benefits guide
for active state employees
effective january 1, 2008
Department of Management Services Division of State Group Insurance
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Notes
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Dear State of Florida Benefits Participant:
I am pleased to greet you as a new or returning participant in the State of Florida Group Insurance program. As a state employee, your public service plays a vital role in improving the lives of Florida’s citizens. YOU have the power to make a change! You also have the power to best care for yourself and your loved ones through the State of Florida Group Insurance Program. Each year, the Department of Management Services (DMS) Division of State Group Insurance offers an Open Enrollment period. During this period, you have the power to choose the most appropriate benefit plans for you and your family. Throughout the rest of the year, you will need to meet the criteria for a Qualifying Status Change (QSC) to change your coverage. A few examples of QSCs include the birth or adoption of a child, a marriage, or a divorce. Or, if you are a new hire, you have 60 days from the date you begin employment to enroll in state group insurance benefit plans. In this year’s Open Enrollment packet, we are including this Benefits Guide which provides information on all benefit plans including health and dental insurance, life insurance and supplemental insurance. Please take time to carefully review this information. Decisions regarding benefit plans affect you and your loved ones. To help you make the best decision, you will find the following items in this package: • • Your Summary of Benefits... showing you the benefits you will have in 2008 UNLESS you make a change during Open Enrollment. This Benefits Guide which answers many of your questions about the types of coverage available to you as a valued state employee. It includes: • • Important News for 2008 A dental comparison chart... an easy way to compare the increased dental offerings for 2008.
For assistance and information on benefit options, DMS offers the following resources: • • Visit www.MyFlorida.com/myBenefits for a complete guide of insurance options, including a cost calculator, plan details and plan comparisons. Visit the People First Web site to take advantage of the self-service option, which is the easiest way to make your benefit elections. You will need your People First user ID and password to log in. Select the “Health and Insurance” tab for enrollment information and opportunities. Call the People First Service Center, toll-free, at (866) 663-4735. Representatives are available Monday through Friday from 8:30 a.m. to 5:30 p.m. EDT. TTY users may call toll-free, (866) 221-0268.
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We take pride in serving you while carrying out our mission to “Serve Those Who Serve Florida.” We encourage you to take an active role in making decisions regarding your benefits. Sincerely,
Michelle Robleto, Director Division of State Group Insurance
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Table of Contents
Important News for 2008 …………………………………………………… 5 Making the Most of myBenefits ……………………………………………… 6 Basic Definitions for myBenefits …………………………………………… 9 Enrollment and Eligibility for myBenefits ………………………………… 10 myBenefits = myHealth ………………………………………………… 13 Preferred Provider Organization (PPO)……………………………… 14 Health Maintenance Organization (HMO) ………………………… 18 Prescription Drug Benefits ………………………………………… 22 Supplemental Insurance Plans ……………………………………… 22 myBenefits = myLife……………………………………………………… 34 myBenefits = myWealth ………………………………………………… 36 myPrivacy ……………………………………………………………… 39 Special Notice About the Medicare Part D Drug Program ………………… 42 Table of CharTs PPO Benefits-at-a-Glance ………………………………………………… 16 Standard HMO Benefits-at-a-Glance ……………………………………… 19 Dental Plan Comparison Chart ………………………………………… 24-25
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Important News for 2008
The Division of State Group Insurance (DSGI) is extremely proud to present this benefits package to you. You have an impressive selection of benefits to choose from; review this book and carefully consider your personal benefit needs. Your benefits are a valuable part of your state employee compensation. For 2008, we are pleased to offer a new life insurance carrier and several new dental plans - in addition to the already extensive list of insurance choices. Here are highlights of the new offerings: • Minnesota Life Insurance Company will be the new carrier for life insurance effective January 1, 2008. The benefits remain the same, but you must submit a new beneficiary Designation form to Minnesota life identifying who your beneficiaries are. Forms are available on the People First Web site and at www.minnesotalife.com. We are introducing new enrollment tiers for dental benefits. These tiers offer expanded coverage options to better fit your needs. Please note, unless you were enrolled in “employee only” you will be automatically moved to Family Coverage for 2008. You can change this selection during Open Enrollment if there is a tier that better matches your needs. The new tiers are: • • • • Employee Only Employee + Spouse Employee + Child(ren) Employee + Spouse + Child(ren)... also referred to as Family Coverage
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There are several new dental carriers. Read this guide or visit www.MyFlorida.com/myBenefits to learn more about the dental options available to you and your family. Remember... Some supplemental products require additional enrollment steps: • Enrollment for some supplemental products described in this guide requires completion of both the state’s enrollment process and the carrier’s application form. Unless both are completed and any required form appropriately submitted, you will not be enrolled. • For those products that require medical underwriting, you may have to provide some information or pass some type of medical test before you are accepted for coverage. Coverage is not effective until People First receives approval and a full month’s premium has been withheld.
The state is unable to offer a supplemental vision product for the 2007 Open Enrollment for the 2008 plan year. We encourage you to take advantage of the vision benefits offered by your health insurance plan.
This guide summarizes your choices and explains the steps to sign up for coverage. For more information call the People First Service Center at (866) 663-4735 (TTY users 866-221-0268) or visit www.MyFlorida.com/myBenefits. This guide also provides contact information for the different carriers, and you are encouraged to contact them directly with your questions or talk to company representatives at the Benefit Fairs scheduled during open enrollment. The plans and benefits descriptions included in this booklet are summaries and describe the options available to you. These are not intended to change or replace the express written terms of any policy, plan or coverage. Other Personal Services (OPS) employees are not eligible for the benefits listed in this publication.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Making the Most of myBenefits
Address Corrections
One of the most important ways to get the most out of your benefit options is to make sure that we have your correct and current address. It is extremely important for you to update your address and personal information via the Employee SelfService tool on the People First Web site at https://PeopleFirst.MyFlorida.com. If your address is not up-to-date, you may not receive important information, such as notification of Open Enrollment, benefit plan changes and documentation of proof of coverage.
Resources to Help You Choose
• • Benefits Guide The new myBenefits Web site at www.MyFlorida.com/myBenefits with convenient links to all our benefit vendors People First – the way to enroll online for most state benefits. Make sure you know your password or reset it by calling (866) 663-4735 or TTY (866) 221-0268.
The Importance of Choice
This year we have a new tool to help you review and understand your insurance options. The informational Web site, www.MyFlorida.com/myBenefits, provides easy access to publications, forms, information about coverage, descriptions of benefit plans, provider links, and other important information to make your choices easy to understand. •
2008 Enrollment Readiness Checklist
Use this checklist to help you make your benefit choices for 2008. Step 6 includes important information about enrollment deadlines. step 1: review Your Medical Plan options
Through the state, you and your family have a variety of medical plans available. To decide what’s best for you: ▶ Consider the medical and prescription drug needs you and your family may have in 2008 1. Make a note of any care you will need in 2008, such as an annual physical, suggested surgery, a baby on the way or prescription drugs you take regularly. 2. Consider the medical and prescription drug care you received in 2007. Will any of that care be repeated in 2008? What did it cost? 3. If you’re currently in the Standard or the Health Investor PPO, review your claims for the last year by logging on to the “myBlueService” page on the BlueCross BlueShield of Florida’s (BCBSF) Web site. You need your user BCBSF ID and PIN to log in; if you haven’t received one, register using your Social Security number and birth date. If covered dependents authorize you to see their claim records, gather the claim history for the entire family and use it to consider what your 2008 expenses may be. ▶ Understand your medical plan options Most employees have four types of health plans to choose from: • A standard Preferred Provider Organization with statewide coverage. • A Health Investor Preferred Provider Organization that’s also available statewide. • A standard Health Maintenance Organization Plan, depending on where you live or work. • A Health Investor Health Maintenance Organization Plan, again depending on where you live or work. Use the myBenefits Web site to learn more about how the plans work and what they cover.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Compare your options The state offers a Medical Plan Cost Comparison Tool to help you compare what your total costs are likely to be under each of the medical plan options – including what you pay for care and what you pay to purchase coverage. The tool is available on the myBenefits Web site. Check out the doctors, hospitals and other medical professionals participating in each plan. The standard and Health Investor PPO plans both use the same network of BCBSF medical professionals. The provider networks available under the HMO plans will vary by plan. Remember: With the PPOs, you receive a higher level of benefits when you use network providers; with the HMOs, there are no benefits for care outside the network (except in emergency situations). There are links to the BCBSF Web site and all the HMO Web sites from the myBenefits Web site. If you decide to participate, enroll in the plan that is best for you. See Step 6 for more information on how to enroll. Consider the dental care you and your family will need in 2008. 1. Make a note of any care you anticipate, like cleanings, crowns, fillings or orthodontia. 2. Consider the dental care you received in 2007. Will any of that care be repeated in 2008? What did it cost? Understand your dental options Most employees have an expanded set of options for 2008 that fall into one of three categories: 1. A standard statewide dental PPO Plan through CompBenefits 2. Dental indemnity plans – through Ameritas, Assurant and American Dental Plan 3. Dental HMOs (DHMOs), depending on where you live – through American Dental Plan, Assurant, CIGNA, CompBenefits and UnitedHealth Care Use the dental plan comparison in this Guide or go to the myBenefits Web site to learn more about how the plans work and what they cover. Keep in mind that the services offered will vary; some plans do not include orthodontia, for example.
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step 2: evaluate the Dental Plans ▶
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Check out the dentists participating in each plan. There are links to plan Web sites for each of the dental plans on the state’s myBenefits Web site. Remember: With the PPO, you receive a higher level of benefits when you use network providers; with the DHMOs, there are no benefits for care outside the network. Call your desired dentist or dental group to confirm that they are accepting new patients and will accept your insurance plan. Compare your options Once you narrow your dental plan choices based on where you live, the covered services and the dentists in their networks, use the Dental Plan Cost Comparison tool on the myBenefits Web site to compare your likely total cost under each of the options on your list. The tool adds up what you pay for care (based on services you think you will need) and what you pay to purchase coverage. If you decide to participate, enroll in the plan that is best for you. See Step 6 for more information on how to enroll. ask yourself: Will I have out-of-pocket costs for health care or prescription drugs? What about expenses for child care, a disabled spouse or elderly dependents who need care while I work? If your answer to either question is yes, consider the pre-tax benefits of the reimbursement accounts.
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step 3: Consider reimbursement accounts (flexible spending accounts) ▶
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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learn more about the accounts. There is information in this Benefits Guide for Active State Employees and on the myBenefits Web site. Use the online flexible spending account estimator tools to calculate how much to contribute and the estimated tax savings. If reimbursement accounts are a good fit, enroll. See Step 6 for more information on how to enroll. learn more about your options. Most full-time employees are eligible for: • • Basic term life insurance with Accidental Death and Dismemberment in an amount based on employment classification, and Optional term life insurance from one to five times base annual earnings, up to a maximum of $500,000 in coverage.
step 4: review Your life Insurance options ▶
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Think about your family needs in the event of your death. What expenses would they have on an ongoing basis such as daily living expenses, college education, and what financial resources would they have to draw on? select your coverage amount and enroll. See Step 6 for more information on how to enroll.
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step 5: Consider supplemental benefits We offer a variety of additional benefits from hospitalization and intensive care coverage to cancer insurance, accident insurance and disability coverage that provides continuing income if a disability keeps you from working. ▶ ▶ ▶ learn more about these programs by visiting the mybenefits Web site. It includes copies of the brochures that describe these programs and links to the companies offering these plans. Consider your income protection needs. Most of these programs provide income benefits if you and/or covered family members suffer from illness or injury. If you decide you want to participate, enroll in the plan (s) that are best for you. See Step 6 for more information on how to enroll.
step 6: enroll Make your 2008 benefit selections on the People First Web site or by telephone through People First or by completing and returning an enrollment form. state employees participating in the spouse Program must submit a spouse Program enrollment form, available on the People first Web site. 1. For annual enrollment, you must enroll by 5:30 p.m. eDT on october 26, 2007. 2. As a new hire in 2008, you have 60 days from your date of hire to enroll, or 60 days from the start of a new term of office if you are a state elected official. 3. If you are enrolling in 2008 because of a qualifying change in status, you have 31 days from the qualifying status change to make related benefit changes. For the death of a spouse or dependent or for a birth or adoption you have 60 days to make related benefit changes. Some of the supplemental plans require a second step and ask that you complete a separate application for medical underwriting and submit it to the insurance company for their approval. The medical underwriting questionnaires/forms are available on each company's Web site via links from the People First Web site.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Basic Definitions for myBenefits
• annual Maximum – Total dollar amount a medical or dental plan will pay during a calendar year toward the covered expenses of each person enrolled. Co-insurance – Co-insurance is a percentage you are required to pay for certain services you receive after meeting the calendar year deductible. Co-payment – Set dollar amount you pay for network doctor office visits and specified in-network preventive care. No other fees or deductibles apply. Deductible –Total dollar amount you must pay for covered medical care each calendar year before the State Employees’ PPO Plan or the Health Investor PPO plan pays benefits for most services. Deductible does not apply to network preventive care and any services where you pay a co-payment rather than co-insurance. Some of your dental options also have an annual deductible – generally for basic and major dental care services. • flexible spending account (fsa) – Account that allows you to reimburse yourself with pre-tax dollars for eligible outof-pocket health care costs and/or the costs associated with caring for a dependent. With these accounts, you decide what you want to contribute before the start of a plan year. If you do not submit claims for the plan year by the April 15th filing deadline for the entire amount you had withheld, you lose the unused money. health Investor hMo and PPo – The state’s name for two of its medical options where you pay a higher deductible in exchange for: Lower cost to buy coverage (payroll deductions) than the State Employees’ Standard PPO or the Standard HMO. The opportunity to have a Health Savings Account that can be used to pay eligible health care expenses with pre-tax dollars, and is partially funded by the state. health Maintenance organization (hMo) – A prepaid medical plan in which you agree to use a specific, more limited network of providers. health savings account (hsa) – An account associated with the Health Investor HMO and PPO that allows you to use pre-tax dollars to pay your share of the cost for eligible medical, dental or vision care services that aren’t covered by your medical or dental plan. When you are eligible for an HSA, the state makes a contribution to your account; you may also add your own contributions to your HSA. The HSA differs from an FSA in three ways: • • • You must be in a Health Investor medical option to contribute to an HSA. Any unused HSA funds at the end of a year carry forward to the next year; you may also take unused HSA balances with you if you stop working for the state. You must open a personal HSA bank account at Tallahassee State Bank by completing the HSA Bank Account Application on the People First Web site. lifetime Maximum – Combined total dollar amount the State of Florida medical plans pay toward the covered expenses of each person enrolled in the PPO plan while covered as an employee or an employee’s dependent. out-of-Pocket Maximum (medical plan) – Annual dollar limit an individual or family pays in medical co-insurance in a calendar year. The PPO plan pays 100% of eligible expenses when you reach the out-of-pocket maximum. This feature provides financial protection for you by limiting your out-ofpocket expenses in a given calendar year. Pre-Determination of benefits (Dental) – A request you can submit to find out in advance how much the plan will pay for recommended dental care. This feature can be particularly useful in the PPO or indemnity dental plans where you pay a percentage of the cost. The process is not required but can help avoid surprises. Preferred Provider organization (PPo) – A plan offering discounted rates on services if you use providers in the network. If you use services outside of the network, you are reimbursed a smaller portion of the charges. Primary Care Physician – The health care professional who monitors your needs and coordinates your medical care, including referrals for tests or specialists. Provider Network – A group of health care providers, including physicians, hospitals and other health care providers, who agree to accept pre-determined rates when serving members. Qualifying status Change – A specific event or change meeting federal guidelines that allows you to make changes to your benefit elections outside of the annual Open Enrollment period. A QSC is a change in employment status (e.g., beginning or terminating employment with a new employer), loss of insurance coverage and certain personal status changes (e.g., marriage, having children or acquiring other new dependents). •
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Enrollment and Eligibility for myBenefits
General Enrollment Information
We offer all benefit plans, other than the optional life insurance, on a pre-tax basis. This means, because you are an active state employee, your health insurance premiums are deducted from your paycheck before taxes are taken out. As part of our pre-tax offerings, federal regulations require us to conduct an Open Enrollment period once a year. During this time, you can make changes for the upcoming plan and tax year beginning January 1. During Open Enrollment, you can enroll for the first time, make changes to your current plans or cancel participation. Except for certain underwriting requirements of some supplemental insurance plans, you do not have to “qualify” to make changes during Open Enrollment. We encourage you to carefully consider all available options during Open Enrollment. Outside of the annual Open Enrollment period, state and federal regulations prohibit additions, changes or cancellations in pre-tax plans unless you experience a Qualifying Status Change (QSC) event. (See the Definition section for more information on QSCs.)
Enrollment Opportunities
There are three opportunities to make benefit elections: 1) when you are hired as a new employee 2) when you have a QSC event 3) during Open Enrollment
Option 1 – Hired as a New Employee
If you are a newly-hired full-time or part-time employee, you have 60 days from the date you begin employment to enroll in state group insurance benefit plans. You can enroll on line at the People First Web site. If you do not enroll within 60 days from the date your employment began, you cannot enroll until the next Open Enrollment period. Choose your options carefully. Once enrolled, you cannot make changes until the next Open Enrollment unless you have a QSC event.
Option 2 - Qualifying Status Changes
If you have a QSC, you typically have 31 days from the date of the QSC to make any changes to your benefits (like enrolling, increasing coverage or changing family status). You have 60 days from the date you make changes to your benefits to submit any required documentation. Currently, the following are some, but not all, valid QSC events: • Marriage or divorce • Death of a spouse or dependent, a birth or adoption (60 days for notice rather than 31 days) • Legal guardianship • Change in dependent eligibility • Change in employment status for you, your spouse, or dependent: • • • Termination of spouse’s or dependent’s employment Unpaid leave of absence longer than one calendar month Change from part-time to full-time status or vice versa
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
If you have a QSC and want to change your benefits selections, complete the following steps: 1. 2. Make the change online at the People First Web site within 31 days of the event. If your QSC is not listed, then contact the People First Service Center . Complete all required forms authorizing the change. The People First Service Center must receive the required enrollment forms within 31 days of the QSC event. If the forms are received after 31 days, your change(s) will be denied and you will not be able to make changes until the next Open Enrollment. Provide the supporting documentation (e.g. marriage certificate, birth certificate, divorce decree, etc.).
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(Note: To make an enrollment change based on a QSC, federal law requires the event to result in a gain or loss of eligibility for coverage, and general consistency rules must be met. For example, if you have family health insurance coverage and you get a divorce and no longer have dependents, you may change from family to individual coverage. However, you cannot cancel enrollment in health insurance because the QSC event only changes the level of coverage eligibility. Cancellation would not be consistent with the nature of the QSC event.)
Option 3 - Open Enrollment
We have Open Enrollment each year to give you an opportunity to review benefit plan options and make changes for the following plan year. It is usually held in the fall. All benefits chosen during this time take effect on January 1 of the following calendar year. The benefit plan year is January 1 through December 31. Before Open Enrollment begins, we mail and/or e-mail notices announcing Open Enrollment dates so you can confirm your address, update your password and be ready to make your selections. We encourage you to take full advantage of this once-a-year opportunity to review your benefit plans and select the options that best meet the needs of you and your family.
General Eligibility Information
All active full-time or part-time State of Florida employees qualify for coverage under the benefit plans described in this guide. If you work part time, you should contact the People First Service Center to find out the cost of coverage since you will be paying proportionately more. OPS employees do not qualify for any of the benefits in this publication.
Dependents eligible for coverage:
• • Your legal spouse Your natural children, legally-adopted children, and children placed in the home for the purpose of adoption in accordance with Chapter 63, Florida Statutes Stepchildren Foster children Children for whom you have established legal guardianship (Chapter 744, Florida Statutes) or court-ordered temporary custody
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To ensure appropriate coverage, you must provide documentation for the dependent(s) you have added to your plans. This documentation can be mailed to:
If you do not provide documentation, you may lose coverage for your dependent. You or your dependent may also be responsible for any cost for services received while your dependent was listed as eligible.
State of Florida People First Service Center P.O. Box 6830 Tallahassee, FL 32314
You can also fax the information to (904) 828-6092.You must write your People First ID Number on the top right corner of each page of your fax.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Generally, children must be under the age of 19 and dependent on you for support. Eligibility for dependent children usually ceases at the end of the month the child turns 19 years old, but over-age dependent children and children with disabilities may be covered beyond the age of 19. • Over-age dependent children: From age 19 through the end of the calendar year when the child turns 25, children must meet both of the following criteria to remain eligible dependents: • • • Must be dependent on you for financial support, and Must either live with you or be a full-time or part-time student
Children with disabilities: Children who have mental or physical disabilities are eligible to continue coverage after they attain these age limits when you enroll or while your family coverage is in effect, provided that they are incapable of selfsustaining employment because of mental or physical disability and are chiefly dependent on you for financial support and maintenance.
Spouse Program
When you and your spouse are active state employees, you are eligible for health insurance coverage at no cost to you. If you meet this criteria, you must take the following steps to enroll in the Spouse Program: • • • • You and your spouse complete the Spouse Program Enrollment Form located on the People First Web site under Health & Insurance / Benefits Materials. Be sure to Identify all eligible dependents. Attach your marriage license to the enrollment form when you submit it to the People First Service Center. Include your People First ID number on each page. You and your spouse must enroll in the same health plan. You and your spouse must agree to notify the People First Service Center within 31 days of becoming ineligible for the Spouse Program. Employees become ineligible for the Spouse Program due to one of the following: • • • One or both terminate employment In the event of a divorce One or both retire
If the People First Service Center receives notification that one of you becomes ineligible for the Spouse Program, we notify the other spouse and instruct him or her to change to other appropriate coverage. If you fail to notify the People first service Center of your ineligibility for the program, you may be liable for incurred medical claims and any premiums paid by the state during the time you were not eligible.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
One of the most important benefits available to you from the state is health insurance. There are a number of things to consider before selecting a health plan. Keep in mind, one plan is not better than another; each plan simply offers different benefits. Carefully consider the health care needs of you and your family and review the comparisons and other materials available before making your selection.
myBenefits = myHealth
Things to Consider When Choosing Health Insurance
• While the core benefits between the PPO Plan and the HMO plans are similar, there are differences. PPO coverage has broader provider access. Both plans contract with networks of providers to deliver services. HMO plans require you to use an exclusive network of providers for services with very few options for using non-network providers. In the State Employees’ Standard PPO Plan, you have the option of using out-ofnetwork providers, but this may result in additional costs. PPO plans allow you to self-refer or visit specialists without approval from a primary care physician. Some HMO plans require you to first obtain a referral from your primary care physician to have your treatment by a specialist covered under the plan. All Standard HMO plans charge co-payments for visits. A co-payment is a fee you pay to visit a provider. The Standard PPO Plan has deductibles, co-insurance and co-payments. Health Investor PPO and Health Investor HMO plans have higher deductibles and co-insurance. Co-insurance is a percentage you are required to pay for certain services you receive after meeting the calendar year deductible. HMO plans typically provide care through regionally-based networks of providers; these plans cover out-of-network care only in emergencies. To enroll in an HMO, you must therefore live or work in its service area. If you choose an HMO, make sure coverage is available. The State Employees’ Standard PPO Plan uses a statewide network and offers outof-state coverage through the BlueCross BlueShield BlueCard™ Program. If you spend a lot of time traveling or do not live in Florida, the State Employees’ Standard PPO Plan may be more suitable to your needs. We recommend that you select a plan with providers you would feel comfortable using in the event that your current provider’s relationship with a plan ends. •
You may choose between four types of health plans: • the State Employees’ Standard Preferred Provider Organization (PPO) plan, • a Health Investor PPO plan, • a Standard Health Maintenance Organization (HMO) plan*, or • a Health Investor HMO plan.* *HMO coverage is only available if you live or work in the HMO’s service area. These are managed-care plans, which mean they have specific provider networks you are expected to use. If you use a provider outside of the plan’s network, you may have higher out-of-pocket costs. To get the maximum benefits from your plan, you may need to follow specific procedures before receiving care. If you work full-time, you pay the same premium whether you choose the State Employees’ Standard PPO or a Standard HMO. You pay the same reduced premium for the Health Investor PPO and the Health Investor HMO. Although part-time employees pay a higher contribution than full-time employees, their premium for each of the plans is the same. If you are a part-time employee, contact the People First Service Center or visit the People First Web site to learn how much your premiums will be. Please note, the Florida Legislature decides how much insurance contributions are and may change the amounts during the course of a plan year.
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Carefully consider all of these factors.You should call the plans to learn more. The People First Web site provides links and contact phone numbers for all of the plans outlined in this guide. To further help you, the Agency for Health Care Administration has a Florida Health Plans Consumer Information Web site that evaluates all the health plans in Florida, with their findings posted at: http://healthplans.floridahealthstat.com.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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The following is a brief description of each type of plan.
Preferred Provider Organization (PPO)
The State Employees’ Standard PPO Plan is a self-insured health plan administered by BlueCross BlueShield of Florida, Inc. (BCBSF). As the administrator, BCBSF processes health claims, supplies the preferred provider care network and provides customer service. To learn more about BCBSF, contact them at (800) 825-2583 or visit www.bcbsfl.com. Pharmaceutical services are administered by Caremark. Caremark can be contacted by calling (800) 378-4408 or visiting www.caremark.com. Charges for the State Employees’ Standard PPO plan and Health Investor PPO plan include: • • Pre-negotiated fees: the plan negotiated in advance with a network provider are usually lower than the provider’s actual charge. Annual Deductible: a yearly amount you are required to pay first for certain services before the plan starts paying. The deductible varies based on the network status of the provider you choose, either a network or non-network provider and the type of plan, either individual or family. Once your deductible is met, you will typically only pay your co-insurance or copayment. Co-insurance: a percentage of the medical costs you are required to pay for certain services after your annual deductible is met. Co-payment: a per visit fee for select services.
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The State Employees’ Standard PPO plan and Health Investor PPO plan rely on a network of providers contracted with BCBSF. When you need to see a provider, you have the freedom of choice to visit a network provider or a non-network provider. You should contact BCBSF Customer Service to find out if using a non-network provider will cost you more. Network providers include physicians, hospitals and other providers who will charge you no more than a pre-negotiated fee for covered
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
services. This fee is generally lower than the provider’s actual charge and you do not pay more than this pre-negotiated fee. Choosing a network provider saves you money. Non-network providers do not participate in the preferred provider network. hospital-based physicians such as radiologists, pathologists, anesthesiologists and emergency room physicians may be non-network providers. When you receive covered services from a non-network provider, you will have to pay higher non-network deductibles, co-payments and co-insurance costs. For these services, you will be billed directly by the provider for the difference between the amount BCBSF allows for a covered service and the non-network provider’s actual charge for that service. When care is provided by a non-network provider, the plan will pay the provider a formula-determined amount based on the type of service provided. The non-network provider’s actual charges often exceed these amounts. If that occurs, the enrollee will experience higher out-of-pocket costs than those associated with services from a network provider. You are responsible for checking to see if your provider is part of the BCBSF network before you receive service. Otherwise, you may have to pay more than you expected. You can find this out by searching the provider networks of the BCBS plans across the country through the BlueCard® Program. Even if you travel outside of Florida you receive the same coverage you would receive in Florida when a provider or hospital is part of the network. If you have questions about the BlueCard® Program, contact (800)-825-BLUE (2583). You can learn more about out-of-state participating PPO providers by calling (800)-810-BLUE (2583) or visiting www.bluecares.com.
Vision Care Coverage
Discounted coverage for exams, glasses and some corrective surgeries is available to PPO members through BCBSF’s Enhanced Vision Care program. You pay $40 for eyeglass exams and save up to 40% off retail prices for frames and lenses. You can also take advantage of the discounts offered through the TruVision contact lens mail order service. Use your ID card to receive discounts at participating providers including optometrists, ophthalmologists, opticians or optical retailers. You can find more details and participating providers by going to the “BlueComplements” information sheet on the Members site at www.bcbsfl.com or by calling (800) 825-2583.
Maximum Lifetime Benefit
The State Employees’ Standard PPO Plan and Health Investor PPO plans pay a maximum of $2 million during your lifetime.
Maximum Annual Out-of-Pocket Expenditures
The State Employees’ Standard PPO Plan has a $2,500 (individual) or $5,000 (family) annual out-of-pocket maximum limit. Your coinsurance amounts count toward this limit. Once you reach this maximum dollar amount in a calendar year, the plan will pay 100 percent of your co-insurance or allowed amount for covered expenses for the rest of the calendar year. The Health Investor PPO plan requires you to pay up to $3,000 (individual) for network providers and $7,500 (individual) for nonnetwork providers each year. For family coverage, you pay up to $6,000 for network providers and $15,000 for non-network providers each year. Once you’ve reached this maximum dollar amount in a calendar year, the plan pays 100 percent of the allowed amount for covered services for the rest of the calendar year. for the state employees’ standard and health Investor PPo plans, deductibles, office visit and er co-payments, non-covered services and/or supplies, per admission fees and provider charges exceeding the plan’s allowed amounts do not count toward the annual out-of-pocket maximum limit.
Pre-existing Condition Limitation
The State Employees’ Standard PPO plan and Health Investor PPO plan have a “6 month/12 month” pre-existing condition limitation for new members. A pre-existing condition may be diabetes, asthma or some other condition that you or your dependent(s) have been diagnosed with or treated for during the 6 months before your coverage began. If you or your dependents have a pre-existing condition, the State Employees’ Standard PPO plan and Health Investor PPO plan will not cover services for this condition for 12 months after your coverage begins. However, if you and your dependent(s) had prior health insurance coverage, and it has been less than 63 days since that coverage ended, you may be eligible to have all or part of the pre-existing condition limitation waived. If you would like to be excluded from pre-existing condition limitation, submit a “waiver of the pre-existing limitation” to the People First
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com 15
Service Center. You will need a Certificate of Creditable Health Insurance Coverage or Portability from your previous insurer which provides your covered family members’ beginning and ending dates of coverage. People First will review your information and contact you about your eligibility for a waiver.
PPO Benefits-at-a-Glance
state employees’ PPo
Covers care received in or out of network
You meet annual deductible
• Individual • Family What you pay for care received • Doctor office visits • Hospital stay
Network
$250 $500 $15/visit for PCP; $25/visit for specialists
Non-Network
$750 $1,500 40% of non-network allowed amount plus amount between charge and allowed amount $500/admission then 40% of non-network allowed amount plus amount between charge and allowed amount
$250/admission then 20% of network allowed amount
• Prescription drug (provided by Caremark) • generic • preferred brand • non-preferred brand
Up to 30-day retail or 90-day mail order prescription
$10/retail; $20/mail order Pay in full and file a claim $25/retail; $50/mail order Pay in full and file a claim $40/retail; $80/mail order Pay in full and file a claim
Preventive care; some routine physical exams, health screenings and immunizations
40% of non-network allowed amount plus amount between charge and allowed amount; see preventive care. annual out-of-pocket co-insurance maximum (not including deductible, co-payments, cost of care not covered by plan) • Individual coverage $ 2,500 network & non-network combined • Family coverage $5,000 network & non-network combined after your out-of-pocket co-insurance costs reach these maximums, for the rest of the calendar year, the plan pays 100% for covered co-insurance in most cases, up to the allowed amount
100% of allowed amount; see preventive care.
In addition: • Network co-payments make doctor visit and prescription drug costs more predictable. • Plan pays 100% of allowed amounts for some preventive care services received from network providers. • You meet an annual deductible and pay a co-insurance percentage of most other costs. For more information, see the BCBSF-PPO Brochure that summarizes the State Employees’ PPO Plan on the People First Web site.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Health Investor Preferred Provider Organization
Like the current State Employees' PPO Plan, the Health Investor PPO gives you flexibility to see network or non-network providers, with a lower cost to you when you use network providers. If you are Medicare-eligible, the Health Investor PPO provides secondary coverage paying benefits after Medicare pays it's benefits.
Prescription Drug Benefit
Prescription drug benefits for the State Employees’ Standard PPO plan and Health Investor PPO plan are administered by Caremark, L.L.C. Caremark is a pharmacy benefit management company providing your comprehensive prescription benefit management services. To learn more, call (800) 378-4408 or visit www.caremark.com.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Health Maintenance Organization (HMO)
Each HMO is a self-administered, pre-paid health plan providing health services for people who live or work within the HMO’s service area. There is limited or no coverage for services outside their service areas except in limited circumstances. Carefully consider the HMO’s policy, especially if you have dependents who do not live in the service area. Do not choose your HMO plan only because a particular physician, physician group, hospital or other provider participates in a plan. At any point providers can leave the HMO. If this happens, you will have to choose a new provider from the network. If you continue to use the provider who is not part of the network, you will have to pay for services. You will not be able to change health plans simply because your doctor leaves the health plan, except during the annual Open Enrollment period. HMO plans focus on prevention, early detection and treatment of illnesses to reduce expensive and inconvenient hospital stays. There are no pre-existing condition exclusions or waiting periods. HMO coverage is not available in all Florida counties. To find out if your county offers HMO coverage, visit the People First Web site or call the People First Service Center. For some HMOs, you must choose a primary care physician within the HMO provider network. A primary care physician is the provider you visit for most of your health care needs. If you need to see a specialist for a specific concern, the primary care physician must make a referral for you. (Please note: You do not need a referral to see dermatologists, gynecologists, chiropractors, podiatrists or for emergency care.) If you decide to change your primary care physician, you must contact the HMO and complete the necessary paperwork. Some participating HMOs do not require referrals from your primary care physician, but you will need to use specialists in the HMO network. Primary care physicians and other providers vary among HMOs and the list can change at any time. You should contact the HMO and review the network providers. There is a list of the HMOs and their contact information on the People First and myBenefits Web sites. The Agency for Health Care Administration publishes an HMO Report Card that evaluates the services provided by HMOs in Florida. Please visit www.floridahealthstat.com and select"Health Plans," then "HMO Report." It can also be obtained by mail from the State Center for Health Statistics by calling their toll-free number at (888) 419-3456. Charges for HMO plans include: • • • Co-payment: a payment for office visits, rehabilitation therapy, emergency room visits and hospital admissions fees. Co-insurance: a percentage of the medical and pharmacy costs you are required to pay after your annual deductible is met. Annual Deductible for the Health Investor HMO: Aside from some preventive services, this is a yearly amount you are required to pay for services. The annual deductible is $1,250 individual and $2,500 family. Once your total annual deductible is met, you pay the co-insurance amount. Charges for the Health Investor HMO include:
Vision Care Coverage
Routine eye exams are covered as part of your preventive benefit package when you enroll in an HMO. HMO plans may also offer significant discounts on glasses, contact lenses and some corrective surgeries. Contact the HMOs available in your area to get details on the vision care discounts they offer.
Health Investor Health Maintenance Organization Plan
While the Health Investor HMOs cover all the same services and supplies as their traditional HMO counterparts, there are some key differences. Under the Health Investor HMO: • • If you contribute toward the cost of your coverage, your monthly insurance premiums are lower. If you or your covered dependents do not have other medical coverage, you may open a Health Savings Account and make pretax contributions to it. You can use the HSA to pay out-of-pocket expenses like your deductible and coinsurance - now or in the future. For specific preventive care services, there's no deductible.
•
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Standard HMO Benefits-at-a-Glance
standard hMos Covers care received in network only No annual deductible • Individual coverage $0 • Family Coverage $0 What you pay for care received • Doctor office visits $ 15/visit for PCP; $25/visit for specialists • Hospital stay • Prescription drug • generic • preferred brand • non-preferred brand Annual out-of-pocket maximum • Individual coverage • Family coverage Preventive care: routine physical exams, health screenings and immunizations at specified intervals $250/admission $10/retail; $20/mail order $25/retail; $50/mail order $40/retail; $80/mail order $1,500 $3,000 See the HMO’s certificate of Insurance for specifics for the HMO you are considering
View a list of the standard HMOs offered in 2008 and the areas where each is available. The 2008 Benefit Statement you receive in late September 2007 will show the specific HMO options available to you. aDverTIseMeNT
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Prescription Drug Benefits
All your health insurance options include comprehensive prescription drug coverage with two components: a network-based retail program and a mail-order pharmacy program. For the State Employees’ Standard PPO and the Standard HMO plans, retail co-payments, for up to a 30-day supply are $10 for generic, $25 for preferred brand name and $40 for non-preferred brand name drugs. Co-payments for the mail order program for up to a 90 day supply are $20 for generic, $50 for preferred brand and $80.00 for non-preferred brand drugs. You will need to have your doctor write your prescription for up to a 90-day supply to take advantage of the savings offered by the mail order program. Preferred brand drugs are medications on the preferred drug lists supplied by Caremark, the pharmacy benefits administrator for the State Employees’ Standard PPO plan and Health Investor PPO plan, and by each of the various HMOs. Non-preferred brand drugs are brand name medications that do not appear on any of the preferred drug lists. For the Health Investor PPO and Health Investor HMO, you must first satisfy the appropriate individual or family annual deductible. After paying this deductible, your co-insurance for retail and mail order drugs is 30 percent for generic and preferred brand drugs and 50 percent for non-preferred brand drugs. In all of the plans described above, if you request a brand name drug when a generic is available, you must pay the difference between the generic and brand name drug, plus the appropriate co-payment or co-insurance. If your physician writes on the prescription that the brand name drug is medically necessary, you will only pay the appropriate co-payment or co-insurance.
Supplemental Insurance Plans
The state offers you the opportunity to participate in optional “employee-pay-all” supplemental insurance plans. Like the other health plans, the premiums for these plans are deducted on a pre-tax basis (withdrawn from your paycheck before taxes are taken out). These plans are called employee-pay-all because you pay the entire premium. These supplemental, employee-pay-all plans are made available to you as a convenience. To learn more about each of these plans, visit the People First or myBenefits Web sites which list contact information for all of the plans.
Supplemental insurance products include:
• • • • Dental Insurance Supplemental Hospitalization Insurance Cancer and Cancer/Intensive Care Insurance Accident and Accident/Disability Insurance
Most of these plans offer a variety of benefit and premium levels. Some pay you cash if you need hospitalization, are treated for cancer, spend time in an intensive care unit, have an accident, or become disabled. There are a number of options within each plan, so you can choose different levels of coverage for different premium payments.
Most of the Disability, Cancer and Cancer/Intensive Care insurance plans require medical underwriting, which means you may have to provide some information or pass some type of medical test before you are accepted for coverage. To enroll, you will need to submit applications to the companies directly in addition to enrolling online on the People First Web site. To enroll in Disability plans, you will need to first contact the company to find out what your premium will be and then submit your enrollment forms to the People First Service Center. You cannot enroll in a Disability plan on the People First Web site. You can enroll in the Cancer, Cancer/Intensive Care and Hospitalization plans on the People First Web site during Open Enrollment or as permitted by a QSC or when you are first hired. You must also submit separate applications to the companies.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
Dental Plans
We offer a wide variety of dental plan choices. Each plan has different co-payments, services and providers. You should closely review these plans to determine which one will best fit the needs of you and your family. A comparison chart can be found at the myBenefits Web site and in this benefits guide. In addition to dental benefits, some dental plans also provide you with discounts for vision services. You should contact the plans directly to learn more. There are three types of plans and various company products to choose from:
Dental Health Maintenance Organizations (DHMO)
A DHMO (or more specifically, a pre-paid limited service plan) maintains affordable premiums and low out-of-pocket expenses through a network of participating general dentists. You will pay a co-payment. Before you enroll in a DHMO, make sure the plan has dentists in your area who are accepting new patients and can offer adequate appointment times. Do not choose a DHMO plan only because your dentist is part of the plan. At any time, your dentist might leave the DHMO and you will have to choose a new dentist from the provider network. If you continue to use a dentist who is not part of the network, you will have to pay for services. You cannot change dental plans based on provider preference, except during the annual open enrollment period. • American Dental Plan: call (866) 879-3630 or visit www.compbenefits.com/custom/adpstatemployees • Assurant: call (800) 277-2300 or in Tallahassee (850) 386-2300, or visit www.AssurantHealth.com • Cigna: call (800) 244-6224 or visit www.cigna.com or Capital Insurance at (800) 780-3100, www.capitalins.com. • CompBenefits: call (800) 943-6880 or visit www.CompBenefits.com.* • UnitedHealthcare: call (800) 980-0292 or visit www.myuhcdental.com. *CompBenefits has two different DHMO plans for you to choose from, so be sure to request information about each plan.
Dental Preferred Provider Organization (DPPO)
A DPPO offers you discounted fees from a network of preferred dentists. • CompBenefits: call (800) 943-6880 or visit www.CompBenefits.com.
Dental Indemnity
A dental indemnity plan allows you to visit any dentist you choose and pays a percentage of usual charges for covered services. You will want to ask about these charges before receiving services. • Ameritas Group: call (877) 721-2224or visit www.ameritasgroup.com. • Assurant: call (800) 277-2300 or in Tallahassee (850) 386-2300, or visit www.AssurantHealth.com. • American Dental Plan: call (866) 879-3630 or visit www.compbenefits.com/custom/adpstatemployees
Enroll in or Make Changes to a Dental Plan
Ways to Enroll:
1. Log on to https://PeopleFirst.myFlorida.com, or 2. Complete the state Dental Enrollment Form and mail it to the People First Service Center, P.O. Box 6830, Tallahassee, FL 32314, or fax it to (904) 828-6092. Be sure to list all dependents to be covered. 3. Call People First at (866) 663-4735.
Note: To enroll in a DhMo or Prepaid Plan, you may need to select a dental facility from the company Web sites listed above. Do NoT enroll in a DhMo or Prepaid Plan before making sure there is a dental provider available to you.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Dental Plan Comparison Chart
You have more dental options than ever before as a state employee. This chart helps you compare dental plans so you can choose the one that best meets the needs for you and your family. The rows show how much you pay each month and the amount or percentage you would pay for the common services listed. The columns indicate the costs associated for each individual plan. “Cost above” means that you will pay for any cost higher than the amount listed below.
DENTAL CHOICES
Monthly Premiums Employee Employee + Spouse Employee + Child(ren) Employee + Spouse + Child(ren) Annual Deductible Calendar Year Maximum ***Preventive Care (no deductible) Periodic oral exam (ADA 103, 120) Bite-wing X-rays (ADA 274) Cleanings (Dental Prophylaxis – ADA 1110) Fluoride treatments (ADA 1201, 1203) Sealants (ADA 1351) Space maintainers (ADA 1515) ***Basic and Major Care (after deductible, if applicable) Complete series or panoramic X-rays (ADA 210/330) Amalgam fillings (ADA 2150) Composite resin fillings (ADA 2331) Root canal (ADA 3330) Periodontal surgery – gingivecotomy, per quadrant (ADA 4210) Root planing, per quadrant (ADA 4341) Surgical extraction of tooth, including wisdom teeth (ADA 7240) General anesthesia, each 30 minutes (ADA 9220, 9230) Crowns (ADA 2750) Fixed bridges (ADA 6240) Full lower denture (ADA 5120) Inlays and onlays (ADA 2520) Partial dentures (ADA 5214) Re-cement bridges, crowns, inlays (ADA 2920) Relining dentures (ADA 5730) Repairs to full dentures, partial dentures, bridges (ADA 5510) ***Orthodontia Care Child 24-month treatment fee (ADA 8670) Adult 24-month treatment fee (ADA 8670) $0 $0 $0 $0 $0 $0**
PPO
CompBenefits Plan # 4054 $26.82 $49.62 $55.44 $80.50 In-Network Out-of-Network Employee: $25 Employee: $50 Family: $50 Family: $100 $1,200/person You Pay: 20% 20% 20% 20% 20% 20% You Pay: $0 20% 20% 20% 20% 20% 20% 20% 50% 50% 50% 50% 50% 50% 50% 50% You 50%; $1,500 lifetime Pay: max benefit 50%; $1,500 lifetime max benefit 20% 50% 50% 50% 50% 50% 50% 50% 70% 70% 70% 70% 70% 70% 70% 70% Cost above $45 Cost above $32 Cost above $38 Cost above $238 Cost above $253 Cost above $52 Cost above $104 Cost above $80 Cost above $156 Cost above $151 Cost above $166 Cost above $123 Cost above $193 Cost above $12 Cost above $58 Cost above $32 Cost above $14 Cost above $20 Cost above $30 Cost above $11 Cost above $17 Cost above $174 Ameritas Plan # 4064 $8.84 $17.76 $23.12 $32.04 $50 $1,000/person
Indemnity
Assurant Plan #4074 $38.35 $73.63 $86.76 $114.77 $50/person; 3 per family $1,250/person in network; $1,000/person out-ofnetwork You Pay: $0 $0 $0 $0 $0 $0 You Pay: 20% 20% 20% 75%* 75%* 75%* 20% 20% 75%* 75%* 75%* 75%* 75%* 75%* 75%* 75%* You Pay: 50%; $1,000/child lifetime max benefit 100% American Dental Plan Plan # 4084 $14.74 $21.96 $23.30 $37.10 $50 $1000/person
Cost above $11.70 Cost above $16.20 Cost above $18.90 Cost above $15.30 Cost above $6.30/tooth Cost above $108
Cost above $23.40 Cost above $18 Cost above $22.50 Cost above $243 Cost above $51.30 Cost above $14.40 Cost above $61.60 Cost above $30.60 Cost above $180 Cost above $180 Cost above $129.60 Cost above $26.10 Cost above $79.20 Cost above $11.70 Cost above $32.40 Cost above $26.10
100% 100%
100% 100%
100% 100%
*75% for first year; 50% for subsequent years of consecutive coverage **limited to children under age 16 ***American Dental Association (ADA) codes are shown to help you more easily compare costs across plans.
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
For an online interactive tool that lets you compare your likely total costs under each option, go to www.MyFlorida.com/myBenefits. We’ve made every effort to accurately provide costs of each service; where this chart differs from the plan documents, the plan documents shall take the place of this chart.
Dental HMO/Pre-paid (In-Network Only)
CompBenefits Plan # 4004 $16.22 $31.98 $38.14 $48.70 $0 $0 $0 $0 $0 $0 $0 $0 UnitedHealthcare Plan # 4014 $10.91 $23.95 $29.90 $41.98 $0 $0 $0 $0 $0 $0 $0 $0 Assurant Plan #4024 $12.35 $19.99 $27.03 $31.69 $0 $0 You Pay: $0 $0 $0 $0 $10/tooth $60 You Pay: $0 $8 $10 $64 $39 $14 $27 $23 $150 $150 $320 $115 $354 $6 $18 $9 $0 $0 $37 $245 $375 $50 $80 $125 $245 $245 $325 $235 $425 $15 $85 $325 $0 $15 $45 $245 $120 $50 $100 $180 $265 $265 $335 $125 $380 $15 $60 $30 You Pay: $725 - 1,580 $725 - 1,580 $2,250 $2,350 $1,000 100% $1,700 $2,100 75% 75% $0 $0 $0 $280 $140 $70 $95 $145 $425 $425 $535 $380 $615 $40 $110 $70 $260 $95 $280 $10 $45 $15 $0 $0 $37 $240 $120 $45 $75 $15 $220 CIGNA Plan # 4034 $23.46 $42.14 $49.60 $60.18 $0 $0 $0 $0 $0 $0 $10/tooth $155 American Dental Plan Plan # 4044 $12.64 $21.20 $23.00 $32.98 $0 $0 $0 $0 $0 $0 $7/tooth $45
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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CompBenefits 2008 dual choice dental benefits for the State of Florida American Dental Plan (ADP) Prepaid and Indemnity Benefit Options
2008 Dental Plan Highlights
Prepaid/Select 15
• Most cost effective way to receive
Indemnity/Schedule B
• Freedom to see any dentist • Coverage for Type I, II and III services • Claims paid according to a stated benefit schedule • $50 calendar year deductible (waived for Type I services) • No waiting periods • $1000 calendar year maximum benefit • Vision, contact lens and hearing aid programs
dental care • Choose your own dentist from a list of participating general dentists • Many “no charge” benefits • Savings on every procedure • No deductibles • No maximum benefit limitations • No waiting periods • No claim forms • Child and Adult Orthodontia • Vision, contact lens and hearing aid programs
Please contact us at 866-879-3630 or visit our website at www.compbenefits.com/custom/adpstateemployees/
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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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CompBenefits proudly offers two new and enhanced dental benefit options, as selected by the Department of Management Services Network Plus DHMO and Preferred Plus DPPO
2008 Dental Plan Highlights
Network Plus DHMO
• Includes 330 covered dental procedures
Preferred Plus DPPO
• In and Out of Network Benefits • Child and Adult Orthodontia • Endodontics (root canals), Periodontics (gum treatment), and Oral Surgery covered as Type II - Basic Services • In-Network Benefits not subject to balance billing over PPO provider’s contracted fee • Enhanced out-of-network benefits based on the 90th percentile of usual, customary & reasonable charge
• • •
• • •
at fixed co-payments Orthodontic coverage at fixed copayments for both children and adults Co-payments applicable with both General & Specialist Dentists No specialty referral pre-authorization required; members may “self refer” to Specialists Large network of providers with over 4,100 dentists statewide No office visit fee No waiting periods, annual maximums, deductibles, or claim forms to file
Please contact us at 800-943-6880 or visit our website at www.compbenefits.com/custom/stateofflorida/
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Supplemental Hospitalization Plans
Supplemental hospitalization plans pay for some of the hospital expenses not covered by your health insurance. These charges may include the hospital deductible, non-covered room and board charges, co-payments and any special fees. Alta Health and Life Insurance Company (represented by Capital Insurance Agency, Inc.) and Philadelphia American Life Insurance Company (represented by State Securities Corporation) offer supplemental hospitalization plans. • • Alta Health and Life Insurance Company: call (800) 780-3100 or visit www.capitalins.com Philadelphia American Life Insurance Company: call (800) 227-2300 or in Tallahassee (850) 386-2300, or visit www.ssc-life.com. As with all supplemental plans, be sure you are fully informed before choosing multiple plans of the same insurance type.
Enroll in or Make Changes to a Supplemental Hospital Plan
Ways to Enroll:
1. log on to https://Peoplefirst.myflorida.com, or 2. Complete the state hospital supplement enrollment form and mail it to the People first service Center, P.o. box 6830, Tallahassee, fl 32314, or fax it to (904) 828-6092. 3. Call People first at (866) 663-4735. Note: enrollment also requires a company application to be completed and sent to the company. These applications are not processed by People first.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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Cancer, Intensive Care and Accident and Disability Plans
The American Family Life Assurance Company of Columbus (AFLAC) offers cancer and intensive care supplemental plans. Capital Insurance Agency, Inc. represents AFLAC. To learn more, call (800) 780-3100 or visit www.capitalins.com. Go to the People First Web site to enroll online or complete the "Supplemental Cancer/Intensive Care" enrollment form and mail to the People First Service Center. Read AFLAC's brochure for additional steps. Colonial Life and Accident Insurance Company offers Accident, Accident and Disability, Cancer and Cancer and Intensive Care plans. To learn more, please visit www.coloniallife.com/florida or call: • • • North Florida (800) 858-0779 or in Tallahassee (850) 962-2500 Northeast Florida (866) 684-4030 or in Jacksonville (904) 655-5553 Central/South Florida (888)756-6701 or in Daytona Beach (386) 252-9806
Please note: You must meet with a Colonial insurance agent to complete the “Supplemental Accident/Disability Insurance” enrollment form located on the People First Web site. The agent must calculate, certify and write the required premium on the form, and then you will mail it to the People First Service Center. Next, you must send a completed Colonial Application or Service Form for underwriting approval. If you pass, Colonial will notify People First and coverage will start the first day of the month following a full month’s premium being deducted. Changes to your insurance coverage can only be made when you have a QSC event or during the next Open Enrollment period.
Enroll in or Make Changes to a Cancer and/or Intensive Care Plan
Ways to Enroll: 1. Log on to https://PeopleFirst.myFlorida.com 2. Complete the Enrollment Form and mail it to the People First Service Center, P.O. Box 6830, Tallahassee, FL 32314, or fax it to (904) 828-6092. 3. Call People First at (866) 663-4735. Note: Enrolling in People First does NOT guarantee coverage. Enrollment in the Colonial Accident and Disability Plan requires assistance from an agent. Please see the Colonial contact information above.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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aDverTIseMeNT
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com
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myBenefits = myLife
Life Insurance
We offer term life insurance, including an accidental death and dismemberment benefit, underwritten by Minnesota Life, to full-time and part-time employees. Minnesota Life is a new provider for 2008 and replaces Prudential Life. If you have been enrolled with the Prudential Life plan, you will be covered by Minnesota Life. Because of this change, you must submit a new beneficiary form. Forms are available on the People First Web site and also at www.minnesotalife.com.
Coverage & Premiums
The state pays all or part of the base life insurance premium for employees, depending on their classification. For most employees, coverage is one-and-a-half times your annual salary. For example, if you earn $30,000 a year, your beneficiary would receive a $45,000 benefit if you died. For Senior Management Service, University Senior Management (non-faculty), Selected Exempt Service, legislative employees and employees of other certain classes, coverage is two times your annual salary. That means if you earn $30,000 a year, your beneficiary would receive $60,000 if you die. If you are a career service employee, coverage drops to half (50 percent) when you reach age 70. If you work part time, please contact the People First Service Center to determine available coverage levels and premiums. You should complete your beneficiary form as soon as possible. Please note: Even if you previously submitted a beneficiary form to Prudential Life, you will need to submit a new form to the new carrier, Minnesota Life. If a beneficiary is not designated in writing, the proceeds will be paid according to the default beneficiary provisions of the policy in this order: your spouse, children, parents or the personal representative of your estate. Payments made to an estate, however, may result in a reduction in total benefits due to taxes and probate costs. be sure to complete your beneficiary form. aDverTIseMeNT
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Accidental Death and Dismemberment
Basic life insurance coverage includes accidental death and dismemberment coverage. Significant benefits may be available in the event of accidental death or injury. Payment amounts vary from 25 to 100 percent of your coverage. You may be eligible to receive benefits if you lose the use of limbs in instances where no amputation is required.
Accelerated Death Benefit
The Accelerated Death Benefit, or “living benefit option,” provides you with an advanced benefit if you are diagnosed with a terminal illness that will result in death within one year. You may be eligible for up to 100 percent of your life insurance benefits, with a maximum of $1 million. Upon death, the balance of the life insurance benefit, if any, will be paid to the named beneficiaries.
Conversion Privileges
You will lose your life insurance coverage if you leave employment, become ineligible for coverage or neglect to pay the premium. If you lose your coverage, you can convert some or all of the life insurance to an individual contract. Regardless of your age or health, you can purchase a whole life insurance policy, provided the conversion request and premium payment are made to Minnesota Life within 31 days of group plan termination. You should contact Minnesota Life directly for the conversion forms and applicable premium information.
Optional Insurance
If you are enrolled in the basic term life insurance plan, you can purchase additional term life insurance. You can add coverage from one to five times your annual salary, up to $500,000. This plan is an employee-pay-all, post-tax benefit. When you start working for the state, you can buy this optional coverage on a guaranteed-issue basis, meaning that you do not need to qualify or present evidence of insurability. If you choose to increase the optional coverage amount later, you can increase the benefit amount equal to your annual salary without medical underwriting. If you choose coverage above this amount, you’ll be subject to medical underwriting. If you declined optional life coverage when you were first hired but want to enroll during Open Enrollment, you will need to qualify or present evidence of insurability (pass medical underwriting). To learn more about Minnesota Life call (888) 826-2756 or visit www.minnesotalife.com
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myBenefits = myWealth
Flexible Spending Accounts Program
We offer Flexible Spending Accounts (FSA) with three options for you to set aside a portion your income to pay for health and dependent care expenses. You can participate in any or all of the following fsa options: • • • Medical Reimbursement Account Limited Purpose Medical Reimbursement Account Dependent Care Account
Money to fund FSAs is deducted each paycheck on a pre-tax basis, reducing your federal income tax liability. You decide when you sign up how much you want reserved in your account for the year. As you have medical or dependent care expenses, you submit claims (receipts) for eligible expenses and are reimbursed from your account. You should carefully estimate how much money you will need in each selected FSA account for the year. If you do not submit claims for the plan year by the april 15th filing deadline for the entire amount you had withheld, you lose the unused money. There is no need to change the amounts of your FSA during Open Enrollment if you want to keep the same amounts. Your existing FSA(s) will continue at the same annual deduction amounts plan year to plan year, unless you want to change your contribution amount or cancel during Open Enrollment.
Medical Reimbursement Account
A Medical Reimbursement Account (MRA) is an account that reimburses you for eligible medical expenses. The minimum to open the account is $60 per year and the maximum is $5,000 per year. If you have a Health Savings Account, you cannot enroll in a MRA. The entire amount in your account is available at the beginning of the plan year. That means you do not have to wait for the regular contribution to be withheld from your paycheck before you submit a claim. Example: It’s January and you’ve had $100 withheld from your paycheck for your MRA. You have to get an x-ray and have to pay $120 for the service. You submit your receipt and receive $120 even though there is only $100 in the account. If you stop working for the state, you will not be reimbursed for services after you leave unless you make arrangements with the People First Service Center to continue the account(s).
eligible health Care expenses*
• • • • • • • • deductibles you pay as part of your or your spouse’s health care insurance plan co-payments for eligible medical bills after deductibles have been satisfied any qualifying amount you pay for eligible expenses after your maximum benefit has been paid other health care expenses not covered by an insurance plan that otherwise would be eligible for deduction on a federal tax return acupuncture ambulance services contraceptive devices (prescription only) dentures • • • • • • • • • • eye examinations, eyeglasses, and contact lenses and supplies hearing aids and batteries obstetric care orthodontia oxygen seeing-eye dog smoking cessation programs and prescription drugs hearing impaired equipped telephone wheelchair certain over-the-counter items, medicines or drugs
*This list is not exhaustive and there are many other expenses which qualify for reimbursement. 36
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Ineligible Expenses*
The following is a list of expenses which are ineligible for reimbursement. • • • • • weight-loss programs and appetite suppressants anti-hair loss drugs cosmetics and toiletries health club (gyms, exercise programs, etc.) dues dental procedures to whiten the teeth (bleaching)
*This list is not exhaustive and there are many other expenses which do not qualify for reimbursement.
Limited Purpose Medical Reimbursement Account
A Limited Purpose Medical Reimbursement Account (LPMRA) reimburses you for dental, vision and over-the-counter drug costs considered tax deductible by the IRS but not paid by any health plan. The minimum to open the account is $60 per year and the maximum is $5,000 per year. Unlike the MRA, if you have a Health Savings Account, you can still enroll in a LPMRA. The entire amount in your account is available at the beginning of the plan year. That means you do not have to wait for the regular contribution to be withheld from your paycheck before you submit a claim. Example: It’s January and you’ve had $100 withheld from your paycheck for your LPMRA. You have to get a new pair of glasses for $140. You submit your receipt and receive $140 even though there is only $100 in the account. If you stop working for the state, you will not be reimbursed for services after you leave unless you make arrangements with the People First Service Center to continue the account(s). For more information about qualified expenses and other FSA provisions, read the IRS Publication 502, “Medical and Dental Expenses,” available at www.irs.gov.
Dependent Care Reimbursement Account
A Dependent Care Reimbursement Account (DCRA) reimburses you for eligible expenses you pay to take care of a dependent. The minimum to open the account is $60 per year and the maximum is $5,000 per year. (Married employees filing separately have an annual maximum deduction amount for each enrollee of $2,500.) At any given time, you can only be reimbursed for dependent care expenses up to the current balance amount in your account. Unlike MRAs, the entire annual deduction amount is not available for reimbursement at the beginning of the plan year. Only the amount you have contributed to the account, less any claims paid, is available at any given time. Before you enroll, you should carefully compare the potential tax savings from this plan to the federal income tax credits available. In the following instances, you will generally reduce the amount of taxes paid by enrolling in this plan if: • • • You file a federal IRS income tax form1040 EZ. Because there is no line to deduct dependent care expenses, the only way to get a tax benefit is through a DCRA. You and your spouse file taxes as “married, filing separately.” The IRS will only allow a tax credit for those filing as “single, head of household” or “married, filing jointly.” Your expenses are more than $2,400 for one dependent or $4,800 for two or more dependents.
Qualifying Dependents
A qualifying dependent is any person you take care of who lives in your home. Qualifying dependents include, but are not limited to: • • • a parent a disabled person or any child under the age of 13.
If you are divorced or legally separated and your dependent lives with you, you can claim work-related dependent or child care expenses. This is true even if you do not claim the dependent on your tax return.
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Qualified Expenses
Qualified expenses are expenses for the care of dependents so you (and your spouse, if married) can work, look for work, or attend school. Qualified expenses include: • • • • • a licensed child care center for either children or adults; an after school, YMCA or summer program; a neighbor who cares for the children before or after school; an individual who provides care in his/her home; or an individual who provides care in your home, such as: • a live-in nanny, • a Licensed Practical Nurse (LPN) or assisted care provider for an adult, or • a babysitter
Expenses paid to the following providers do not qualify: • someone who can be claimed as the employee’s dependent • overnight camp • charges for materials, transportation, and other charges not directly related to the care of the individual You will need to supply the federal tax ID number or Social Security Number of the dependent care provider when you file claims for dependent care expenses, and there must be adequate funds in the account for you to be reimbursed. For more information about qualified expenses and other FSA provisions, read the IRS Publication 503, “Dependent Care Expenses” available at www.irs.gov.
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myPrivacy
State of Florida Employees’ Group Health Insurance Program Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information, known as protected health information, includes virtually all individually identifiable health information held by plans — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices for the State of Florida’s Flexible Spending Account, and discusses administrative activities performed by the State for the State of Florida Employees’ Group Health Self-Insurance Plan (the self-insured plan) and for insurance companies and HMOs in the State Group Insurance Program (the insured plans). The plans covered by this notice, because they are all sponsored by the State of Florida for its employees, participate in an “organized health care arrangement.” The plans may share health information with each other to carry out Treatment, Payment, or Health Care Operations (defined below). The Plans’ duties with respect to health information about you The plans are required by law to maintain the privacy of your health information and to provide you with a notice of the plans’ legal duties and privacy practices with respect to your health information. Participants in the self-insured plan will receive notices directly from BlueCross Blue Shield of Florida (BCBSF) and Caremark (which provides third-party medical and pharmacy support to the self-insured plan); the notices describe how BCBSF and Caremark will satisfy the requirements. Participants in an insured plan option will receive similar notices directly from their insurer or HMO. It’s important to note that these rules apply only with respect to the health plans identified above, not to the State as your employer. Different policies may apply to other State programs and to records unrelated to the plans. How the plans may use or disclose your health information The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care Treatment, Payment activities, and Health Care Operations. Here are some examples of what that might entail: Treatment includes providing, coordinating, or managing health care by one (1) or more health care providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the plans may share health information about you with physicians who are treating you. Payment includes activities by these plans, other plans, or providers to obtain premiums, make coverage determinations and provide reimbursement for health care. This can include eligibility determinations, reviewing services for medical necessity or appropriateness, utilization management activities, claims management, and billing, as well as “behind the scenes” plan functions such as risk adjustment, collection, or reinsurance. For example, the plans may share information about your coverage or the expenses you have incurred
with another health plan in order to coordinate payment of benefits. Health care operations include activities by these plans (and in limited circumstances other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include vendor evaluations, credentialing, training, accreditation activities, underwriting, premium rating, arranging for medical review and audit activities, and business planning and development. For example, the plans may use information about your claims to review the effectiveness of wellness programs. The amount of health information used or disclosed will be limited to the “Minimum Necessary” for these purposes, as defined under the HIPAA rules. The plans may also contact you to provide appointment reminders or information about treatment alternatives or other healthrelated benefits and services that may be of interest to you. How the plans may share your health information with the State The plans will disclose your health information without your written authorization to the State for plan administration purposes. The State needs this health information to administer benefits under the plans. The State agrees not to use or disclose your health information other than as permitted or required by plan documents and by law. The plans may also disclose “summary health information” to the State if requested, for purposes of obtaining premium bids to provide coverage under the plans, or for modifying, amending, or terminating the plans. Summary health information is information that summarizes participants’ claims information, but from which names and other identifying information have been removed. In addition, the plans may disclose to the State information on whether an individual is participating in the plans or has enrolled or disenrolled in any available option offered by the plans. The State cannot and will not use health information obtained from the plans for any employment-related actions. However, health information collected by the State from other sources is not protected under HIPAA (although this type of information may be protected under other federal or state laws). Other allowable uses or disclosures of your health information In certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information describing your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made, for example if you’re not present or if you’re incapacitated). In addition, your health information may be disclosed without authorization to your legal representative.
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The plans are also allowed to use or disclose your health information without your written authorization for uses and disclosures required by law, for public health activities, and other specified situations, including: • Disclosures to Workers’ Compensation or similar legal programs, as authorized by and necessary to comply with such laws Disclosures related to situations involving threats to personal or public health or safety. Disclosures related to situations involving judicial proceedings or law enforcement activity Disclosures to a coroner or medical examiner to identify the deceased or determine cause of death and to funeral directors to carry out their duties Disclosures related to organ, eye or tissue donation and transplantation after death Disclosures subject to approval by institutional or private privacy review boards and subject to certain assurances by researchers regarding the necessity of using your health information and treatment of the information during a research project. Certain disclosures may be made related to health oversight activities, specialized government or military functions and US Department of Health and Human Services investigations
agreement), or unilaterally by the plans for health information created or received after you’re notified that the plans have removed the restrictions. The plans may also disclose health information about you if you need emergency treatment, even if the plans had agreed to a restriction. Right to receive confidential communications of your health information If you think that disclosure of your health information by the usual means could endanger you in some way, the plans will accommodate reasonable requests to receive communications of health information from the plans by alternative means or at alternative locations. Right to inspect and copy your health information If you want to exercise this right, your request to the plans must be in writing and you must include a statement that disclosure of all or part of the information could endanger you. This right may be conditioned on your providing an alternative address or other method of contact and, when appropriate, on your providing information on how payment, if any, will be handled. With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “Designated Record Set.” This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication, and case or medical management record systems maintained by a plan; or a group of records the plans use to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. In addition, the plans may deny your right to access, although in certain circumstances you may request a review of the denial. If you want to exercise this right, your request must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible onsite), the plans will provide you with: • • The access or copies you requested; A written denial that explains why your request was denied and any rights you may have to have the denial reviewed or file a complaint; or A written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the plans expect to address your request.
• • •
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Except as described in this notice, other uses and disclosures will be made only with your written authorization. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization for a plan that has taken action relying on it. In other words, you can’t revoke your authorization with respect to disclosures the plan has already made. Your individual rights You have the following rights with respect to your health information the plans maintain. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right for the Flexible Spending Account and for the State activities relating to the self-insured plan and insured plans. Contact the Division of State Group Insurance, PO Box 5450, Tallahassee, FL 32314-5450 to obtain any necessary forms for exercising your rights. The notices you receive from BCBSF, Caremark, and your insurer or HMO (as applicable) will describe how you exercise these rights for the activities they perform. Right to request restrictions on certain uses and disclosures of your health information and the Plan’s right to refuse You have the right to ask the plans to restrict the use and disclosure of your health information for Treatment, Payment, or Health Care Operations, except for uses or disclosures required by law. You have the right to ask the plans to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the plans to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request must be in writing. The plans are not required to agree to a requested restriction. And if the plans do agree, a restriction may later be terminated by your written request, by agreement between you and the plans (including an oral
•
The plans may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The plans also may charge reasonable fees for copies or postage. If the plans do not maintain the health information but know where it is maintained, you will be informed of where to direct your request. Right to amend your health information that is inaccurate or incomplete With certain exceptions, you have a right to request that the plans amend your health information in a Designated Record Set. The plans may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the plans (unless the person or entity that created the information is no longer available), is not part of the Designated Record Set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal, or administrative proceedings).
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If you want to exercise this right, your request must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the plans will: • • Make the amendment as requested; Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint; or Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the plans expect to address your request.
•
The plans must abide by the terms of the Privacy Notice currently in effect. This notice took effect on April 14, 2003. However, the plans reserve the right to change the terms of its privacy policies as described in this notice at any time and to make new provisions effective for all health information that the plans maintain. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to a plan’s privacy policies as described in this notice, you will be provided with a revised Privacy Notice through posting on the DSGI Web site or mailed to your last known home address. Complaints If you believe your privacy rights have been violated, you may complain to the plans and to the US Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. Complaints about activities by your insurer or HMO, or by BCBSF or Caremark, can be filed by following the procedures in the notices they provide. To file other complaints with the plans, contact the DSGI for a complaint form. It should be completed, including a description of the nature of the particular complaint, and mailed to the Division of State Group Insurance, PO Box 5450, Tallahassee, FL 32314-5450. Contact For more information on the privacy practices addressed in this Privacy Notice and your rights under HIPAA, contact the Division of State Group Insurance at PO Box 5450, Tallahassee, FL 32314-5450.
Right to receive an accounting of disclosures of your health information You have the right to a list of certain disclosures the plans have made of your health information. This is often referred to as an “accounting of disclosures.” You generally may receive an accounting of disclosures if the disclosure is required by law in connection with public health activities or in similar situations listed in the table earlier in this notice, unless otherwise indicated below. You may receive information on disclosures of your health information going back for six (6) years from the date of your request, but not earlier than April 14, 2003 (the general date that the HIPAA privacy rules are effective). You do not have a right to receive an accounting of any disclosures made: • • • • • • For Treatment, Payment, or Health Care Operations; To you about your own health information; Incidental to other permitted or required disclosures; Where authorization was provided; To family members or friends involved in your care (where disclosure is permitted without authorization); For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances; or As part of a “limited data set” (health information that excludes certain identifying information).
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In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official. If you want to exercise this right, your request must be in writing. Within 60 days of the request, the plans will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the plans expect to address your request. You may make one (1) request in any 12-month period at no cost to you, but the plans may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request. Right to obtain a paper copy of this notice from the plans upon request You have the right to obtain a paper copy of this Privacy Notice upon request. Changes to the information in this notice Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com 41
Special Notice About the Medicare Part D Drug Program
Please, read this notice carefully. It explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll
Medicare prescription drug coverage (Medicare Part D) became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All approved Medicare prescription drug plans must offer a minimum standard level of coverage set by Medicare. Some plans may offer more coverage than required. As such, premiums for Medicare Part D plans vary and all plans should be researched carefully. The State of Florida Department of Management Services has determined that the prescription drug coverage offered by the State Employees’ Health Insurance Program (State Health Program) is, on average, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage. If you do decide to enroll in a Medicare prescription drug plan and drop your State Health Program coverage, be aware that you and your dependents will be dropping your hospital, medical and prescription drug coverage. If you choose to drop your state health Program coverage, you will NoT be able to enroll back in the state health Program unless a special open enrollment period for non-enrolled state of florida retirees is mandated by the florida legislature. If you enroll in a Medicare prescription drug plan and you DO NOT drop your State Health Program coverage, you and your eligible dependents will still be eligible to receive all of your current health and prescription drug benefits. If you drop or lose your coverage with the State Health Program and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. Additionally, if you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage, and you may have to wait until the following November to enroll.
Additional information about Medicare prescription drug plans is available from:
• • Visit www.medicare.gov Your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, payment assistance for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you may call them at 1-800-772-1213 (TTY 1-800-325-0778). For more information about this notice or your current prescription drug coverage, contact the People First Service Center at 1-866-663-4735. Keep this notice. If you enroll in one of the plans approved by Medicare which offers prescription drug coverage you may need to give a copy of this notice when you join to avoid paying a higher premium amount (a penalty).
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