2013 plan year benefits annual open enrollment guideimages.pcmac.org/uploads/habershamcounty... ·...

2013 Plan Year Benefits Annual Open Enrollment Guide

AOE Begins: Tuesday, October 9, 2012 AOE Ends: Friday, November 9, 2012

1Habersham County Schools 2013 Annual Open Enrollment Guide

Dear Employee:Welcome to Annual Open Enrollment for your 2013 benefits! This is a great time to re-familiarize yourself with the benefits we offer and make changes for the 2013 year. We are pleased to offer you a comprehensive benefits package.

This enrollment guide provides valuable information concerning your benefits package for 2013. Please take the time to review this guide carefully.

Annual Open Enrollment is from Tuesday, October 9th through Friday, November 9th.

For questions about your benefits, please call the Benefits Service Center at 1-866-664-1166. Benefits Service Center hours are Monday through Thursday from 8am to 6pm and Friday from 8am to 5pm.

Please remember the Benefits Service Center is your resource for all open enrollment and benefit questions, including State Health Benefit Plan questions.

Our employees are our greatest asset. Thank you for your service!

Sincerely,

Habersham County Schools

Table of ContentsEnrollment ...........................................................................2

State Health Benefit Plan ....................................................5

Dental ..................................................................................7

Vision ...................................................................................8

Voluntary Life .................................................................... 10

Disability ............................................................................ 11

Critical Illness .................................................................... 13

general information

Important Contact InformationEnrollment and Benefit QuestionsBenefits Service Center1-866-664-1166 Website: www.totemtools.com

Flexible Spending AccountsMedcomCustomer Service: 1-800-523-7542Website: www.emedcom.net

Dental InsuranceHealth Smart Benefit SolutionsCustomer Service: 1-888-745-3274Website: www.healthsmart.com

Vision InsuranceEyeMed Vision CareCustomer Service: 1-888-439-3633 (1-888-4-EYEMED)Website: www.eyemedvisioncare.com (“Select” Network)

Voluntary Life InsuranceMetLifeCustomer Service: 1-800-275-4638 (1-800-ASK-4-MET)Website: www.metlife.com

Disability InsuranceThe HartfordCustomer Service: 1-866-945-4558Website: www.thehartfordatwork.com

Critical IllnessHM Life Insurance Company, administered by AFLACCustomer Service: 1-800-433-3036Website: www.aflac.com

Medical - State Health Benefit PlanPlease visit www.myshbp.ga.gov for very important information about the 2013 changes and to complete your health insurance enrollment process.


New this Year! Employee Benefit MeetingsHabersham County Schools would like to be sure you receive all of the important information about your 2013 benefits, including what is changing, how to enroll, and your benefits resources. We will have a designated Benefits Specialist available for you to answer questions about your 2013 benefits, review the enrollment process, and complete your voluntary elections.

There will not be a formal presentation, but rather access to a Benefits Specialist for assistance with questions about your benefits. We hope you find this service both helpful and informative.

enrollment


Below is the schedule for the 2013 Employee Benefit Meetings:

2012 Date Location Participants Invited

Tuesday October 16 8am to 5pm

South Habersham Middle School

Media Center

• Baldwin Elementary• Cornelia Elementary• Fairview Elementary

• Level Grove Elementary• South Habersham Middle• Bus Drivers

Wednesday October 17 8am to 5pm

North Habersham Middle School

Media Center

• Clarkesville Elementary• Woodville Elementary

• North Habersham Middle• Bus Drivers

Friday October 19 9am to 2pm

Habersham Central High School

Cafeteria

• Demorest Elementary• Hazel Grove Elementary• Wilbanks Middle School• Habersham Ninth Grade Academy• Alternative School

• Habersham Central High• Bus Drivers & Bus Shop• Central Office• Maintenance Department• Technology Department


enrollment

In order to complete your non-medical elections for the 2013 plan year, you may either call the Benefits Service Center at 1-866-664-1166 or complete your elections on-line at www.totemtools.com.

Telephonic EnrollmentIf you choose to call the Benefits Service enter to complete your non-medical elections, you will speak with a trained Benefits Specialist who will explain the 2013 benefits and complete your enrollment. Benefits Service Center hours are Monday – Thursday 8am to 6pm and Friday 8am to 5pm.

On-Line EnrollmentYou also have the option of accessing www.totemtools.com to complete your 2013 non-medical benefit elections.

• User ID: Full social security number (no dashes)

• Initial Password: Date of birth (yyyymmdd)

• Example: Mary Miller: SSN: 123456789, Date of birth: 5/16/1970 Mary’s User ID: 123456789 Mary’s Initial Password: 19700516

Upon initial login, you will enter the above User ID and Password and be prompted to change your password. Passwords are case-sensitive.

Remember, the Benefits Service Center is available to assist you with the enrollment process and password resets should you choose to enroll on-line.

Non-Medical Benefits – Enrollment Process and Updates Tuesday, October 9 – Friday, November 9, 2012

Enrollment Reminders:• You are not required to take any action

for your non-medical benefits in order to carry these forward to 2013.

• If you do not complete your non-medical elections by calling the Benefits Service Center or accessing www.totemtools.com, your 2013 benefits will be carried forward from 2012.

• No changes are allowed to your FSA plan at this time unless you have a qualifying life event.

• The FSA medical and dependent care plan year is July 1, 2012 –June 30, 2013. This is not annual open enrollment for this benefit.

2013 Non-Medical Benefit Updates:

• Life, Disability, and Critical Illness elections at Annual Open Enrollment require EOI health questions.

• Slight premium increase for the dental plan.

• No other benefit changes for 2013.


enrollment

About Your Payroll Deductions• Equal payroll deductions will be taken from each paycheck.

• Your dental, vision, and FSA premiums are deducted on a pre-tax basis, unless you provide a written request to have these deductions post-tax.

• Your life, disability and critical illness benefits are deducted on a post-tax basis.

Some Information you will need• Your name, date of birth and Social Security Number.

• The name(s), date(s) of birth and Social Security Number(s) of your dependent children up to age 26.

• The name, date of birth and Social Security Number of your spouse (if applicable).

• Your current address, so that we can update our records. This will also ensure that your ID cards and other important information are sent to the correct address.

• The full name and relationship of your beneficiary (your beneficiary must be at least 18 years old or you will be required to name a guardian for him or her).

Life EventsNo changes are allowed to your dental, vision or flexible spending account coverage during the plan year, except in the case of a “qualifying life event.” (For critical illness, no changes to enrollment are allowed except at initial eligibility and Annual Open Enrollment.)

If you have a qualifying life event, you should notify HCS Payroll and Benefits Office of your new elections. You must also provide the necessary documentation to the HCS Payroll and Benefits Office within 31 days of the change. If you do not do so within 31 days, you must wait until the next open enrollment to make dental and vision benefit plan changes.

Benefit Plan DocumentsThis guide provides a summary of each voluntary benefit offering. The Habersham County Schools plan documents govern the administration and benefits for each plan. The plan documents include a detailed description of each benefit and are located on www.habershamschools.com . Click “Departments,” “Human Resources,” “Benefits” to access the plan documents.


The Georgia Department of Community Health (DCH), which administers the State Health Benefit Plan (SHBP), continually seeks to offer high-quality, affordable health coverage.

You have the option to enroll in the following medical plans for 2013 offered by CIGNA and United Healthcare:

• High Deductible Health Plan (HDHP)

• HRA

• HMO (only if currently enrolled in State Health Benefit Plan)

TRICARE Supplement is also available for members enrolled in TRICARE.

How to Enroll in SHBP for 2013In order to elect your state health benefits for 2013, you are required to access the State Health Benefit Plan (SHBP) website at www.myshbp.ga.gov. This guide provides a summary of the state health benefits. Please access www.dch.ga.gov/shbp_plans for the complete eligibility, plan details, and legal notices for your health benefits.

Web access begins at 4:00 am on 10/09/2012 and closes at 4:30pm on 11/09/2012.

Active election is NOT mandatory. If no election is made, 2012 benefits will rollover.

If you do not take action, your current medical elections will carry forward to 2013. Remember, the deadline to complete your State Health Benefit Plan election for 2013 is 4:30pm on Friday, November 9.

2013 Health Updates• Elimination of Spousal Surcharge

• Deductible, Co-Insurance, Co-Payment, Premium Changes

• HRA credit changes

• Childhood Obesity Initiative –Provides PCP and Dietician coverage for children diagnosed with obesity as determined by the child(ren) physician

• Expansion on women’s preventive care (See www.healthcare.gov for more details)

Please refer to the 2013 Employee Health Decision Guide at www.dch.georgia.gov/shbp for complete details.

Wellness Promise Health Actions1. Members and spouses (if covered) must complete

an online SHBP member Education module at www.AHealthierSHBP.com between January 1, 2012 and 4:30pm on May 31, 2013.

2. Members and spouses (if covered) must also complete an online health assessment between January 1, 2013 and 4:30pm on May 31, 2013.

3. Members and spouses(if covered) must obtain their biometric screenings between July 1, 2012 and May 31, 2013 and have their physician fax a completed Screening form between November 1, 2012 and 4:30pm on May 31, 2013.

Members who re-elect a Wellness Plan (met their 2012 Wellness Promise) must complete Health Actions 1 and 2.

Members who newly elect a Wellness Plan must complete Health Actions 1, 2, and 3.

State Health Benefit Plan – Enrollment Process and Updates Tuesday, October 9 - Friday, November 9

state health benefit plan


State Health Benefit Plan Summary of Benefits (Jan. 1, 2013 - Dec. 31, 2013) This is a brief overview of plan options. You must access the State Health Benefit Plan Decision Guide at www.dch.ga.gov/shbp_plans.com for complete information.

HMO OptionHigh Deductible Option (HDHP) HRA OptionIn-Network Out-of-Network In-Network Out-of-Network

Maximum Lifetime Benefit (combined for all SHBP Options)

Unlimited Unlimited Unlimited

Pre-Existing Conditions (first year in Plan only, subject to HIPAA)

Not Applicable Not Applicable Not Applicable

Deductibles/Co-payments Wellness Standard Wellness StandardYou $1,300 $1,800 $2,000 $3,600 $4,000 $1,600You + Spouse $1,950 $3,600 $2,000 $7,200 $8,000 $2,800You + Child(ren) $1,950 $3,600 $4,000 $7,200 $8,000 $2,800You + Family $2,600 $3,600 $4,000 $7,200 $8,000 $4,000

Out-of-Pocket Maximums Wellness Standard Wellness Standard Wellness Standard Wellness StandardYou $4,000 $4,500 $4,000 $4,500 $8,000 $9,000 $4,000 $4,500You + Spouse $6,500 $7,000 $8,000 $9,000 $16,000 $18,000 $6,500 $7,000You + Child(ren) $6,500 $7,000 $8,000 $9,000 $16,000 $18,000 $6,500 $7,000You + Family $9,000 $9,500 $8,000 $9,000 $16,000 $18,000 $9,000 $9,500

HRA Credits Wellness StandardYou

None None

$500 $150You + Spouse $1,000 $300You + Child(ren) $1,000 $300You + Family $1,500 $500

Remember: In order to elect health benefits for 2013, you are required to enroll online at www.myshbp.ga.gov.

state health benefit plan


Dental

Habersham County Schools will continue to offer two dental reimbursement plans administered by HealthSmart for 2013:

• Basic Plan

• Enhanced Plan

• You may seek care from any dentist.

HealthSmart is committed to improved service in 2013. The claims and eligibility service teams have been changed, which should result in enhanced service for you.

Assignment of BenefitsAs long as your dentist files the claim and accepts assignment of benefits, you should not need to pay at the time of service. The dentist will submit the claim to HealthSmart for processing and he/she will be reimbursed by HealthSmart accordingly. Then, you will receive a bill from your dentist for your portion (if any) once the claim has been processed.

The benefits are as follows:• Basic Dental Reimbursement Benefits:

○ 100% of the first $100

○ Then, 50% of the next $1,800

○ Orthodontia not included.

○ Maximum annual benefit is $1,000 per person

• Enhanced Dental Reimbursement Benefits:

○ 100% of the first $150

○ Then, 50% of the next $2,700

○ Includes Orthodontia

○ Maximum annual benefit is $1,500 per person

A Note About Late Applicants:If you did not elect the dental plan upon initial eligibility and choose to enroll at this time, you will be considered a late applicant. If you (or your dependents) are considered a late applicant, the amount of expenses is reduced for the first Plan Year in which you participate in the plan. The plan will pay 50% of covered expenses and the maximum will be 50% of the normal maximum benefit for the first year you are enrolled as a late applicant.

Dental Monthly Payroll Deductions:

Basic Plan Enhanced PlanEmployee $24.33 $38.71Employee + 1 $46.37 $75.13Family $72.79 $118.83Dependent children are eligible up to age 26.

Dental (HealthSmart)


V ision

The EyeMed Vision Plan provides coverage for exams, eyeglasses and contacts. There are two vision plans from which to choose. Your out-of-pocket costs are reduced if you seek care from a participating EyeMed Vision provider. Please review the vision summary of benefits on the following page.

For information regarding participating vision providers:

• Go online to www.eyemedvisioncare.com.

• Choose “Select” from the “Locate a Provider” drop down box and follow search instructions.

How it Works:• If you go to a participating EyeMed provider, you

will pay your portion of the bill at the time of service.

• If you have services from a non-participating provider, you will need to pay at the time of service and file a claim with EyeMed for reimbursement.

Vision Monthly Payroll Deductions:

Basic Plan Enhanced PlanEmployee $4.08 $6.56Employee + 1 $7.76 $12.44Family $11.40 $18.28Dependent children are eligible up to age 26.

Vision (EyeMed Vision Care)


Vision Summary of BenefitsBasic Enhanced

Member Cost Out-of-Network Reimbursement Member Cost Out-of-Network

Reimbursement

Vision Exam $10 copay Up to $35 $10 copay Up to $36

Standard Plastic Lenses

Single Vision $25 Up to $25 $10 copay Up to $25

Bifocal $25 Up to $40 $10 copay Up to $40

Trifocal $25 Up to $60 $10 copay Up to $60

Progressive $25; 80% of charge less $55 allowance Up to $40 $10; 80% of charge

less $55 allowance Up to $40

Frames$100 allowance; 20% discount off

balance over $100Up to $40

$120 allowance; 20% discount off


Lens Options

UV Coating 20% off retail N/A 20% off retail N/A

Tint 20% off retail N/A 20% off retail N/A

Standard Scratch Resistant 20% off retail N/A 20% off retail N/A

Standard Polycarbonate 20% off retail N/A 20% off retail N/A

Standard Anti-reflective Coating 20% off retail N/A 20% off retail N/A

Other add-ons and services 20% off retail N/A 20% off retail N/A

Contact Lenses

Conventional$115 allowance; 15% discount off


$135 allowance; 15% discount off


Disposable $115 allowance Up to $81 $135 allowance Up to $95

Medically Necessary $0 copay, covered in full Up to $200 $0 copay,

covered in full Up to $200

Lasik or PRK from US Laser Network

15% off retail price or 5% off

promotional priceN/A

15% off retail price or 5% off

promotional priceN/A

Frequency Limits

Eye Exam Once every 12 months Same as in-network Once every 12 months Same as in-network

Frame Once every 24 months Same as in-network Once every 24 months Same as in-network

Lenses or Contact Lenses Once every 24 months Same as in-network Once every 12 months Same as in-network

Note: Once benefits are exhausted, some discounts may apply.

V ision


Voluntary life

Voluntary Term Life Insurance and AD&D (MetLife)As a Habersham County Schools employee, you have the opportunity to elect voluntary term life insurance for yourself, your spouse and your children. This benefit will pay if you die as a result of an illness or an accident.

Beneficiaries It is important that the Benefits Service Center has your updated life insurance beneficiary(ies). A beneficiary is the person(s) who receive the benefit in the event of your death.

Voluntary Term Life Summary of Benefits

Empl

oyee Benefit Amount Up to 5x annual income in

$10,000 increments

Benefit Maximum $500,000

Spou

se

Benefit Amount $5,000 to $100,000 (in $5,000 increments)


Chi

ldre

n

Aged 14 days to 26 years*

$10,000 flat benefit (covers all children; not to exceed 50% of the employee’s amount)

Dependent children are eligible up to age 26.

Sample Monthly Payroll Deductions

Below are sample payroll deductions. Your Benefits Specialist will review your specific costs based on your age and desired benefit level.

Employee Spouse Child(ren)Benefit Amount Age 25 Age 35 Age 45 Age 55 Age 65 Benefit

Amount Age 25 Age 35 Age 45 Age 55 Age 65 Benefit Amount

Age 14 days to 26 years

$10,000 $0.84 $1.11 $2.73 $7.15 $16.44 $5,000 $0.42 $0.56 $1.37 $3.58 $8.22 $10,000$2.00

(covers all children)

$50,000 $4.20 $5.55 $13.65 $35.75 $82.20 $25,000 $2.10 $2.78 $6.83 $17.88 $41.10

$100,000 $8.40 $11.10 $27.30 $71.50 $164.40 $50,000 $4.20 $5.55 $13.65 $35.75 $82.20

$200,000 $16.80 $22.20 $54.60 $143.00 $328.80 $100,000 $8.40 $11.10 $27.30 $71.50 $164.40

Evidence Of Insurability (EOI)

If you wish to elect or increase your life insurance benefit amount at Annual Open Enrollment, an Evidence of Insurability (EOI) form is required (including for new child life elections). Please access the EOI form on www.habershamschools.com. Select Departments, then Human Resources, then Benefits to access the EOI form. Please complete the EOI and return it to MetLife for review. You will not be payroll-deducted until you are approved for the new or additional life insurance amount.


Disabil ity

Three Disability Choices• Options 1 provides a benefit for up to 2 years.

With this option, the benefit begins on the 15th

day of accident or sickness.

• Options 2 also provides a benefit for up to 2 years.

With this option, the benefit does not begin until

the 31st day of the accident or sickness. (Option

1 pays a disability benefit sooner and is therefore

more expensive than Option 2.)

• Option 3 is a true long term disability plan. No

benefit is payable until day 91 after accident/illness.

This plan provides income protection for you up to

age 65 should you become injured or ill.

A Note about your Benefit AmountThe amount of your monthly benefit should you become disabled will be reduced by Other Income Benefits. Other Income Benefits examples include those payable under a Workers’ Compensation law, government law/program, mandatory no-fault auto insurance, the Veterans Administration, the employer’s Retirement Plan, unemployment benefits, membership/association/organization benefits, and United States Social Security.

Evidence of Insurability (EOI)Should you wish to elect or change disability plans at Annual Open Enrollment, the change will require Evidence of Insurability (EOI). Please access the EOI form on www.habershamschools.com. Select Departments, then Human Resources, then Benefits to access the EOI form. Please complete the form and submit it to The Hartford for review. You will not receive the new plan election until you have been approved for coverage.

Disability Coverage (The Hartford)Disability coverage provides a benefit in the event you miss work due to an accident or illness. This coverage provides an income benefit to you if you are temporarily or permanently disabled. Without long term disability insurance, the typical working American will use savings and retirement funds in order to pay the bills in the case of a disability.


Disability Summary of Benefits

Option 1 Benefits begin after 14 days.

Option 2 Benefits begin after 30 days.

Option 3 Benefits begin after 90 days

and continue to age 65.

Weekly Benefits Begin After 14 days (on day 15) of accident/sickness

After 30 days (on day 31) of accident/sickness N/A

Maximum Benefit Period 11 weeks 9 weeks N/A

Benefit Amount 60% of earnings 60% of earnings N/A

Maximum Benefit $1,250 per week $1,250 per week N/A

You will begin receiving monthly benefits if you are still disabled after 11 weeks for Option 1 and 9 weeks for Option 2.

Monthly Benefits Begin After 90 days of accident/sickness

After 90 days of accident/sickness

After 90 days of accident/sickness

Maximum Benefit Period 2 years 2 years To age 65 or Normal Retirement Age

Benefit Amount 60% of earnings 60% of earnings 60% of earnings

Maximum Benefit $5,000 per month $5,000 per month $8,000 per month

Own Occupation Coverage 2 years 2 years 3 years

Sample Monthly Payroll Deductions

Option 1Annual Income Age 25 Age 35 Age 45 Age 55

$10,000 $12.00 $9.00 $10.33 $15.25

$15,000 $18.00 $13.50 $15.50 $22.88

$25,000 $30.00 $22.50 $25.83 $38.13

$35,000 $42.00 $31.50 $36.17 $53.38

$45,000 $54.00 $40.50 $46.50 $68.63

$55,000 $66.00 $49.50 $56.83 $83.88


$10,000 $9.25 $6.92 $8.00 $12.08

$15,000 $13.88 $10.38 $12.00 $18.13

$25,000 $23.13 $17.29 $20.00 $30.21

$35,000 $32.38 $24.21 $28.00 $42.29

$45,000 $41.63 $31.13 $36.00 $54.38

$55,000 $50.88 $38.04 $44.00 $66.46


$10,000 $2.00 $4.08 $8.00 $13.42

$15,000 $3.00 $6.13 $12.00 $20.13

$25,000 $5.00 $10.21 $20.00 $33.54

$35,000 $7.00 $14.29 $28.00 $46.96

$45,000 $9.00 $18.38 $36.00 $60.38

$55,000 $11.00 $22.46 $44.00 $73.79

Disability Coverage (The Hartford)

Disabil ity


Crit iCal illness

Should you elect or increase your critical illness coverage at this time, your total election will be subject to the appropriate rate based on your current age.

Habersham County Schools provides its employees with the option to purchase critical illness insurance. This benefit pays a lump sum if you are diagnosed with a serious illness, such as:

• Stroke

• Cancer* (internal)

• Kidney Failure

• Major Organ Transplant

• Heart Attack

• Coronary Artery Bypass Surgery

The plan continues to provide a benefit if you are later diagnosed with the same illness or diagnosed with one of the remaining covered illnesses. (See certificate for details.)

Critical Illness pays a benefit from $5,000 to $50,000 upon diagnosis of a covered illness, and you may use the money to pay for anything you wish. Many people enrolled in a high deductible health plan elect this benefit. In the event of deductible expenses related to an unexpected covered illness, this plan can provide financial protection.

Health Screening Benefit! The plan includes a $50 Health Screening Benefit. You can receive up to $50 each calendar year for any one covered health screening test regardless of the results.

Any election or increase in critical illness at Annual Open Enrollment will require health questions. The Benefits Service Center will review these questions with you when you call to enroll. There is no paperwork necessary for critical illness enrollment.

Critical Illness

Monthly Payroll Deductions

Uni-Tobacco – Monthly RatesAges $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,00018-29 $3.90 $6.05 $8.20 $10.35 $12.50 $14.65 $16.80 $18.95 $21.10 $23.25

30-39 $5.75 $9.75 $13.75 $17.75 $21.75 $25.75 $29.75 $33.75 $37.75 $41.75

40-49 $10.55 $19.35 $28.15 $36.95 $45.75 $54.55 $63.35 $72.15 $80.95 $89.75

50-59 $17.35 $32.95 $48.55 $64.15 $79.75 $95.35 $110.95 $126.55 $142.15 $157.75

60-69 $26.75 $51.75 $76.75 $101.75 $126.75 $151.75 $176.75 $201.75 $226.75 $251.75

Critical Illness Summary of Benefits

Empl

oyee Benefit Amount $5,000 increments


Spou

se Benefit Amount Up to 50% of the employee’s benefit ($5,000 minimum)


Chi

ld(re

n)

Benefit Amount 10% of the employee’s amount included at no extra cost

Waiting Period and First Diagnosis ClauseThis Plan contains a 30-day “Waiting Period.” This means no benefits are payable for any Insured who has been diagnosed before their coverage has been in force 30 days from the “Effective Date.” In order for coverage to apply, the date of diagnosis of a covered illness must occur after the waiting period and while this certificate is in force.

* Cancer does not include any skin cancers except melanoma, nor does it include pre-malignant tumors or polyps, Stage I Hodgkins and Stage A Prostate, Basal Cell carcinoma and squamous cell carcinoma of the skin, carcinoma in situ (non-invasion), and melanoma that is diagnosed as Clark’s Level I or II or Breslow less than .77mm.

Please note that this guide is a general summary of your benefits. For specific details, you may refer to each carrier’s summary plan description. Every effort has been made to ensure that this booklet accurately represents the benefits. However, if there are any discrepancies between the terms in this booklet and the terms in the plan document, the plan document will prevail.