pinellas county sheriff’s office 2013 – 2014 benefits plan year benefits enrollment: 7/29/13 -...
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Pinellas County Sheriff’s Office 2013 – 2014 Benefits Plan YearBenefits Enrollment: 7/29/13 - 8/9/13
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Welcome!
Benefit Options:– Medical – Choice of 2 plans with POS network– Dental – Preventive Only or Direct Reimbursement– Vision – United Healthcare Vision (Spectera)– Employee Assistance Program (EAP)– Life and Disability – The Standard– Flexible Spending Accounts (FSA’s)
Dependent Care Account Health Care Account
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What Is Not Changing Your premium contributions
Medical, pharmacy, dental and vision deductibles, out-of-pocket maximums, co-insurance and co-pays
UnitedHealthcare continues as claims administrator for medical
United Concordia continues as claims administrator for dental
UnitedHealthcare (Spectera) continues as claims administrator for vision
The Standard continues as our carrier for life and disability
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What IS Changing OptumRX (a partner with UHC) will replace
Medco/Express Scripts as our Pharmacy Benefits Manager
A new employer paid Short-Term Disability benefit through The Standard is being added
The Direct Reimbursement Dental benefit is being enhanced
The maximum contribution to a healthcare Flexible Spending Account is reduced to $2,500
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– Add health, dental or vision coverage
– Change your current health plan and/or dental plan
– Add dependents to your coverage
– Delete dependents from your coverage
– Increase supplemental life by $20,000 (restrictions apply)
– Change your life insurance beneficiary designation
– Enroll in FSA for 2013-2014 Plan Year
Open Enrollment - July 29th to August 9th
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What you MUST do during open enrollment
– You must confirm and/or elect your benefit coverage for the new plan year of October 1, 2013 – September 30, 2014 using the on-line enrollment platform
– You must provide documents to HR for any newly added dependents (by August 9th)
– You must enroll and elect your FSA contributions every year — prior year elections do not carry over
Open Enrollment
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Medical Plan
Choice of two medical plans– CPOS Platinum – Includes coverage for acupuncture, infertility, and
weight reduction surgery – CPOS Gold – Does not provide coverage or follow-up care for
acupuncture, infertility, or weight reduction surgery
Both plans use the same network of doctors and providers
Both plans are open access and do not require a primary care doctor or a referral to visit a specialist
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Platinum Plan Gold PlanIn Network Out of Network In Network Out of Network
DeductibleIndiv. / Family
$750 / $1,500 $1,500 / $3,000 $1,000 / $2,000 $2,000 / $4,000
Out of Pocket MaximumIndiv. / Family
$2,500 / $5,000 $5,000 / $10,000 $2,850 / $5,600 $5,700 / $11,200
Office Visits - General Practice
$15 Copay 40% after deductible
$20 Copay 50% after deductible
Office Visits - Specialist
$35 Copay 40% after deductible
$40 Copay 50% after deductible
ER Visits $150 Copay $150 Copay $150 Copay $150 CopayOutpatient Surgery 20% after
deductible40% after deductible
30% after deductible
50% after deductible
Outpatient Diagnostics (Lab & X-ray)
20% after deductible
40% after deductible
30% after deductible
50% after deductible
Preventative/Routine Mammograms
Paid at 100% 40% after deductible
Paid at 100% 50% after deductible
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Tools on myuhc.com
• Check claims status and history
• Learn about benefits and coverage
• Find in-network physicians and hospitals • Online statements
• View account balances
• Estimate and compare treatment costs
• Access discounts
• Print temporary ID card/request new card
• Research health topics & read articles
• Chat with a nurse in real-time
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ComPsychEmployee Assistance Program
www.guidanceresources.com, password: PCSO
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EAP Benefits
Information and assistance with life and work issues
24 hours a day, 7 days a weekLife/work issues impact job performanceCompletely confidentialAll members in home may access benefit
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EAP Services Up to Six (6) free face-to-face sessions
— per family member, per issue, per plan year Employee Assistance Specialists, Certified Employee
Assistance Professional, 3-5 years clinical experience EAP benefits include:
Family, marital and relationship problems Emotional difficulties such as depression, anxiety, guilt Online personal health info, news and resource tools Drug and alcohol dependence Job stress Child and elder care research and referrals Legal and financial concerns
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Drug Co-payments
Participating Retail Pharmacies
Up to a 30-day supply*
Participating RetailPharmacies
Up to a 30-day supply*
1½ x copay on 3rd fill
Participating Retail Pharmacies
Up to a 90-day supply*
1½ x copay 3 months
OptumRX by Mail
Up to a 90-day supply*
2 x copay
Generic drugs $10.00 $15.00 $45.00 $20.00
Brand-name drugs (Preferred) $25.00 $37.50 $112.50 $50.00
Brand-name drugs (Non-preferred)
$40.00 $60.00 $180.00 $80.00
* As prescribed by your doctor.
OptumRx by Mail Can Save You Money
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Drug Coverage Retail Coverage
- Use retail pharmacy for short-term medications
- Go to www.myuhc.com or call Member Services at 800-377-5108, Group Number 712474
OptumRx By Mail – For maintenance/long-term
medications– No charge for standard shipping– Cost-effective and convenient,
medication delivered to your door– Continue to use retail pharmacy
for short term medications
Generics and plan-preferred medications will cost you less than non-preferred medications
Consider using OptumRx by Mail for long-term (maintenance) medications
Money Saving Tips
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How to use OptumRx Mail Service Pharmacy
1. Talk to your doctor
- Request up to a 3-month supply of your prescription, with refills up to a year (if appropriate)
2. Pass your information to the mail service pharmacy
By fax or electronicallyBy fax or electronically:
- Your doctor can call 1-800-788-4863 for instructions to fax prescriptions directly to OptumRx Mail Service Pharmacy (only doctor can fax prescription)
- Ask your doctor to send immediately by using ePrescribe
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How to use OptumRx Mail Service Pharmacy
OnlineOnline:
-Log on to myuhc.com
-Click on “Manage my Prescriptions”
-Select “Transfer Prescriptions” and select the medications you would like to transfer to mail service
By mailBy mail:
-As your doctor for a new prescription for up to a 3-month supply, plus refills for up to one year (if appropriate)
-Go to myuhc.com and download an order form
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How to use OptumRx Mail Service Pharmacy
Mail the new prescription and order form to the address provided
NOTE: Most prescriptions arrive within 7 days from the date your completed order is received. If you need your medication right away, ask your doctor to write a prescription for a 1-month supply that can be immediately filled at a participating retail pharmacy.
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Visit www.myuhc.com Locate participating retail pharmacies by zip code
View information about possible lower-cost medication alternatives
Compare medication prices and options
Manage your mail order account
View your prescription history
Access drug information
Set up email or text message reminders to take medications and order refills
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Dental Plan Options Preventative Only plan
– Reimburse the first $200 of preventative care – Procedures covered are:
Routine oral exams Cleaning and scaling of teeth Two bite wing x-rays per year One panoramic x-ray per 36 month period Fluoride treatments
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Dental Plan Options
Preventative Only Direct ReimbursementPlan * Full Dental Plan
Covered service 100% of the first $200100% of the first $20050% of the next $3,600
Maximum Benefit $200 $2,000
Deductible None None
* Out of Network benefits reimbursed at the 90% of Usual and Customary charge
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Dental Plan Administration
Contact United Concordia for dental claim questions – Customer Service : 1-800-332-0366– Website: www.ucci.com– Network: Advantage Plus
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United Healthcare Vision Providers No change in vision benefits from last year
Large provider network– Over 30,000 providers nationwide– Private practice and retail chain providers
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Schedule of Vision BenefitsCovered Services In-Network Out-of-NetworkExam every 12 months $10 copay $25 allowanceFrames $130 retail, $50
wholesale$50 allowance
Lenses Single Vision Lens $20 copay $20 allowance Bifocal Lens $20 copay $30 allowance Trifocal Lens $20 copay $40 allowance
UV Coating $15 Not CoveredTint (Solid) $13 Not CoveredTint (Gradient) $16 Not CoveredScratch Resistance $0 Not CoveredBasic Polycarbonate $25 Not CoveredStandard Anti-Reflective $45 Not CoveredOther Add-ons and Services 20% off retail price Not Covered
Medically Necessary 100% after $10 exam & $20 material copay
$200 allowance
Standard (includes clear, spherical, biweekly disposables)
$20 copay* includes fitting fee, 6 boxes of contacts and up to 2
follow-up visits
$50 allowance
Other Services Allowance AllowanceLasik $562.50 per eye $562.50 per eye
Lens Options
Contact Lenses
Custom (includes toric, gas permeable and bifocal)
$150 allowance toward fitting, materials and up
$50 allowance
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Accessing Vision Benefits Internet www.myuhcvision.com or www.myuhc.com
24-hour access Provider Locator & FAQ Claims and eyewear order tracking Nominate a provider to join network
Customer Service Center 8:30 a.m. to 8:00 p.m. ET Monday - Friday 9:00 a.m. to 5:00 p.m. ET Saturday
The StandardLife Insurance Accidental Death & Dismemberment Long Term DisabilityShort Term Disability
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Life and AD&D Benefits Accelerated benefit for terminally ill
Waiver of premium - 6 months total disability
Repatriation Benefit up to $5,000
MEDEX Travel Assist
Seat belt benefit - Up to $10,000
Air bag benefit - Up to $5,000
AD&D Family Benefits Package– Higher education benefit – Up to $20,000– Child care benefit – Up to $10,000 – Career adjustment benefit - Up to $10,000 for spouse training
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Life and AD&D Benefits Line of duty benefit - Up to $50,000 result of action performed in
the course of controlling or reducing crime and assigned duties
AD&D covers variety of accidental losses:– Loss of speech or hearing in both ears– Disappearance – Quadriplegia, Hemiplegia, Paraplegia– Occupational Assault– Public Transportation
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Short Term Disability Benefit New employer-paid benefit
60% of weekly earnings for up to 26 weeks, maximum of $2,300 paid per week
30 day qualifying period
Must exhaust sick leave before becoming eligible
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Long Term Disability Provisions
Waiting Period: 180 Days
Benefit: 60% of the first $10,000 of monthly pre-disability earnings
Maximum Benefit: $6,000
Minimum Benefit: $100
Maximum Benefit Period: To age 65 or Social Security Normal Retirement Age
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LTD Benefits Return to work incentive
$25,000 reasonable accommodation benefit
Standard SecureCard
Social Security assistance
3 months survivor benefits
Assisted Living Benefit - 80% of pre-disability earnings, adds up to $2,000 (month) to LTD benefit, not reduced by deductible income
Lifetime Security Benefit - Income for severely disabled employees beyond maximum benefit period
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The Standard Customer Service
Medical underwriting: 888-456-3505
STD claim questions: 800-368-2859
LTD claim questions: 800-368-1135
Life claim questions: 800-628-8600
Visit the website at www.standard.com
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PayFlex Flexible Spending Account (FSA)
— Funded with pre-tax dollars
Two kinds of eligible expenses:
Healthcare - Medical FSA
— Maximum Contribution: $2,500
Dependent care - Dependent care FSA
—Maximum contribution: $5,000 or $2,500 if married and filing separately
FSA results in lower taxable income and more take-home pay
Flexible Spending Account
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– Medical FSA eligible expenses include: Prescription co-pays Doctor visit and ER co-pays Health plan deductible and coinsurance Dental services and orthodontics Lasik surgery, glasses, contacts
– Dependent care expenses - Dependent children & adults Elderly parent or disabled spouse Daycare, camps
Flexible Spending Account (FSA)
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Examples of Ineligible Health Care Expenses
– Diet Foods
– Cosmetics, Cotton Balls, Teeth Whitening
– Vitamins, Supplements, Aromatherapy
– Shampoo, Toothpaste, Suntan Lotion
– Cosmetic Surgery (unless medically necessary and approved by the plan)
– Shaving cream, Razors, Soap and Hand lotions
– Over the Counter Medications without a prescription
Refer to IRS Publication 502 for more information about eligible and ineligible expenses
What is NOT covered under an FSA?
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Tax Savings ExampleBased on $30,000 annual salary
No Flexible Spending Account Flexible Spending Account
Gross Monthly Income $2,500 $2,500
Pre-tax Dependent Care $0 $867
Pre-tax Health Care Expenses
$0 $100
Taxable Income $2,500 $1,533
Federal Tax (15%) $375 $229
FICA (7.65%) $191 $117
After-tax Dependent Care $867 $0
After-tax Health Care Expenses
$100 $0
Monthly Take Home Pay $967 $1,187
Estimated Savings for Member who Participates in the Healthcare and Dependent Care Flexible Spending Accounts = $220 per month or $2,640 per year
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Using your FSA Debit Card Use your FSA Debit Card like a regular debit or credit card for
your FSA eligible expenses– At your Physician’s office or the Pharmacy for copays– NOTE: You can no longer receive
reimbursement for over-the-counter
medicine without a doctor’s prescription
based on the new healthcare law
No Credit Check needed
Benefits of using the Debit Card include:– Instant Reimbursement– Reduction in receipt submission– Up to 80% of total claims are auto-adjudicated
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PayFlex Contact Information 1-800-284-4885
Web Access – 24/7 secure site– Check account claims status– Look up qualified expenses– Download claim forms– Interactive tool to calculate tax savings– Online at www.healthhub.com
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Action Steps for Members Prior to August 9th at 5:00 pm:
Active members must submit changes and/or confirm all elections in Ebonline, and provide documents for newly added dependents to HR
Retired members who wish to make a change must do so by: submitting changes in EBOnline, or by mailing form to HR-Benefits (must be received by 8/9/13 at 5pm), or by faxing completed enrollment form to (727) 582-5893, or by e-mailing the completed enrollment form to [email protected]. If no change, no action is required.
Questions? Contact HR - Benefits at (727) 582-2835