occurrences)
Did you know that about 2,340 disabling injuries happen every four seconds? And a disabling injury occurs in the
home about every four seconds? Accidents happen 24 hours a day, 7 days a week. They can happen to you, your
spouse or your children. AFLAC's accident plan has you covered.
• Personal Cancer Indemnity Plan
According to the American Cancer Society, men have a 1 in 2 lifetime risk of developing cancer while a woman's risk is
1 in 3. Cancer treatment can cause out-of-pocket expenses that are not covered by your insurance health insurance
such as travel, lodging, special food and supplements, special beds, household help and more. All of these extra
expenses happen on top of your regular bills at a time when you are likely to be at least one income down, if not two.
AFLAC can help you to keep on top of your bills, not the other way around.
• Life Protector
Life insurance is not "what if" insurance, but "when." Protect your loved ones with the money they will need in your
absence. 10, 20 and 30 Year Term and Whole Life policies are available. Face amounts are now available for up to
$200,000. You can also provide policies for your spouse and child(ren). Premiums for this coverage will be payroll
deducted on a post-tax basis.
If you are interested in purchasing, changing or canceling an AFLAC policy, you must meet with a Benefits Counselor during
Open Enrollment to discuss how these plans work and the associated premiums. You will not be able to enroll, modify or
cancel an AFLAC policy on you own via the Internet.
l~ ~y Approvals for AFLAC changes or new AFLAC policies are pended until the end of open enrollment. Approved policies
will appear on your confirmation statement that will be sent to your worksite at the conclusion of open enrollment.
All benefits covered in this booklet are subject to diange. This is an Emplenlee Benz~it Highlight Summanl and not a mnYrart. All 6znzfits are subject to the proaisions anA exclusions of the master contract. 2Z
~r Benefit Contact Information
Aetna (Healthcare)
Aetna Customer Service ........................................................................................................................... ............................ (877) 402-8742
Aetna Rx Home Delivery ......................................................................................................................... ............................ (866) 612-3862
Vision One Benefit ..................................................................................................................................... ............................ (800) 793-8616
Web Address .............................................................................................................................................. ........................ www.aetna.com
Conseco (Heart /Stroke (ICU) & Cancer)
Seacoast Contact: Sheri Louer, Regional Manager ............................................................................... ............................ (800) 628-6428
E-mail ........................................................................................................................................................... ................ SGL516@comcast.net
Web Address .............................................................................................................................................. ....................www.conseco.com
Credit Unions
Gold Coast Federal (local) ........................................................................................................................ ............................(561) 965-1000
Fax ............................................................................................................................................................... ............................ (561) 641-4064
People's Alliance (Miami) ......................................................................................................................... (305) 261-1255 / (631) 434-3500
Fax ............................................................................................................................................................... ............................ (305) 261-4841
Dental Decisions (Administered by Covenant Administrators)
Customer Service & Claims Department ............................................................................................... ............................ (866) 508-1696
Web Address .............................................................................................................................................. ...... www.dentaldecisions.com
Employees' Club .......................................................................................................................................... ................... Ext. 722 at Seacoast
E-mail Address ........................................................................................................................................... .. www.empclubsuaC~sua.com
Eagles, Benefits by Design, Inc. (Flexible Spending Account)
Customer Service ........................................................................................................................................ ........................... (800) 726-5603
Fax ........................................................................................................................................................................................... (772) 334-7059
Web Address ....................................................................................................................................................... www.eaglesbenefits.com
Group Insurance Agency
Gehring Group ............................................................................................................................................ ........................... (561) 626-6797
Fax ................................................................................................................................................................ ........................... (561) 626-6970
Web Address ............................................................................................................................................... ........ www.gehringgroup.com
Lincoln Life Insurance Company
Customer Service ........................................................................................................................................ ........................... (800) 423-2765
Life Insurance Customer Service ............................................................................................................... ........................... (800) 279-4598
Short and Long-Term Disability Customer Service ............................................................................... ........................... (877) 843-3948
Web Address ............................................................................................................................................... ............................www.lfg.com
Life Insurance /Deferred Compensation
Lincoln National ......................................................................................................................................... ........................... (800) 375-7526
Local Contact: Frank Searing ..................................................................................................................... .......................... (561) 656-2096
Fax ................................................................................................................................................................ ...........................(561) 656-2089
Pension
PDI Resources of Florida (Frank Searing) ................................................................................................ ........................... (561) 656-2096
Fax ................................................................................................................................................................ ........................... (561) 656-2089
Nationwide /Best of America (Acct No.063-01298) ............................................................................... .......................... (800) 772-2182
Web Address ............................................................................................................................................... ........... www.nationwide.com
Preferred Employee Relationship (PERK)
Wachovia ...............................................................................................................................................................................(888) 353-PERK
Web Address ................................................................................................................................................................ww~v.~vachovia.com
Seacoast Utility Authority
Personnel Specialist (Hope Dexter) ......................................................................................................................... (561) 627-2900 ext 395
Personnel's Email Address ......................................................................................................................................... personnel@sua.com
Web Address .......................................................................................................................................................................... www.sua.com
Seacoast Utility Authority Employee Web Page ........................................................................................................ employee.sua.com
Horizon Health - EAP
Customer Service (24 hours) ................................................................................................................................................. (888) 272-7252
Web Address .................................................................................................................................................. www.horizoncarelink.com
GEIIRIN(;~GROUP