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Open Enrollment Guide2010

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					        E n ro l l m e n t G u i d e
               P l a n Ye a r 2 0 1 0




Read carefully!
 Inside you will find
valuable information
   about your 2010
 employee benefits.
PEBC
Public Employee
Benefits Cooperative


What is the PEBC?

The Public Employee Benefits Cooperative (PEBC) was created in
1998. On behalf of its member governments, the PEBC works
diligently to keep benefit costs affordable. The PEBC is dedicated to
providing you choice, flexibility and value as we strive to manage
costs in this era of double-digit health care increases. The PEBC
performs many services including joint purchase of employee
benefits and cost effective centralized administration. In addition to
a choice of health benefit plans, you have access to several dental
benefit programs, long-term disability insurance, long term care
insurance, flexible spending programs and life insurance for you
and your dependents.

This Enrollment Guide highlights features of your Employer’s
benefits package. Full details are contained in the legal documents
governing the plans. If there is any discrepancy or conflict
between the plan documents and the information presented here,
the plan documents will govern. Your Employer reserves the right
to change or discontinue the plans at any time. Issuance of an ID
card is not a guarantee of benefits. Benefits are subject to plan
provisions and eligibility on the date the service is delivered.
Participation in the plans does not constitute an offer of
employment or an employment contract.

Multiple Employers use this Enrollment Guide. Contact your
Human Resources Department if you have any questions about
the Enrollment Guide contents and how they apply to you.
Using the Enrollment Guide

This Enrollment Guide is used by multiple employers. In all cases, you should consult the Plan Documents
or Plan Booklets for detailed information. Your Employer’s enrollment deadlines apply. For
those currently enrolled in the HMO Blue Medical Plan (not available after 2009), watch for HMO            Watch for
Transition Tips designed to help you as you change to the EPO Plan or PPO Plan. All enrolling                 HMO
for Plan Year 2010 should note changes from the prior year are highlighted in red font.
                                                                                                           Transition
If your Employer Group is new to the PEBC, it is important you remember that references to prior              Tips
year plan changes apply only to 2009 PEBC plan provisions when compared to the 2010 PEBC plan
provisions – not the 2009 benefit plan in which you are enrolled.




                                      The information in this
                                         Enrollment Guide
                                        can help you make
                                      informed decisions for
                                       you and your family.




The PEBC – A Little History
Faced with increasing medical costs, Dallas County and Tarrant County formed a regional cooperative program (the PEBC) in 1998
to help create savings in providing employee health benefits. One year later, the North Texas Tollway Authority joined the PEBC.
Denton County joined the PEBC effective January 1, 2003 and the City of Frisco joined the group effective January 1, 2005. The
PEBC welcomes its newest Employer Group, Parker County, effective January 1, 2010. The benefit of PEBC membership is even
more valuable today, especially with current economic conditions and the rapidly rising cost of health care.



                                                              i
Contacts and Websites
You can access all PEBC plan contacts and provider search websites by visiting www.pebcinfo.com and selecting the appropriate
link. Each vendor’s website is helpful if you want to confirm a provider’s participation in any plan. Website information is
updated at different times. A telephone call is the best resource for the most up-to-date provider participation information. All times
listed below are shown as Central Time.

Medical Plans Medical Plans                                           Dental Plans           Dental Plans

EPO Plan Medical Network                                              Assurant DHMO Dental Plan
Network HealthSmart GEPO & HPN Network                                Network Assurant DHMO Series 189 Plan
Toll Free 800-444-3995                                                Toll Free 800-227-3055
Hours 8:00 AM – 5:00 PM (M-F)                                         Hours 7:00 AM – 5:30 PM (M-F)
Online Provider Search – www.pebcinfo.com                             Online Provider Search – www.pebcinfo.com

PPO Plan Medical Network                                              PEBC PPO Dental Plan
Network HealthSmart (in Texas)                                        Network Delta Dental PPO & Delta Dental Premier
             Beech Street (outside Texas)                             Claims Delta Dental
Toll Free 800-444-3995                                                Toll Free 800-521-2651
Hours 8:00 AM – 5:00 PM (M-F)                                         Hours 6:15 AM – 6:30 PM (M-F)
Online Provider Search – www.pebcinfo.com                             Online Provider Search – www.pebcinfo.com
Outside Texas Only - www.beechstreet.com
Select “Patients” & “Find a Doctor or Hospital”

EPO Plan & PPO Plan Claims Administrator
Claims HealthSmart Benefit Solutions
Toll Free 800-444-3995                                                                 Plan Information
Hours 8:00 AM – 5:00 PM (M-F)                                                          Provider Search
Website – www.pebcinfo.com                                                            www.pebcinfo.com
EPO Plan & PPO Plan Prescription Drug Plan
PBM Express Scripts
Toll Free 877-613-1227
Hours 24 hours / 7 days a week
Website – www.express-scripts.com
*Specialty Pharmacy Mail Order                                                     Other Plan Benefits
PBM Curascript (or contact Express Scripts)                           Other Plan Benefits
Toll Free 866-848-9870
                                                                      FLEX Spending Accounts
EPO Plan & PPO Plan Mental Health Care & EAP                          Contact PayFlex Systems USA, Inc.
Network MHN (not HealthSmart, HPN or Beech Street)                    Toll Free 877-644-5124
Claims MHN                                                            Hours 24 hours / 7 days a week
Pre-Cert MHN                                                          Online Account Access – www.payflex.com/pebc
Toll Free 888-779-2225
Hours 24 hours / 7 days a week                                        Life Insurance
Online Provider Search – www.mhn.com                                  Contact Fort Dearborn Life
Select “Members”                                                      Toll Free 800-778-2281
Select “Practitioner Search”                                          Hours 8:00 AM – 6:00 PM (M-F)
Select Member Type “Other”
Select “Texas”                                                        Long Term Care Insurance
                                                                      Contact Prudential Life Insurance Company of America
                                                                      Toll Free 866-500-0864 (Enrollment or Billing Info )
               EAP Benefits                                           Toll Free 800-732-0416 (Access Benefits)
               888-779-2225                                           Hours 7:00 AM – 7:00 PM (M-F)
         Visit www.pebcinfo.com                                       Online Enrollment Info – www.prudential.com/gltc
                                                                      Group Name/Password – pebc



                                                                 ii
                                                                                                 1



Enrollment Guide Contents                                                                                                                                 Plan Year
                                                                                                                                                            2010


Using the Enrollment Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Contacts and Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
Enrollment Guide Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Enrollment Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Enrollment Packet Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Choosing Benefits –Annual Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Choosing Benefits – Newly-Hired Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Enrolling Your Newborn – Important Deadlines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HealthSmart Baby Connection Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Dependent Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2010 Changes-At-A-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7
Transition of Care Information (HMO Blue Members & New PEBC Employee Groups) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Medical Plan – EPO Snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Medical Plan – PPO Snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
MHN Mental Health Benefits EPO Plan & PPO Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Plan Service Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Prescription Drug Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
New! VSP Choice Plan Vision Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Opt-Out of a Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Your Total Out-of-Pocket Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
EPO Plan Quick Reference Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PPO Plan Quick Reference Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Dental Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Identification (ID) Card Information – 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What is a Self-Funded Plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Contemplating Retirement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Celebrating Your 65th Birthday? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Change in Status Events / Important Deadlines Apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Flexible Spending Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-21
Long Term Care Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Employee Assistance Program (EAP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Life, AD&D, Long Term Disability Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Carefully Consider Your Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Problem With a Claim? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Understanding the Explanation of Benefits (EOB) Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Coordination of Benefits – Non-Duplicating Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26


           Even if you are satisfied with your current coverage, be sure to take a fresh look at your options
              to make an informed decision for 2010. Employee contribution rates can be found on the
                        2010 Employee Benefit Rate Sheet included in your Enrollment Packet.
                                                       2



                               Enrollment Resources
QUICK INDICATORS               How do you know which plans are right for you? Your Employer provides many resources
                               to help you choose. This Enrollment Guide, the Enrollment Packet, and the information
                               available at www.pebcinfo.com will help you evaluate your options, estimate your benefit
Employee                       needs, and compare your benefit choices. Your Human Resources/Benefits Staff is always
Plan Choices                   available to assist you if needed.
Medical Plans
 • EPO Plan                    Make an Informed Choice
 • PPO Plan
 • OPT-OUT
                               In today’s economy, it’s more important than ever to make the most of your benefit dollars.
                               Your responsibility is to carefully evaluate your options and make informed choices. To do
Dental Plans
                               that, it is important you read the information in the Enrollment Packet. Making informed
  • Assurant DHMO Plan
                               decisions helps you keep costs down while getting the benefits coverage you and your
  • PEBC PPO Dental Plan
                               family need. Be sure to review all of the resources available to you to learn more about your
    (Delta Dental)
                               plan options. Weigh the cost of each plan against your needs and determine the right
                               benefits mix for you and your family.
Vision Plan
  • VSP Choice Plan            Enrollment Packet Tools
Life Insurance                 Some of the key information included in your packet is listed below.
  • Employee Optional          • Enrollment Guide – A quick summary guide which includes features of each plan
     Term Life & AD&D            available to you, contact information, and important information about your plan
  • Optional Dependent           benefits;
     Term Life (Two Options)
                               • Prescription Drug Benefit Guide – At-a-Glance Guide to EPO and PPO pharmacy
Long Term
                                 plan benefits;
Care Insurance                 • Rate Sheet – Lists 2010 employee contribution rates for each plan;
  • Offered by The
    Prudential Insurance       • Employee Assistance Program (EAP) Brochure – summarizes this Employer-paid
    Company of America           benefit that helps you deal with the pressures of work and daily life;
                               • PayFlex Brochure – An FSA is Your Key to Tax Savings – summarizes the benefits
Flexible Spending                of a flexible spending account (FLEX account);
(FLEX) Accounts
  • Flexible Health Care       • Changing Your Medical Plan – For New PEBC Groups and HMO Transition
    Spending Account             Valuable information as you consider your 2010 options;
  • Flexible Dependent
                               • Notice of Creditable Coverage – An important notice about your prescription drug
    Care Spending Account
                                 coverage and Medicare; and
                               • Other Information – including flyers from Assurant DHMO and Delta Dental (New
                                 2010 dental programs), and VSP (new vision benefits program). Your Employer may
Other Employer
                                 provide additional information to assist you.
Paid Coverage
Employee Term Life
Insurance (Basic                                              Evaluate Your Plan Choices
Coverage)
                                     Your Next                Even if you are satisfied with your current coverage, be sure
Employee Assistance                                           to take a fresh look at your available plan choices and each
Program (EAP)                          Steps                  plan’s cost for the next plan year, as well as your coverage
                                                              needs, so you can make informed decisions. The EPO
Long Term Disability (LTD)                                    Medical Plan and the PPO Medical Plan have changed for the
                                                              year 2010 and you need to make sure you know what those
                                                              changes are before you enroll. Dental plans have changed as
                                                              well. Review this Enrollment Guide carefully as you think
                                                              through your plan choices.
                                                                     3



Choosing Benefits – Annual Enrollment
                                                                                            QUICK INDICATORS
Annual enrollment gives you an opportunity to review your options and select a new
plan if you wish. This is the only time each year you can change your benefits without      ANNUAL
first experiencing a Qualified Change in Status Event. The changes you make during          ENROLLMENT
annual enrollment become effective January 1st of the next year. Remember – you must
follow your Employer’s annual enrollment deadline. It is also very important that           You must
your Employer has your correct mailing address to avoid delays in receiving ID cards,       re-enroll if . . .
claim information and other important benefit news.
                                                                                            • Your Employer requires
                                                                                              you re-enroll (important
                                                                                              deadlines apply) and/or
                 Carefully Review the Features of Each Plan                                 • Your eligible dependent(s)
                                                                                              changed; and/or
    Follow these three steps.
    Step 1: Learn – by studying your enrollment materials. Ask questions!                   • You want to contribute
    Step 2: Compare – the differences between the available plans. Look at your out-          to a FLEX Spending
                                                                                              Account.
            of-pocket cost, check the service areas and if your doctor is in the network.
    Step 3: Choose – the best plan for your needs. As your personal and family                Remember – you have to
            situation changes, your benefit plan needs may also change.                       re-enroll each year if you
                                                                                              want to contribute to a
               Don’t take any shortcuts! If you skip Steps 1 or 2, you may not choose         FLEX Spending
                   the plan that best meets your health care and financial needs.             Account – even if you do
                                                                                              not change your annual
                                                                                              election amount.

Choosing Benefits – Newly-Hired Employee                                                    • Be sure you check your
                                                                                              Employer’s instructions “If
If you are a newly-hired employee in Plan Year 2010 and selecting benefits for the first      You Do Not Enroll.”
time (not during annual enrollment), review your enrollment information with careful
attention to deadlines.
   • You must return your enrollment documents to your Human Resources                           If Your Employer Is
     Department within 14 days of the date you begin working. If you miss that                    New to the PEBC
     deadline, your Employer will enroll you in the PPO Medical Plan,
     employee-only coverage, and you cannot change it until the next annual                     Make sure you read
                                                                                                all information about
     enrollment.
                                                                                                the plans available to
                                                                                                you. As long as you
   • Your health benefits coverage becomes effective on the 1st day of the month                are covered on your
     following 30 consecutive calendar days of active, regular employment.                      Employer’s plan at
                                                                                                December 31, 2009,
   • Your Employer allows you to Opt-Out of medical plan coverage. If you select                during this first
     this option, you must provide proof of other comparable coverage and complete a            annual enrollment
     “Certification of Other Coverage” Form. Both documents must be received by                 only, you can enroll
     your Human Resources Department within 14 days of the date you begin working.              without medical
                                                                                                underwriting in two
     If you miss that deadline, your Employer can enroll you in the PPO Medical
                                                                                                of the available
     Plan – even if you have alternate coverage. If your other coverage is no longer in         plans; the Long Term
     effect, make sure you notify your Human Resources Department immediately.                  Care Plan (applies to
                                                                                                employee coverage
   • As long as you select optional term life insurance for yourself or your                    only) and Optional
     dependents when you are newly-hired and enrolling for the first time, you                  Life Insurance at any
     do not have to provide proof of insurability.                                              offered coverage
                                                                                                amount. Dental
   • You are guaranteed acceptance in the Long Term Care Plan provided you                      waiting periods will
                                                                                                not apply.
     enroll within 30 days of your hire date. Eligible family members may also
     enroll; however, they are subject to medical underwriting and acceptance is
     not guaranteed.
                                                        4



                                 Eligibility
QUICK INDICATORS
                                 Who Is Eligible?
Are You an
Expectant Mom?                   If you are an eligible, regular, active employee or an eligible retiree, you and your eligible
                                 dependents can enroll in a health benefit plan. If you and your spouse work for the same
                                 Employer, your dependents can be covered by only one of you. The Dependent Eligibility
HMO Transition Tips              page helps explain who is and who is not an eligible dependent. Remember, FLEX
                                 Spending Accounts require that claims can be submitted only for eligible expenses
If you are in the HMO            incurred by you or those who qualify as your Federal Tax dependents without regard to
Plan in 2009 and you are         income limitations. Consult the Plan Documents if you have questions. Other eligibility
enrolling in the EPO Plan or     requirements may apply.
PPO Plan for 2010, contact
HealthSmart as soon as you
can to enroll in the Baby        Dependent Eligibility Audits
Connection Program               The PEBC conducts random dependent eligibility audits. If you receive a letter requesting
(see below). The Baby            documents to prove your enrolled dependent’s eligibility, your cooperation in quickly
Connection Program has           returning the requested documents is very much appreciated. Your Employer makes
a dedicated phone line           benefits available to you and your eligible dependents only. Unfortunately, there have been
(888-828-7322) and they          cases where ineligible dependents were enrolled on a plan, which unfairly drives up the
can help you with all of your    cost of benefits for everyone. Avoid severe penalties. Enroll your eligible dependents only.
transition needs.

If your HMO Blue doctor is       Change of Address
not in the HealthSmart EPO
or PPO Network, and if you
                                 If you move, be sure to provide your Human Resources Department your new address as
are in your second or third
                                 soon as possible. By doing so, your benefit plans receive your updated information. Avoid
                                 delays in receiving your ID cards, Explanation of Benefits (EOB) forms, and other valuable
trimester or you are
                                 information. Make sure your mailing address is correct.
considered high-risk, you
may be eligible for Transition
of Care benefits. This
benefit allows you to            Enrolling Your Newborn - Important Deadlines
continue to see your current
                                 If you are expecting a new addition to your family, congratulations! Take a few minutes to
doctor through delivery and
                                 read this very important newborn enrollment information. At this very special time in your
post-partum care. Simply
                                 life, it can be devastating to learn your newborn does not have health benefits because
complete a Transition of         you did not enroll your newborn before the deadline.
Care Form (available at
www.pebcinfo.com) or call        Adding a newborn is considered a Qualified Change in Status Event. Newborns are not
the Baby Connection care         automatically covered from the date of birth. You must add your newborn to
management staff at              your EPO Plan or PPO Plan plan within 31 days of the date of birth or coverage
888-828-7322 for                 is not available until the next annual enrollment period. Do not miss this very
assistance. They are             important deadline. To add your newborn, you must contact your Employer. If you call the
happy to help you!               EPO Plan or PPO Plan, they cannot add your newborn to your coverage.

Employer Group
New to the PEBC                  HealthSmart
If you are expecting a baby,     Baby Connection Program                                            Call the
the information above
applies to you as well.
                                 For those enrolled in the EPO Plan or PPO Plan, the            Baby Connection
                                 Baby Connection program is a confidential program
Call the Baby Connection
                                 developed to promote healthy pregnancies through                 888-828-7322
as soon as possible.
                                 early and regular prenatal care. The Healthsmart Care
                                 Management Team consists of experienced RNs
                                 who coordinate the program. When you enroll in the
                                 program, you will receive a pregnancy health survey,
                                 a monthly newsletter, educational materials, and gifts
                                 for you and your newborn.
                                                                          5



                                                         Dependent Eligibility

            Who Is An Eligible Dependent?                                                        Who Is NOT An Eligible Dependent?

While each plan could have some differences, in                                 Enrollment of an ineligible dependent is considered
general all of the PEBC benefit plans have the                                    fraud and may subject you to severe penalties
same eligibility rules. Your dependent can be                       Avoid             including termination of employment and
enrolled in a plan only if he/she is an eligible                    Severe             criminal prosecution. The PEBC performs
dependent. Remember, if both you and your                                              random dependent eligibility audits, and you
spouse work for the same Employer, your                            Penalties         may have to provide documents proving your
dependents can be covered by only one of you. As                                  dependent’s eligibility. Anyone eligible as an
costs continue to rise, it is important that you enroll                        employee is not eligible as a dependent. Here are
your eligible dependents only.                                               examples of ineligible dependents.
                         Eligible Spouse                                                                   Ineligible Spouse
• Your lawful spouse (you must have a valid Certificate of                      • Your divorced spouse, or a person to whom you are not
  Marriage considered lawful in the State of Texas or a signed                    lawfully married, such as your boyfriend or girlfriend –
  and filed legal Declaration of Informal Marriage considered                     (a signed and filed legal Declaration of Informal Marriage
  lawful in the State of Texas); or                                               considered lawful in the State of Texas is required); or
• A surviving spouse of a deceased retiree, only if the                         • A surviving spouse who was not covered by the
  spouse was covered at the time of the retiree’s death.                          deceased retiree at the time of the retiree’s death.
                        Eligible Child(ren)                                                                Ineligible Child(ren)
• Your natural, unmarried child under age 25;                                   • A child that is married or age 25 or over;
• Your natural, unmarried mentally or physically                                • Your married or age 25 or over child who is not
  disabled child, if the child has reached age 25 and is                          disabled or whose disability occurred after the
  dependent upon you for more than one-half of their                              25th birthday;
  support as defined by the Internal Revenue Code. To be
                                                                                • A child for whom your parental rights have been
  eligible, the disability must occur before or within 31 days
                                                                                  terminated;
  of the child’s 25th birthday;
                                                                                • A child living temporarily with you, including a foster
• Your legally adopted child, including a child who is living                     child who is living temporarily with you or a child
  with you who has been placed for adoption or for whom                           placed with you in your home by a social service
  legal adoption proceedings have been started;                                   agency, or a child whose natural parent is in a
• Your stepchild whose primary residence is your                                  position to exercise or share parental responsibility
  household;                                                                      or control, unless you are required to provide
                                                                                  coverage by court order;
• Your unmarried grandchild (child of your child) under
  age 25 who, at the time of enrollment, is your dependent                      • Your stepchild who does not live with you and for
  for federal income tax purposes, without regard to                              whom your residence is not the primary residence;
  income limitations;                                                           • Your spouse’s stepchild;
• A child for whom you are required to provide                                  • A surviving child of a deceased retiree who was not
  coverage by court order; or                                                     covered as a dependent at the time of the retiree’s death;
                                                                                  or
• A surviving, eligible child of a deceased retiree, only if
  the child was covered as a dependent at the time of the                       • A brother, sister, other family member, or an individual not
  retiree’s death.                                                                specifically listed by the plan as an eligible dependent.

                                               Dependent Eligibility Audit Coming Soon!
     The PEBC will be conducting a 100% dependent eligibility audit in early 2010. During the audit, you will be asked to provide documentation
      confirming eligibility for any dependent enrolled in a medical or dental plan. You will receive full details about the audit later. Please take a
                 moment now to review this Dependent Eligibility summary to make sure your enrolled dependent(s) are still eligible.


 IMPORTANT: Check both columns. Full details regarding eligibility are found in the legal documents governing the plans.
                          6



2010 Changes At-A-Glance
More information about these changes can be found later in this Enrollment Guide.

Medical Plan Changes Effective January 1, 2010

✔ The HMO Blue Medical Plan is not available after 2009.
✔ Pre-existing condition limitations no longer apply to either the EPO Plan or PPO Plan.

✔ The EPO Plan and PPO Plan combined lifetime maximum claims limit is increased to
   $4,000,000 per person.

✔ With the new VSP Choice Plan (Vision Plan) available in 2010, the refraction connected
   to an annual, routine eye exam is no longer covered by the EPO Plan or the PPO Plan.

   EPO Plan Changes

   ✔ A written referral form from your PCP in order to see a specialist is no longer
       required. If you self-direct to a provider, be sure you remain in-network or you will
       pay much more. Your PCP can help you determine if a specialist is needed.

   ✔ EPO members must still select a PCP.
   ✔ Pre-certification requirements still apply.
    ✔ Out-of-network benefits are now available, but they are very expensive and you will
       pay a large portion of the cost. To find an in-network provider, call HealthSmart at
       800-444-3995.

   ✔ In-network $150 per day inpatient hospital copay up to $600 maximum (coinsurance
       does not apply).

   ✔ In-network $300 per admission outpatient hospital copay (coinsurance does
      not apply).

   PPO Plan Changes

   ✔ The out-of-area, in-network coinsurance level is now the same as in-area, in-network.
      This means that after deductibles, for those services requiring coinsurance (instead of
      a copay), employees will pay 20% of the allowed amount instead of the current 30%
      level. The annual out-of-pocket maximum amount remains the same.

New Vision Plan!

   ✔ VSP Choice Plan covers your annual eye health and vision exam plus eyewear (up to
      allowance amounts).

   ✔ Out-of-network reimbursement is available. Additional discounts are also available for
      optional lens services and Lasik vision correction.

   ✔ In-network special programs are available for soft contact lens wearers.
   ✔ With this new plan, refractions performed in connection with a routine, annual eye
      exam are no longer covered by the EPO Plan or PPO Plan. VSP out-of-network
      reimbursement may be available.
                                                                      7



2010 Changes At-A-Glance                                   (continued)
More information about these changes can be found later in this Enrollment Guide.


Dental Plan Changes
    Assurant DHMO Plan

    ✔ The Assurant DHMO Series 189 Plan (underwritten by United Dental Care of
       Texas, Inc.) replaces the Safeguard DHMO Plan.

    ✔ Some preventive services require no copay; other services have
       pre-determined copays.

    ✔ Full take-over of orthodontic services in process is available. This means if you are
       already in treatment, in many cases you can continue with your current treating
       orthodontist, even if he/she is not in the Assurant network (form required).

    PEBC PPO Dental Plan

    ✔ Delta Dental PPO Dentists and Delta Dental Premier Dentists replace the
       Careington Network.

    ✔ Delta Dental replaces ICON (HealthSmart) as the dental claims payer and
       Delta Dental will send Explanation of Benefits (EOB) forms.

   ✔ Preventive services no longer count toward the annual maximum benefit
       of $1,500 per person - stretching your benefits even further.

    ✔ Beginning in 2010, the waiting period to access major restorative services
       changes from 12 months to 6 months. If you are enrolled in this plan on
       December 31, 2009, any months you’ve satisfied will count toward your waiting
       period on January 1, 2010.

    ✔ Major restorative benefits can be used toward the cost of dental implants.

FLEX Account Annual Election Amount
(City of Frisco and North Texas Tollway Only)
    ✔ The Health Care FLEX Account annual election maximum increases from
       $2,400 to $3,600.


                      TRANSITION OF CARE INFORMATION
      PEBC HMO BLUE MEMBERS & NEW PEBC EMPLOYER GROUP MEMBERS ONLY
   The HealthSmart Care Management Team is dedicated to helping you during your transition to the EPO
   Plan and PPO Plan. Transition of care benefits are intended to allow members to continue to receive
   services from an out-of-network physician for a limited period of time and only for specified acute medical
   and behavioral conditions. HealthSmart must approve transition of care medical benefits and MHN must
   approve transition of care benefits for behavioral health/mental health conditions in active treatment on
   January 1, 2010.
   Your Enrollment Packet includes a booklet intended for those enrolled in the HMO Blue Plan in 2009
   enrolling in the EPO Plan or PPO Plan and employees of groups joining the PEBC for the first time
   effective January 1, 2010. Please check the Transition of Care section of the Changing Your Medical Plan
   2010 – New PEBC Groups and HMO Transition booklet for more information.
   If you are a new employee, opting-in to medical coverage, or changing from the EPO Plan to the PPO Plan
   or vice versa, this benefit does not apply to you.
                                                        8



                                  Medical Plans
QUICK INDICATORS
                                  EPO Plan - Snapshot
HMO Transition Tips
                                  This information gives you a quick snapshot of the EPO Plan. If you enroll in this plan,
If your HMO Blue PCP              you will select a Primary Care Physician (PCP) who will help coordinate your medical
participates in the EPO Plan,     care. You can choose a different PCP for yourself and each member of your family.
unless you select a new
PCP, your current PCP will        PCP Referrals
automatically transfer on         Everyone in the EPO Plan must select a PCP. Beginning in 2010, you no longer need
January 1, 2010 if you enroll     your PCP’s written referral to see a specialist or another provider. It is very
in the EPO Plan.                  important you remember that your PCP can assist you in finding an in-network specialist
                                  or another provider if needed.
EPO Plan                          Pre-Certification Required
                                  Even though you no longer need a written referral, you still need pre-certification for
• No deductibles                  certain services. In most cases, your PCP will do this for you. If you self-refer to a
• Low coinsurance                 specialist without seeing your PCP, be sure to check if a pre-certification is needed and if
• PCP referral is not             so, that it was completed. Otherwise, payment for that service will be denied. Check the
  required.                       QUICK INDICATORS section for the list of those EPO services requiring pre-certification.
• ID cards are mailed after
  you choose a PCP.               Network
• Out-of-pocket maximum           HealthSmart Preferred Care GEPO Network in the 40-County North Texas area and HPN
  does not apply to               Network elsewhere in Texas. Call Customer Service (or check the website) if you need
  out-of-network care.            assistance locating a participating provider.
EPO Plan and PPO Plan             Office Visit Copays (In-network)
Pre-Certification Required        $25 PCP / $30 Specialist
• Chemotherapy                    Prenatal & Postnatal Care (In-network)
• CT, MRI, or MRA scans           $25 PCP / $30 Specialist, 1st visit only (see inpatient hospital for additional information)
• Durable medical equipment       Out-of-Pocket Maximum (In-network)
  expenses over $500              Once you reach $1,750 in annual out-of-pocket costs, the EPO Plan pays 100% of your
• ERCP or EGD                     eligible expenses ($3,500 family). Copays and out-of-network services do not count
• Home health care                toward your annual out-of-pocket maximum.
• Hospice care                    Urgent Care Center (In-network)
• Inpatient admissions            $30 copay
• Inpatient rehabilitation
  services                        Emergency Room (In-network, Out-of-network)
• Invasive radiological           $75 copay – waived if admitted
  procedures                      Inpatient Hospital (In-network)
• Non-routine OB care             The inpatient hospital copay is $150 per day with a maximum copay of $600 per
• Outpatient surgeries            admission. The plan pays 100% of allowable cost after copay.
• Pain clinic evaluations
                                  Outpatient Hospital or Free-Standing Ambulatory Surgery Center (In-network)
• Routine expenses in             The outpatient copay is $300 for each outpatient admission. The plan pays 100%
  connection with a clinical      of allowable cost after copay.
  trial for cancer diagnosis or
  treatment                       Pharmacy
• Sleep apnea studies             Express Scripts
• 23-hour observation             Retail Pharmacy – $15 generic; $25 Brand Formulary; $50 Brand non-Formulary
                                  Mail Order – 90-day supply for cost of two retail copays
Emergency Admissions              See the Prescription Drug Benefit Section for more information.
You or a family member must       New Out-of-Network Benefit – You Will Pay More!
notify HealthSmart within         In 2010, the EPO Plan will have a limited out-of-network benefit. Please remember these
48 hours of admission.            very important rules about EPO Plan out-of-network benefits. Always check to make sure
See QUICK INDICATORS
                                  your provider participates in the HealthSmart GEPO Network or the HPN Network. If not,
on Page 9 for important
                                  it is an out-of-network service and you will pay much more of the cost. You will have to
Emergency Care Information.
                                  pay 40% of the Reasonable and Customary (R&C) cost if you use the services of an out-of-
                                  network provider. You will also pay the difference between your provider’s billed cost and
                                  the R&C amount. This is referred to as balance billing.
                                                                    9



Medical Plans
                                                                                               QUICK INDICATORS
PPO Plan - Snapshot
                                                                                               PPO Plan
This information gives you a quick snapshot of the PPO Plan. The PPO Plan provides you
the greatest freedom and choice of either medical plan available to you. You do not need       • In-network deductible
to select a Primary Care Physician (PCP), and you do not need referrals.                         $250 individual/
                                                                                                 $500 family
Network
                                                                                               • Low coinsurance
HealthSmart Preferred Care Network in the North Texas area and elsewhere in the State
of Texas; Beech Street PPO Network outside Texas. Call Customer Service (or check the          • PCP referral not required
website) if you need assistance with locating a participating provider. Limited out-of-        • Nationwide in-network
network benefits are also available.                                                             coverage
Office Visit Copays (In-network)                                                               • Out-of-network coverage
$25 PCP / $30 Specialist                                                                         available
Prenatal & Postnatal Care (In-network)                                                         • Out-of-pocket maximum
After deductible, you pay 20% of allowed charges; the Plan pays 100% after the out-of-           does not apply to
pocket maximum is met.                                                                           out-of-network care.
Out-of-Pocket Maximum (In-network)                                                             • Pre-certification required
As long as your medical care is delivered in-network, once you reach $2,750 in annual out-       for certain services.
of-pocket costs, the PPO Plan pays 100% of your eligible expenses ($5,500 family). Copays        See QUICK INDICATORS
and deductibles do not count toward the annual out-of-pocket maximum.                            on Page 8.
Urgent Care Center (In-network)
$30 copay
                                                                                                  What About
Emergency Room (In-network, Out-of-network)                                                       Emergencies?
$75 copay – waived if admitted
                                                                                                  In the event of a true
Inpatient Hospital
                                                                                                  medical emergency,
- In-network – After deductible, you pay 20% of the allowed cost. After the out-of                go to the nearest
   pocket maximum is met, the plan pays 100%.                                                     Hospital Emergency
 - Out-of-network – You pay 40% of the allowed cost, and you could be responsible for the         Room. If your
   difference between the hospital’s billed cost and the allowed cost (balance billing).          Emergency Room
Outpatient Hospital or Free-Standing Ambulatory Surgery Center (In-network)                       visit is not a true
Same as inpatient hospital                                                                        medical emergency,
                                                                                                  regular plan benefit
Pharmacy                                                                                          provisions will apply.
Express Scripts                                                                                   You will pay less cost
Retail Pharmacy – $15 generic; $25 Brand Formulary; $50 Brand non-Formulary                       at an in-network
Mail Order – 90-day supply for cost of two retail copays                                          Urgent Care Center,
See the Prescription Drug Benefit Section for more information.                                   even after hours.




         MHN Mental Health Benefits – EPO Plan and PPO Plan
                                                                                               Important Note All Plans
     When you enroll in either the EPO Plan or PPO Plan, your mental health benefits are
     provided by MHN. Your mental health benefits include both outpatient and inpatient        No plan can guarantee a
     care, and substance abuse services. MHN is one of the largest and oldest providers        provider’s participation.
     of managed behavioral health care and Employee Assistance Programs (EAP) in the           Always double-check with
     United States. Remember, HealthSmart/Beech Street medical networks do not                 your provider before you
     extend to your mental health benefits.                                                    access care to make sure
                                                                                               he or she is a participating,
     To receive benefits for mental health treatment, you must contact MHN to                  in-network provider.
     pre-certify care before you receive it. If you fail to pre-certify your treatment, no
     benefits will be paid and you will be responsible for paying all costs incurred for the
     care you receive. In addition to your EPO or PPO mental health benefits, you are
     also eligible for EAP benefits at no cost. Refer to the EAP Section in this
     Enrollment Guide for more information.
                                  10



Plan Service Areas
Service area is important. If you enroll in the EPO Plan or PPO Plan, in order for your service to
be considered in-network, your provider must be located in the service area. Listed below are
the EPO Plan Texas Counties. You will notice that the PPO Plan offers in-network service through
the HealthSmart PPO network in Texas and the Beech Street network outside Texas. Contact
the Plan’s Customer Service Department if you question whether your care will be considered
in-network.


           County/Geographic            EPO In-Network                   PPO In-Network
                 Area               HealthSmart/GEPO/HPN              HealthSmart (in Texas)
                                                                    Beech Street (outside Texas)
           Texas Counties
           Texas Counties                   Yes = In-Network
                                        Yes = In--Network      No = Not In-Network
                                                                         No = Not In--Network
           Bosque                             Yes                                 Yes                   Yes
           Bowie                              Yes                                 Yes                   Yes
           Camp                               Yes                                 Yes                   Yes
           Collin                             Yes                                 Yes                   Yes
           Comanche                           Yes                                 Yes                   Yes
           Cooke                              Yes                                 Yes                   Yes
           Dallas                             Yes                                 Yes                   Yes
           Delta                              Yes                                 Yes                   Yes
           Denton                             Yes                                 Yes                   Yes
           Eastland                           Yes                                 Yes                   Yes
           Ellis                              Yes                                 Yes                   Yes
           Erath                              Yes                                 Yes                   Yes
           Fannin                             Yes                                 Yes                   Yes
           Franklin                           Yes                                 Yes                   Yes
           Grayson                            Yes                                 Yes                   Yes
           Gregg                              Yes                                 Yes                   Yes
           Hamilton                           Yes                                 Yes                   No
           Henderson                          Yes                                 Yes                   Yes
           Hill                               Yes                                 Yes                   Yes
           Hood                               Yes                                 Yes                   Yes
           Hopkins                            Yes                                 Yes                   Yes
           Hunt                               Yes                                 Yes                   Yes
           Jack                               Yes                                 Yes                   Yes
           Johnson                            Yes                                 Yes                   Yes
           Kaufman                            Yes                                 Yes                   Yes
           Lamar                              Yes                                 Yes                   Yes
           Montague                           Yes                                 Yes                   Yes
           Navarro                            Yes                                 Yes                   Yes
           Palo Pinto                         Yes                                 Yes                   Yes
           Parker                             Yes                                 Yes                   Yes
           Rains                              Yes                                 Yes                   Yes
           Red River                          Yes                                 Yes                   Yes
           Rockwall                           Yes                                 Yes                   Yes
           Somervell                          Yes                                 Yes                   Yes
           Tarrant                            Yes                                 Yes                   Yes
           Titus                              Yes                                 Yes                   Yes
           Upshur                             Yes                                 Yes                   Yes
           Van Zandt                          Yes                                 Yes                   Yes
           Wichita                            No                                  No                    No
           Wise                               Yes                                 Yes                   Yes
           Wood                               Yes                                 Yes                   Yes
           Texas Counties            *Yes - HPN providers                       *Yes                    *Yes
           Not Listed                   Check Directory                 HealthSmart Providers
           Outside Texas               Emergency Only                    *Yes - Beech Street       Emergency Only

  *Contact Customer Service for more information.
                                                                       11



Prescription Drug Benefits
                                                                                                     QUICK INDICATORS
Both the EPO Plan and PPO Plan have the same prescription drug plan benefits. For more
information or if you have questions about a specific drug, visit www.pebcinfo.com or call           HMO Transition Tips
Express Scripts at 877-613-1227.                                                                     If you use mail order to fill
                                                                                                     your prescriptions, be sure
EPO/PPO Plan - Specialty Drugs and Injectables                                                       you have a sufficient supply
Specialty drugs treat chronic and complex conditions such as hepatitis C, multiple sclerosis         of medications on hand
and rheumatoid arthritis. These drugs can require frequent dosing adjustments, specialized           to carry you through
handling and sometimes require specialized administration, such as injection. Specialty              January 2010. You will
drugs generally cost at least $500 for a 30-day supply (often more) and require intensive            need a new prescription
clinical monitoring. The EPO Plan and the PPO Plan cover specialty drugs and injectables,            from your doctor when you
                                                                                                     send your first Express
subject to plan requirements.                                                                        Scripts mail order. A mail
For those enrolled in the EPO Plan or PPO Plan and through Express Scripts, CuraScript               order form will accompany
Specialty Pharmacy provides care, service and value to meet the complex needs of specialty           your Express Scripts
patients. CuraScript times the mail order delivery of specialty drugs requiring strict storage       ID Card.
conditions and includes necessary supplies to administer your drugs if needed. Patient Care          $4.00 Generic
Coordinators are available to answer any questions you may have.                                     Programs
If you are currently taking a specialty medication, both you and your doctor will likely             Many retailers now offer
receive a letter introducing the CuraScript Specialty Pharmacy with instructions                     $4.00 generic programs
                                                                                                     (30-day supply) and some
explaining how prescriptions can be filled. Except for chemotherapy, in some cases,
                                                                                                     offer $10 generic programs
the injectable medication may be shipped directly to your doctor’s office so that                    (90-day supply). You pay the
it is there in time for your next visit. Refer to the EPO/PPO Pharmacy Benefit Guide                 lesser of the retail price or
for more information about specialty drugs and injectables.                                          your copay. Check the
                                                                                                     dosage cost differences and
                                                                                                     the specific generics covered
        Most people believe that if something costs more, it has to be better quality.
         In the case of generic drugs, this is not true. A generic drug is a copy                    by each retailer.
           that is the same as a brand-name drug in dosage, safety, strength,                        FLEX Accounts
                  how it is taken, quality, performance and intended use.
                                                                                                     and Pharmacy
                         – United States Food and Drug Administration (FDA)
                                                                                                     Some over-the-counter
                                                                                                     medications and products
                                                                                                     are eligible for FLEX
     Prescription Drug Benefit                             EPO Plan and PPO Plan                     reimbursement! Check
                                                                                                     out the PayFlex brochure
    Retail pharmacy (30-day supply)                *You pay $15 / $25 / $50                          for more information about
                                                                                                     eligible over-the-counter
    Mail order (90-day supply)                     *You pay $30 / $50 / $100
                                                                                                     products.
    Quantity limits on selected drugs              Yes

    Prior authorization on selected drugs          Yes

    Non-network retail pharmacy                    Copay + difference between in and out-of-
    copay/cost (file claim with receipt for        network RX cost                                          Review the
    reimbursement)                                                                                           EPO/PPO
    Pharmacy benefit manager (PBM)/                Express Scripts - 877-613-1227
                                                                                                         Prescription Drug
    Customer Service                                                                                       Benefit Guide
    Preferred drug list (formulary)                Express Scripts National Preferred
                                                   Formulary

    Online refills, preferred drug lists,          www.express-scripts.com (select Members)
    price-checkers
                                                                                                     This handy booklet will help
    Diabetic supplies                              Preferred brands - no cost to member              you navigate through your
                                                   if filled via mail order. Retail fills and non-
                                                   preferred brands - applicable copays apply        prescription drug benefits.
                                                                                                     Check it for the most
    Smoking cessation medications.                 Chantix™ - Formulary                              commonly prescribed
                                                   Zyban® - Non-formulary (generic available)        formulary drugs, formulary
                                                   Others could be available.
                                                   Discuss with your doctor.                         alternatives and other
                                                                                                     important information.

*($ generic / $ preferred brand / $ non-preferred brand)
                                                        12



                                 New! VSP Choice Plan Vision Benefits
QUICK INDICATORS
                                 Consider enrolling in the VSP Choice Plan, the new PEBC vision plan available in 2010.
                                 The VSP network is made up of private-practice doctors (ophthalmologists & therapeutic
Low Vision                       optometrists) and many offer affordable, high-quality eyewear choices on-site.
What is low vision?
Low vision is a vision loss
                                 In-Network Benefits
sufficient enough to prevent
reading and performance of           ✓ VSP WellVision Exam® - $30 Copay (once each plan year)
daily activities.                      The VSP WellVision Exam is more than just a quick eye check. It focuses on your
                                       eyes and overall wellness. VSP doctors look for more than just vision problems.
With pre-approval from VSP,
                                       They can detect signs of serious health conditions like glaucoma, diabetic eye
low-vision supplemental
testing is covered once every
                                       disease, high blood pressure and high cholesterol.
two years.                           ✓ Prescription Eyeglass Lenses (once each plan year)
VSP will pay 75% of the cost           • Glass or plastic, single vision, lined bifocal, lined trifocal lenses – covered in full
for approved low-vision aids,          • Polycarbonate lenses for enrolled children – covered in full
up to a maximum of $1,000              • 20% off lens options including progressives, anti-reflective, photochromics,
(less the cost paid for                  scratch resistant coating, polycarbonate, plastic dyes, and UV protection
supplemental testing) per
member every two years.              ✓ Eyeglass Frames (once each plan year)
                                       • Covered in full up to $150 retail allowance for frame of your choice
                                       • 20% off any amount exceeding the allowance
Plan Exclusions
                                     ✓ Contact Lenses (once each plan year instead of eyeglasses)
The following items are
excluded under this plan.              • Any type of prescription contact lenses and contact lens evaluation/fitting fee up
                                         to $200 combined allowance
• Two pair of eyeglasses
                                       • Replacement contact lens wearers may be eligible for a covered-in-full initial
  instead of bifocals
                                         contact lens fitting and evaluation and initial supply of approved lenses,
• Replacement of lenses,                 including toric, multifocal, and hydrogel (check with the VSP doctor for
  frames or contacts
                                         eligibility)
• Medical or surgical
                                     ✓ Laser VisionCare Program
  treatment
                                       • VSP-contracted laser centers provide discounts for laser surgery including PRK,
• Orthoptics, vision training
                                         LASIK, and Custom-LASIK
  or supplemental testing
                                       • Discounts average 15% off or 5% off if the laser center is offering a
The following items are not              promotional price
covered under the contact              • Laser Vision Care discounts are only available from VSP-contracted facilities
lens coverage.

• Insurance policies or
                                                         Locate a VSP Provider - www.vsp.com
  service agreements
                                                       Select Members; Select “Find a VSP Doctor”
• Artistically painted or                        Select “Not a Member” and “Continue as a Non-Member”
  non-prescription lenses
• Additional office visits for
  contact lens pathology         Out-of-Network Benefits
• Contact lens modification,     Although most VSP members choose to see a VSP doctor, your choice is important!
  polishing or cleaning          The following list is a reimbursement schedule for members who choose a non-VSP
                                 provider. Claim forms are available online at www.pebcinfo.com or www.vsp.com.
                                 Out-of-network reimbursements replace in-network services and are available once each
                                 plan year.
                                 ✓   Eye Exam……………............Up to $43            ✓ Lenticular Lenses………….Up to $100
                                 ✓   Single Vision Lenses….......... Up to $30     ✓ Eyeglass Frames…..............Up to $40
                                 ✓   Lined Bifocal Lenses…..........Up to $45      ✓ Contact Lenses
                                 ✓   Lined Trifocal Lenses….........Up to $62          In lieu of eyeglasses….........Up to $185
                                                               13



Medical Plans
                                                                                                   QUICK INDICATORS
Opt-Out of a Medical Plan
Provided you show valid proof of other comparable medical plan coverage, you may choose             Opt-Out
to Opt-Out of your Employer’s medical plan. If you choose this option, you must provide             • Valid proof of other
proof of other comparable medical coverage and complete a “Certification of Other                     comparable medical plan
Coverage” Form. Both documents must be received by your Employer’s Human Resources                    coverage is required.
Department before the enrollment deadline. If you do not provide a Certification of Other
                                                                                                    • A Certification Form is
Coverage Form, or if your proof of coverage is found to be invalid, your Employer can enroll          required.
you in the PPO Plan, employee only coverage.
                                                                                                    • If you select Opt-Out,
If you select Opt-Out you are considered “absent” from the medical plans. You are not                 you are not eligible for
eligible for continuation of medical coverage (COBRA) if you elect to Opt-Out of medical              COBRA medical
coverage.                                                                                             benefits.
                                                                                                    • Check your Employer’s
Make sure you provide current valid “proof” of your other comparable medical coverage                 policies for other coverage
during annual enrollment. Examples of other coverage that cannot be used to Opt-Out of                requirements.
your Employer’s medical plan include Tri-Care “supplemental” coverage, student insurance
or medical payments coverage provided as part of your auto insurance policy. Your
Employer will confirm your other coverage. Check with your Human Resources
Department if you have questions.                                                                       Retiring Soon?
Participating Employers Only: If your Employer contributes to your FLEX Spending                        If you are an
Account due to your Opt-Out status and your proof of coverage is found to be invalid,                   Opt-Out member
the Employer contribution will be discontinued. In that case, you will be required to                   contemplating
repay any payments made to you and you could be subject to serious consequences.                        retirement, you may
Review your Employer’s enrollment materials for specific information about this program.                want to reconsider
Participation or continuation in any Employer contribution program is at the discretion of              your Opt-Out status
the Employer.                                                                                           during annual
                                                                                                        enrollment. Check
                                                                                                        with your Employer
                                                                                                        for more details.
               Complete a Certification of Other Coverage Form!
      Forms are available at www.pebcinfo.com or from your Human Resources Department.




                                 Your Total Out-of-Pocket Medical Benefit Cost


                 Your benefit cost is not limited to your            EPO Plan/PPO Plan
                   premium payment only. Make sure                   If you enroll in the EPO Plan or PPO Plan, your share of eligible
                        you compare all out-of-pocket                out-of-pocket costs goes toward satisfying your maximum
        Estimate         costs within each plan to see               annual out-of-pocket limit. Once you reach the out-of-
                            which of the plans is best               pocket limit, the plan generally pays 100%. The charges
        Your Total          for you.                                 that do not count toward satisfying your annual out-of-pocket
         Expected                  The maximum annual out-of-        limit include those listed below.
           Cost                  pocket limit protects you in        •   Medical copays (including office visits/hospital copays)
                                 the event of a catastrophic
                          loss. After you reach the annual           •   Prescription drug copays
                       maximum out-of-pocket limit, the              •   Expenses that are not covered by the plan
                    plan generally pays 100% of your
eligible expenses for the remainder of the calendar year,            •   Charges for services or supplies not pre-certified
subject to plan provisions. The costs that count toward              •   Services that are not medically necessary
satisfying your annual out-of-pocket limit will differ depending     •   Out-of-network costs
on the plan you select.
                                                                                         14


                                                        EPO Plan Quick Reference Guide
                                               Refer to Plan Documents for Limitations and Additional Information

                                                                         EPO Plan - In-Network                                             EPO Plan - Out-of-Network
                        Feature                                                                                                You pay deductibles, coinsurance + charges exceeding Reasonable & Customary

                                                                            HealthSmart GEPO/HPN                                                        Out-of-Network
Select a Primary Care Physician                            Yes                                                                In-network PCP required
Annual Deductible                                          Does Not Apply                                                     Does Not Apply
Coinsurance (after copays)                                 You 10%; Plan 90%; Plan 100% after OOP                             You 40%; Plan 60%
Annual Out-of-Pocket Maximum (OOP)                         $1,750 individual/ $3,500 family                                   No Limit
Lifetime Maximum                                                                                      $4,000,000 Combined EPO/PPO
Physician Services
Office Visits                                              $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Hospital Visits                                            Included in Inpatient Copay                                        You 40%; Plan 60%
Urgent Care Visit                                          $30 copay                                                          You 40%; Plan 60%
Preventive Care
Well Child Care (birth to age 17)                          $25 PCP / $30 Specialist                                           You 40%; Plan 60%
*Annual Well-Woman Exam                                    $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Routine Screening Mammography (age 35+)                    No copay                                                           You 40%; Plan 60%
Adult Health Assessments (age 18 +)                        $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Routine Speech & Hearing Exam                              $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Annual Eye Exam                                            Refer to VSP Choice Plan                                           Refer to VSP Choice Plan
Eyewear, Frames, Contacts                                                                                            Not covered
                                                                                                                      Not covered
Maternity Services
Prenatal and Postnatal Care - 1st visit only               $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Delivery in Hospital                                       $150 copay per day, maximum $600                                   You 40%; Plan 60%
Newborn Care in Hospital (Routine)                         Included with routine delivery                                     You 40%; Plan 60%
Inpatient Hospital Services                                $150 copay per day, maximum $600                                   You 40%; Plan 60%
Outpatient Surgery                                         $300 copay                                                         You 40%; Plan 60%
Diagnostic Lab & X-rays                                    In physician, lab or radiological provider office, $25 PCP;        You 40%; Plan 60%
                                                           $30 Specialist. If within 7days prior to inpatient admit,
                                                           plan pays 100%; Screening colonoscopy - $250 copay
Hospital Emergency Care Services                           $75 copay - waived if admitted                                     $75 copay - waived if admitted
Skilled Nursing Facility                                   You 10%; Plan 90%; Plan 100% after OOP                             You 40%; Plan 60%
                                                           up to 60 days annually
Home Health Care                                           You 10%; Plan 90%; Plan 100% after OOP                             You 40%; Plan 60%
                                                           up to 120 days annually
Allergy Care Services                                      $25 PCP / $30 Specialist                                           You 40%; Plan 60%
Chiropractic                                               $30 copay per visit - maximum 20 visits per year                   You 40%; Plan 60% - maximum 20 visits per year
Infertility Services (Limited Services)                    You 50%; Plan 50%; Plan 100% after OOP                             You 50%; Plan 50%
                                                           (excludes in vitro and drug coverage)                              (excludes in vitro and drug coverage)
Medical Supply & Equipment (DME)                           You 10%; Plan 90%; Plan 100% after OOP                             You 40%; Plan 60%
Mental Health Services
    Outpatient Visits                                      $25 visit - maximum 20 visits per year                             You 50%; Plan 50% - maximum 20 visits per year
    Inpatient                                              $150 copay per day, maximum $600                                   You 40%; Plan 60%;
                                                           limits apply to number of days annually                            limits apply to number of days annually
    Serious Mental Illness                                                                                  Treated like any other illness
    Chemical Dependency                                                                                 Limited to 3 lifetime episodes of care

       Prior year changes are noted in Red. *In-network OB/Gyn $25 copay for well-woman services only. If annual mammogram ordered, only 1 copay applies.
                                                                                        15


                                                      PPO Plan Quick Reference Guide
                                           Refer to Plan Documents for Limitations and Additional Information

                Feature                                        PPO Plan - In-Network                                                   PPO Plan - Out-of-Network
                                                                                                                        You pay deductibles, coinsurance + charges exceeding Reasonable & Customary

                                                HealthSmart (in Texas) Beech Street (outside Texas)                                                Out-of-Network
Select a Primary Care Physician               No                                                                       No
Annual Deductible                             $250 individual / $500 family - must be met before OOP                   $500 individual
Coinsurance (after deductibles & copays)      You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Annual Out-of-Pocket Max (OOP)                $2,750 individual / $5,500 family                                        No limit
Lifetime Maximum                                                                               $4,000,000 Combined EPO/PPO
Physician Services
Office Visits                                 $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
Hospital Visits                               You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Urgent Care Visit                             $30 copay                                                                You 40%; Plan 60%
Preventive Care
Well Child Care (birth to age 17)             $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
*Annual Well-Woman Exam                       $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
Routine Screening Mammography (age 35+)       No copay                                                                 You 40%; Plan 60%
Adult Health Assessments (age 18 +)           $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
Routine Speech & Hearing Exam                 $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
Annual Eye Exam                               Refer to VSP Choice Plan                                                 Refer to VSP Choice Plan
Eyewear, Frames, Contacts                                                                                     Not covered
Maternity Services
Prenatal and Postnatal Care                   You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Delivery in Hospital                          You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Newborn Care in Hospital (Routine)            You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Inpatient Hospital Services                   You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Outpatient Surgery                            You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Diagnostic Lab & X-rays                       In physician, lab or radiological provider office, $25 PCP; $30          You 40%; Plan 60%
                                              Specialist. If within 7days prior to inpatient admit, plan pays 100%
                                              Screening colonoscopy - $250 copay
Hospital Emergency Care Services              $75 copay - waived if admitted                                           $75 copay - waived if admitted
Skilled Nursing Facility                      You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60% up to 60 days annually
                                              up to 60 days annually
Home Health Care                              You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
                                              up to 120 days annually                                                  up to 120 days annually
Allergy Care Services                         $25 PCP / $30 Specialist                                                 You 40%; Plan 60%
Chiropractic                                  $30 copay per visit - maximum 20 visits per year                         You 40%; Plan pays 60% - maximum 20 visits per year
Infertility Services (Limited Services)       You 50%; Plan 50%; Plan 100% after OOP                                   You 50%; Plan 50%
                                              (excludes in vitro and drug coverage)                                    (excludes in vitro and drug coverage)
Medical Supply & Equipment (DME)              You 20%; Plan 80%; Plan 100% after OOP                                   You 40%; Plan 60%
Mental Health Services
    Outpatient Visits                                      $25 visit - maximum 20 visits per year                      You 50%; Plan 50% - maximum 20 visits per year
    Inpatient                                   You 20%; Plan 80%; limits apply to number of days annually             You 40%; Plan 60%; limits apply to number of days annually


    Serious Mental Illness                                                                            Treated like any other illness
    Chemical Dependency                                                                           Limited to 3 lifetime episodes of care


         Prior year changes are noted in Red. *In-network OB/Gyn $25 copay for well-woman services only. If annual mammogram ordered, only 1 copay applies.
                                                             16



                                  Dental Highlights
QUICK INDICATORS
Assurant DHMO
                                  Assurant Dental HMO Plan (DHMO) Underwritten by United Dental Care of Texas, Inc.

• Service area – Texas only       The DHMO is a fully-insured dental HMO plan. The plan offers many preventive services
                                  at zero copay. Other dental services have pre-established copays which are less than you
• No claims to file               would pay without the plan. There are no deductibles, coinsurance or annual maximum
• Includes adult/child            limits. You will find a smaller network than the PEBC Dental Plan, but the employee
  orthodontics                    premium is less. The Assurant DHMO Booklet (available at www.pebcinfo.com) lists
• Select a General Dentist
                                  each service and the applicable copay. If you are currently in
  Call Assurant DHMO              orthodontic treatment, the plan will continue that treatment
                                  even if your orthodontist is not in the network. You must
• If you are in Safeguard         complete the Assurant Continuing Orthodontic
  DHMO (2009), if your            Treatment Request Form, which is available at
  General Dentist is in the       www.pebcinfo.com or from your Human Resources
  Assurant Network, the           Department.                                                    Changes
  General Dentist will
  automatically transfer                                                                                  Ahead!
  unless you choose a new         PEBC Dental Plan
  General Dentist
                                  The PEBC Dental Plan is a self-funded PPO plan with access
                                  to both in-network and out-of-network benefits. In 2010, the
                                  best-in-class Delta Dental Network replaces the Careington
  Looking For a Dentist?          Care PPO Network. What does this mean to you? You now have
      www.pebcinfo.com            access to a larger network of in-network dentists which translates to more cost savings to
    or check the Contacts         you. Both Delta Dental PPO Dentists and Delta Dental Premier Dentists are
   Section found at the front
   of this Enrollment Guide
                                  considered in-network, although you will save more when you select a PPO Dentist.
                                  This plan is a non-duplicating plan, which means if this plan is secondary to another
                                  dental plan, this plan will not pay if the primary plan’s allowable cost is greater than the
                                  PEBC Dental Plan’s allowable cost.
PEBC Dental Plan                                                        PEBC Dental Plan
Delta Dental
                                     Type of Service                  Annual           After Deductible   Maximum Benefit
• Nationwide service area                                           Deductible            Plan Pays         Paid by Plan
• Freedom to see any
  dentist – you will pay more                                                                              Preventive services
                                   Preventive Care
  for out-of-network care                                                                                  do not count toward
                                   includes checkups,                    $0                 100%            the $1,500 annual
                                   cleaning, X-rays.
• Explanation of Benefit                                                                                  maximum plan benefit.
  (EOB) forms from
  Delta Dental                     Basic Care includes
                                   fillings, oral surgery,
• Orthodontic treatment in
                                   periodontal treatment,                                    80%
  process can pick up in
                                   root canals, crown
  your first month of                                             $50 per person per
                                   repair.
  enrollment; however,                                            year for Basic and
  out-of-network benefits                                           Major services                         $1,500 per person
                                   Major Care includes
  could apply                                                     combined - up to 3                            per year
                                   crown installation,
• If you are an employee of        fixed bridgework,                 deductibles
  a new PEBC group                 dentures and dental                per family             50%
  enrolling for the first time,    implants. Benefits
  this Plan’s waiting periods      begin after 6 months
  do not apply in your first       of coverage.
  year of enrollment only.
                                                                  $50 per person per
                                   Orthodontia benefits           year for Basic and
                                   begin after 12 months            Major services                         $1,750 per person
                                                                                             50%              per lifetime
                                   of coverage.                   combined - up to 3
                                                                     deductibles
                                                                      per family
                                                                  17



Identification (ID) Card Information – 2010
                                                                                                      QUICK INDICATORS
Why Do You Need An ID Card?
The ID card is a document meant for your doctor, hospital or other health care provider. The          Two Common Reasons
ID card is designed so that your provider can copy it (both sides) and read important                 ID Cards Are Delayed
identification information needed to file a claim. The ID card also has important telephone
numbers and electronic information used to verify your eligibility, benefits and to meet
                                                                                                      • Your Employer does not
pre-certification requirements. The ID card is not proof you are eligible for any plan.
                                                                                                        have your current address.
Benefits are always subject to eligibility at the time service is rendered.
                                                                                                      • You did not choose your
2010 ID Cards                                                                                           PCP, or you were late in
                                                                                                        choosing your PCP (EPO
If you are new to a plan listed below (2010 coverage), the plan will not know who                       Plan only).
you are until after December 20, 2009. Do not try to contact a plan before that date
about your ID card. You should receive your ID cards by December 31, 2009. If your 2010
ID card is late, as long as you are enrolled in a plan you can still access services. Your provider
can easily verify your eligibility and your benefits by calling the applicable Customer Service            If you do not
number shown below and on your ID card. After you receive your ID cards, if you find you                   receive your ID
need additional cards, simply contact the Plan at a Customer Service number listed below.                  card by late
                                                                                                           January, contact
✔ EPO Plan and PPO Plan                                                                                    the Plan’s
                                                                                                           Customer Service
   HealthSmart Medical ID Card - Customer Service 800-444-3995                                             Department. Your
   All enrolled EPO Plan and PPO Plan members will receive a 2010 ID Card from                             eligibility is not
   HealthSmart. This card is to be used when accessing EPO Plan or PPO Plan medical                        interrupted as a
   care or mental health services through MHN. The ID card no longer lists each                            result of an ID
   covered dependent. When you present your card, the provider can electronically                          card delay.
   confirm your eligibility and that of your covered dependents.                                           Providers can
                                                                                                           confirm eligibility
       EPO Plan Only - The EPO Plan ID Card no longer lists the PCP name. The                              by contacting the
       provider has electronic access to PCP information. If you are new to the EPO Plan                   appropriate plan.
       in 2010, you must select a PCP before your ID card can be mailed to you. You can
       select a PCP at any time by calling Customer Service or send your selection via fax
       or mail (form available online at www.pebcinfo.com).
   Express Scripts Pharmacy ID Card – Customer Service 877-613-1227
   Beginning in 2010, all enrolled members will receive a prescription benefits
   ID card from Express Scripts. The employee name is printed on the ID card and
   your pharmacy can electronically identify any covered dependents. If you are currently                  Your Security
   enrolled in the EPO Plan or PPO Plan, it is “business as usual” and there are no changes
   to your pharmacy identification numbers. Be sure to remember that the HealthSmart                            Is
   medical ID card is not for pharmacy use. The new Express Scripts ID card makes it                         Important
   easier for the pharmacy to identify you when filling prescriptions. Present the Express
   Scripts ID card to the pharmacy if you are new to the EPO Plan or PPO Plan, or if you
   are a current member asked for pharmacy identification information.
✔ PEBC Dental Plan - Customer Service 800-521-2651
   All enrolled in the PEBC Dental Plan will receive a 2010 ID card from Delta Dental.
   After December 20, 2009, if you visit www.deltadental.com and register using the
   secure website, you can print a temporary ID card for use until your new ID card arrives.          Rest assured, your
                                                                                                      confidential information is
✔ Assurant DHMO Dental Plan - Customer Service 800-227-3055                                           protected. All PEBC plans
   All enrolled in the Assurant DHMO Dental Plan will receive a 2010 ID card.                         must follow federal rules
                                                                                                      connected to privacy
✔ VSP Choice Plan – Customer Service 800-877-7195                                                     and security of your
   The VSP Vision Plan uses an electronic “paperless” ID card system. Therefore, you will             confidential information.
   not receive an ID card. You need only visit an in-network provider and provide your                ID cards do not list social
   name and your Employer’s name. Your provider can electronically identify you and your              security numbers.
   covered dependents.
                                                      18



                                What is a Self-Funded Health Plan?
QUICK INDICATORS                PEBC Employer groups self-fund (or self-insure) the EPO Plan, the PPO Plan and the PEBC
                                Dental Plan. This means there is no insurance company and your Employer funds the cost
Active Employees                of health claims. With self-funding, each PEBC Employer group’s experience stands on its
                                own and is not combined with any other group. This means your cost is based on your
Considering
                                workforce alone – not on other people’s problems – and your employee cost is based on
Retirement                      the experience of only your Employer group.
Before you retire, be
                                Even with the administrative costs associated with self-funded plans, when compared
sure to consider each
item below.
                                to fully-insured plans (e.g. an HMO Plan), the savings can be significant. The PEBC
                                consistently administers all PEBC Employer health plans which drives savings even further.
• Meet with your Human          To an employee and health care providers, a self-funded insurance plan looks and feels
  Resources Department          no different than any insurance plan.
  at least 60 days before
  you retire.
                                Subrogation Requirements
• Contact the Social
  Security Administration       Both the EPO Plan and PPO Plan have important subrogation requirements. Subrogation is
  90 days before you retire.    the right of a party that has paid medical claims to recover amounts paid if the beneficiary
                                of those payments recovers funds from another source. For example, if you are in a car
• You are eligible for          accident that results in medical claims paid by the EPO Plan or PPO Plan, then the Plans
  Medicare when you turn        have a right to recover amounts paid on your behalf if you receive a payment from the
  age 65, regardless of         other driver’s insurance company.
  when you retire (some
  exceptions apply).
                                If you are involved in an accident, you will receive an Accident Investigation Form from
                                HealthSmart. You should quickly complete the Form and return it to HealthSmart. The EPO
• If you retire and delay       Plan and the PPO Plan have the right to recover all sums up to the amount paid by the
  signing up for Medicare       medical plan for claims arising from the accident.
  Part B, you could pay
  higher premiums for your
  Medicare Part B coverage.                    Some Additional Things to Consider
If Your Employer
Offers Group Retiree            Contemplating Retirement?
Health Benefits
                                If your Employer offers retiree health benefits, this information applies to you. Be sure you
• If you are age 65 or older,
                                review your Employer’s retiree health policies before you retire. They may have changed.
                                Make an appointment to discuss your options with the Human Resources Department. If
  you must have Medicare
                                you are planning to retiree sometime during 2010, pay particular attention to this annual
  Part A & Part B to enroll
                                enrollment period. Your elections during your last active employee annual enrollment
  in the Employer group         period will affect the retiree benefits for which you may be eligible. Contact the Social
  retiree plans.                Security Administration at least ninety (90) days before you retire. If you are considering
• Retiree premiums must be
                                retirement, check out the Retiree Enrollment Guide, available at www.pebcinfo.com or from
                                your Employer.
  paid on time or coverage
  is cancelled.
                                Celebrating Your 65th Birthday?
Online Resources                You are eligible for Medicare when you turn 65, regardless of when you retire. Your
www.medicare.gov                Medicare is effective the first day of the month in which you turn 65. If your birthday is on
www.socialsecurity.gov          the 1st day of the month, Medicare is effective the 1st day of the month before your 65th
                                birthday. As long as you are an active employee, your Employer plan is primary for you and
                                your spouse, even if your spouse is age 65 or older. But once you retire, Medicare is
                                primary. Make sure you contact Medicare ninety (90) days before you retire to avoid
                                potential higher premiums. If you are considering retirement, check the Retiree Enrollment
                                Guide for more information. Visit www.pebcinfo.com and select Retiree from the top
                                menu.
                                                              19



Change in Status Events
As a condition for offering tax-free benefits to you, eligible benefit premiums are deducted from
your payroll check on a pre-tax basis only. Your employee benefits are offered to you through
your Employer’s cafeteria plan. You should choose your benefits wisely. IRS regulations
provide that, unless you experience a qualified “Change in Status” Event (described below),
you cannot change your benefit choices until the next annual enrollment period. If you do
experience a Qualified Change in Status Event, you may make a new election for coverage as
long as the election is consistent with the Qualified Change in Status Event.
To be considered consistent, the Qualified Change in Status Event must result in either becoming
eligible for or losing eligibility under the Plan. The change must correspond with the specific
eligibility gain or loss. As long as the Qualified Change in Status Event is consistent, you may also
change your corresponding FLEX Spending Account elections, dependent life insurance elections, or
your health benefit elections. Refer to the Plan Documents for additional detailed information.
                  Two Types of Qualified “Change in Status” Events
Change in Family Status - Applies to                  Change in Employment Status - Applies
employee, employee’s spouse, or employee’s            to any change in the employment status of
dependents:                                           an employee, spouse or dependent that affects
                                                      benefit eligibility under your benefit plan or the
• Marriage, divorce or annulment;                     employer benefit plan of your spouse or your
• Death of your spouse or dependent;                  dependent.
• Child’s birth, adoption or placement for
  adoption; or                                        • Termination or commencement of
• An event causing a dependent to no longer              employment;
  meet eligibility requirements, such as              • Strike or lockout;
  reaching age 25 or getting married.                 • Start or return from an unpaid leave
                                                         of absence;
                                                      • USERRA (military) leave;
   Examples of Events That Do Not Qualify             • Switching from a salaried to an hourly-paid
                                                         job (or vice-versa);
  • Your doctor or provider is not in the network.
                                                      • Reduction or increase in hours of
  • You prefer a different medical plan.                 employment, such as going from part-time
  • You were late turning in your paperwork,             to full-time; or
    or you gave your paperwork to someone             • Any other employment related change that
    to turn in on your behalf and they were late.        makes the individual become eligible for or
                                                         lose eligibility for a particular plan.
                                   Important Deadlines Apply
Timing is very important. According to IRS rules, coverage elections cannot be retroactive. Except for
newborns and adoptions, a Qualified Change in Status Event is effective the first day of the month
following the date you notify your Employer, provided you met the 31-day notification rule.
  1. 31-Day Notification Rule – you must notify your Human Resources Department of the event
     AND you must complete and turn-in required paperwork (including proof of the change) within
     31 days of the event date. If you do not, you cannot make the change.
  2. Effective Date – Provided you met the 31-day rule noted in #1 above, the change is effective
     the first day of the month following the date you notified your Employer of the Qualified
     Change in Status Event. Effective date exception: Newborns are effective on the date of birth and
     adoptions are effective the date placed for adoption or on the adoption date.
To Illustrate . . .
31-Day Notification: You married on November 9th and on December 3rd you told your Human
Resources Department that you want to add your spouse to your medical plan. You met the 31-day
notification deadline. Refer to the effective date information below.
Effective Date: In this case, your spouse’s coverage is effective January 1st. Your spouse’s coverage
would have been effective on December 1st if you had notified your Human Resources Department by
November 30th.
                                                      20



                                 Flexible Spending Accounts
Quick Indicators                 Take Advantage of this Tax-Free Benefit!

Manage Your FLEX                 What is a Flexible Spending Account?
Accounts Online!                 A Flexible (FLEX) Spending Account is authorized by the IRS and available through
                                 your Employer. This type of account allows you to set aside money for eligible health care
Visit www.payflex.com/pebc
                                 and/or dependent day care expenses on a pre-tax basis. As you incur health care and/or
or www.pebcinfo.com and
follow the link from the
                                 dependent care expenses throughout the year, you may submit a claim to get reimbursed
menu on the left side of
                                 with tax-free dollars from your PayFlex account.
your screen.
                                 How Do You Contribute Funds to Your Account?
View detailed information
about your accounts, check       During annual enrollment (or during your new-hire initial eligibility period) estimate
your Debit Card status,          the annual amount you will likely spend on out-of-pocket health care expenses and/or
view electronic EOB forms        work-related day care expenses (your annual election). That amount is deducted from
showing your claim detail,       your payroll check on a pre-tax basis and in equal installments throughout the year.
and more.

FLEX Claims
                                 FLEX Grace Period (Health Care FLEX Accounts Only)
Incurred By You or               As long as your Employer belongs to the PEBC in 2009, you have an additional period of
Your Federal Tax                 time to incur eligible expenses so that you avoid losing your funds at year end. Authorized
Dependents Only                  by the IRS, the Grace Period runs from January 1 through March 15 each year. The Grace
FLEX Accounts are ONLY           Period does not apply to Dependent Care FLEX Accounts.
for those eligible claims
incurred by you or your          If you are an active employee on December 31, 2009 with an active 2009 FLEX Account
dependents for Federal           (and available funds), expenses incurred during the Grace Period (January 1, 2010 through
Income Tax purposes, without     March 15, 2010) will first be charged against any remaining 2009 funds before applying
regard to income limitations.    those charges to your 2010 fund balance. This allows you additional time to incur eligible
Do not risk IRS difficulties.    claims so that you do not lose your 2009 dollars. If you do not submit your 2009 claims by
Contact your tax or financial    April 30, 2010 (including those expenses incurred during the Grace Period for which you
advisor for information about    could use 2009 funds), you will lose your 2009 remaining fund balance. Your Employer
your specific situation.         does not want you to forfeit funds. Remember, the April 30 claim filing deadline did not
                                 change.
Filing A Claim
Express Claims                             Two Types of Flexible Spending (FLEX) Accounts
Go Green! Instead of mailing
a paper claim, file your claim
online using Express Claims.     Health Care FLEX Account                      Dependent Care FLEX Account
Upload or fax your claim
documentation. It’s fast         The Health Care FLEX Account can be as        This FLEX account reimburses eligible
and easy!                        little as $120 annually up to the maximum     “day care” expenses. It is not to be used
www.payflex.com/pebc             amount allowed by your Employer.              for reimbursement of your dependent’s
                                                                               “medical” expenses. This FLEX Account
To Mail Your Claim                                                             primarily benefits those with dependent
PayFlex Systems USA, Inc.             2010 Employee Maximum                    child(ren) under age 13 or those who care
P.O. Box 3039                           Annual FLEX Election                   for a disabled dependent age 13 or older.
Omaha, NE 68103-3039
                                         by Employer Group                     You can deposit as little as $120 annually
                                                                               or as much as $5,000 (if married filing joint
Use Direct Deposit                                  Health   Dependent         return; $2,500 if married filing individually).
Safe and fast!                                      Care       Care            You can take a tax credit on your Federal Tax
Need a form?                                                                   Return or participate in a Dependent Care
                                   Dallas County    $5,000    $5,000
www.payflex.com/pebc                                                           FLEX Account, but not both.
                                   Tarrant County   $5,000    $5,000
Questions?                         Denton County    $5,000    $5,000           Carefully review the benefits of the
Call 877-644-5124                  NTTA             $3,600    $5,000           Federal Tax Credit with the benefits of
                                   City of Frisco   $3,600    $5,000           the Dependent Care FLEX Account.
                                   Parker County    $5,000    $5,000           You may want to seek advice from a tax
                                                                               advisor before making a final decision.
                                                               21



FLEX Debit Card
Make Every Dollar Count!                                                                      QUICK INDICATORS

A FLEX Debit Card makes it very easy to access your Health Care FLEX Spending Account.        FLEX Debit Cards
Your entire Health Care FLEX Spending Account election amount is available for use at the
later of January 1, 2010 or your effective date. IRS requirements apply when you use a        • A $9.00 FLEX Debit Card
FLEX Debit Card and every cardholder agrees to follow IRS Rules. Each time you use your         annual fee is deducted
FLEX Debit Card, you agree that 1) the expense is an eligible expense incurred by you           from your funds at the
or a dependent claimed on your Federal Income Tax Return, 2) you have not received              beginning of the year.
reimbursement from any other source, and 3) you will not request reimbursement                • Check your FLEX Debit
elsewhere. Read the cardholder agreement that accompanied your FLEX Debit Card.                 Card expiration date.
                                                                                                You will automatically
                                                                                                receive a new Card before
Claims Substantiation and Receipts
                                                                                                the current Card expires,
The IRS requires claims substantiation for Debit Card transactions. If you use the FLEX         provided you select a
Debit Card to pay for medical services and the amount is different than your benefit plan       FLEX Debit Card during
copay, you will receive a letter from PayFlex requesting claims substantiation. The best        annual enrollment.
claims substantiation is your benefit plan’s Explanation of Benefits (EOB) Form, which        • FLEX Debit Cards are not
always shows your out-of-pocket expense. You may also submit an itemized receipt. For a         Available for Dependent
list of required items that must be included on a receipt, visit www.payflex.com/pebc. In       Care FLEX Accounts.
accordance with IRS requirements, your FLEX Debit Card is deactivated if you fail to
provide this claims substantiation and you are required to follow IRS Rules for repayment.
                                                                                              Need an Extra
                                                                                              FLEX Debit Card?
Why Doesn’t Your FLEX Debit Card Work?
                                                                                              If you need another Card
FLEX Debit Card users love the card! But, there could be situations when your FLEX Debit      for an eligible family
Card does not work (see below). If you do experience difficulty and none of the situations    member, just call PayFlex.
below apply to you, contact PayFlex for assistance.                                           Remember – you are still
                                                                                              responsible for appropriate
✔ Do you have available funds in your Health Care FLEX Spending Account? If                   use of the FLEX Debit Card,
    there are insufficient funds to cover your entire purchase, your FLEX Debit Card          even if used by another
    purchase will be denied.                                                                  family member.

✔ Did you present the FLEX Debit Card to a retailer who has an IRS approved
    Inventory Information Approval System (IIAS)? Most retail chain grocery
    stores, discount stores and pharmacies have an IIAS. Your card will not work at a            Run-Out Period
    location without an IIAS. The IIAS automatically identifies those products
    or services eligible for payment with a FLEX Debit Card. For a list of retailers with        Even with the new
    IIAS Systems, visit www.payflex.com/pebc.                                                    Grace Period, you
                                                                                                 have until April 30,
✔ Did you provide claims substantiation as requested by PayFlex? The IRS requires                2010 to submit
    claims substantiation. If you do not respond to a letter from PayFlex requesting that        claims for expenses
    information, your FLEX Debit Card is temporarily deactivated. You can reactivate             incurred during 2009
    your card by providing the claims substantiation requested. Remember, your 2010              or incurred during
    FLEX Debit Card will not work if you did not provide 2009 requested information.             the Grace Period and
                                                                                                 for which you want
                                                                                                 to use available 2009
                                                                                                 funds. Expenses are
                              You must select “Yes” to a FLEX Debit Card when you                incurred when the
                              enroll, even if you already have a card. If you have a FLEX        medical care is
 Did You Select               Debit Card, don’t throw it away. Check its expiration date.        provided or the
  a 2010 FLEX                 As long as you select “Yes” to a 2010 FLEX Debit Card when         service is delivered,
                              you enroll, your card will work in 2010. (If the Debit Card        not when you are
  Debit Card?                 expires soon, you will receive a new card before it expires.)      billed, charged or
                              If you are new to the FLEX Debit Card program, as long as          pay for care.
                              you select “Yes” to a 2010 FLEX Debit Card when you enroll,
                              you will receive your Debit Card in the mail.
                                                                22



                                         Long Term Care Insurance
   QUICK INDICATORS
                                         During annual enrollment, active employees and retirees can choose group Long Term Care
   Qualified family                      Insurance from The Prudential Insurance Company of America. This insurance is offered
                                         on a voluntary basis and at the participant’s sole expense. Long Term Care Insurance can
   members can enroll
                                         help cover the costs of care that you or a loved one may need, including care received at
   . . . even if the                     home, in a nursing home, or in an assisted living or residential care facility. This insurance
   employee does not.                    covers services that are not generally covered by medical insurance, disability income
                                         insurance or Medicare.
   Who Can Enroll?
                                         All applications are subject to medical underwriting (except newly-hired employees
   Eligible employees or                 enrolling during the initial eligibility period or employees of a group new to the PEBC
   retirees and
                                         enrolling for the first plan year). Prudential has the sole right to accept or to decline
   • Spouse                              applications.
   • Parents & Parents-in-law
                                         Annual Enrollment – Except as noted above, if you are enrolling during annual
   • Grandparents &
     Grandparents-in-law
                                         enrollment or adding a qualified family member during annual enrollment, your coverage
                                         is subject to medical underwriting. Each participant must send the forms listed below
   • Adult Children (Age 18+)            directly to Prudential. Your forms must be postmarked by November 30, 2009, or
     and their spouse
                                         your application is considered invalid.
   To Enroll in Long                     Newly-Hired Employee – If you are a newly-hired employee enrolling during your initial
   Term Care                             eligibility period, you are guaranteed acceptance in the Long Term Care Insurance Plan
                                         provided your enrollment takes place within 30 days from your date of hire. Qualified
   For each dependent,
   mail to Prudential a                  family members may also enroll; however, medical underwriting applies. Qualified
                                         family members of new employees must postmark their forms during the new
   • Enrollment Form                     employee’s initial eligibility period, or the application is considered invalid.
   • Medical History and
     Insurability Form
   • Authorization for Release                                  Long Term Care Enrollment Kits and
     of Health-Related                                   Downloadable Enrollment Forms are available online at:
     Information                                         www.pebcinfo.com (select the Long Term Care link)
                                               www.prudential.com/gltc (use pebc as both your group name and password)
   Remember to postmark by                                   Employees enroll online at www.prudential.com/gltc
   November 30, 2009!
                                                     If you are already enrolled in Prudential Long Term Care Insurance,
                                                             you do not have to re-enroll during annual enrollment.



                                        Employee Assistance Program (EAP)

The MHN Employee Assistance Program (EAP) is a confidential           Help is available for you 24 hours a day, seven days a week.
program available to all employees and their dependents,              Each member is entitled to have three (3) face-to-face clinical
regardless of medical plan enrollment. Your employer pays for         consultations per incident, per calendar year. The EAP also
the cost of EAP services.                                             provides telephone counseling services and you can receive as
                                                                      many telephonic sessions as needs warrant.
Call the EAP any time for help with emotional health issues. A
qualified intake specialist will assess your needs and connect or     Examples of other telephonic
refer you to a professional who can help.                             services include tobacco and
                                                                      smoking cessation coaching,
Call the EAP for help with…                                           living wills, estate planning,              EAP
✓ Marriage, family and relationship issues                            financial guidance, limited             888-779-2225
✓ Stress and anxiety                                                  legal assistance, childcare/
✓ Depression                                                          eldercare assistance, ID theft             (MHN)
✓ Grief and loss                                                      recovery services, and more.
                                                                      An EAP brochure is included
✓ Anger management                                                    in your Enrollment Packet.
✓ Domestic violence
✓ Alcohol & drug dependency                                           Look for the Members Matter Newsletter
✓ Other emotional health issues                                       at www.pebcinfo.com.
                                                                                23



Life, AD&D, Long Term Disability Coverage
                                                                                                                           QUICK INDICATORS
                                                                                                                           Employer Paid Term
Basic Employee Term Life and AD&D Insurance                                                                                Life Insurance and AD&D
Employer Paid                                                                                                              • 1 x your annual salary
If you are a benefits-eligible employee, your Employer provides this coverage at no cost                                   • Minimum coverage
to you. Under the Basic Term Life plan, if you die, your beneficiary receives a single                                         $20,000 regardless
payment from the plan. If the cause of death is due to an accident, in addition to term life                                   of salary
benefits, your beneficiary is eligible for an AD&D insurance benefit. You could qualify to                                 • Maximum coverage
receive partial AD&D benefits if you suffer serious injuries from an accident. Refer to your                                   $50,000
insurance policy for additional details.                                                                                   • AD&D Coverage at 1 x
                                                                                                                               basic term life coverage
Coverage Amount                                                                                                            Employee Paid Term Life
Your life insurance amount on January 1, 2010 is based on the later of your annual salary                                  Optional Coverage Choices
at December 31, 2009 or your hire date. Your AD&D coverage equals your basic term life                                     City and County Employees:
insurance amount. *Your Basic Life and AD&D coverage will not be less than $20,000 or                                      • 1/2 x annual salary
more than $50,000. Your coverage amount reduces at age 70.                                                                 • 1 x annual salary
*NTTA Employees – Your basic life insurance is salary times 3 up to a maximum of $300,000.                                 • 2 x annual salary
Premiums for coverage over $50,000 may result in additional taxable income to you.                                         • No optional coverage
                                                                                                                               (Note: Prior year
                                                                                                                               grandfathered
Long Term Disability (LTD) Coverage                                                                                            amounts may apply.)
If you become totally disabled, after 180 days you are eligible to receive up to 60% of your                               NTTA Employees:
monthly salary in Long Term Disability (LTD) benefits up to a maximum of $5,500. Your                                      • 1 x annual salary
LTD benefits continue until you recover, reach age 65, retire, reach the maximum in                                        • 2 x annual salary
benefits or die. Benefit waiting periods and limitations apply.                                                            • 3 x annual salary
                                                                                                                           • 4 x annual salary
Optional Term Life and Evidence of Insurability                                                                            • No optional coverage
Optional employee or dependent term life coverage is voluntary. Premiums for employee                                      All Groups:
coverage (Basic + Optional) greater than $50,000 cannot be offered on a pre-tax basis and                                  Additional AD&D at 1 x
may result in additional taxable income to you. The IRS does not allow dependent group                                     employee optional term life
term life insurance to be offered on a pre-tax basis. Unless you are an employee of a new                                  amount is included with
PEBC group, if you are adding coverage or increasing the current level of optional life                                    optional term life selections.
coverage for you or your dependents, your coverage is not effective until medical                                          Dependent Term Life
underwriting approval is received. To add or increase coverage, complete an                                                Optional Coverage Choices
Application Form and Evidence of Insurability Form and mail both to Fort                                                   Option 1
Dearborn Life by November 30, 2009. Forms postmarked after that date will not                                              $ 5,000 Spouse
be accepted. In some cases, grandfathered coverage amounts may apply. If your                                              $ 2,500 Each Dependent
employment is terminated, you can convert your optional coverage; however, important                                       Option 2
deadlines apply. Contact your Human Resources Department or visit www.pebcinfo.com                                         $10,000 Spouse
for more information.                                                                                                      $ 5,000 Each Dependent


                                     Optional Term Life Coverage Monthly Premium Worksheet
                         Using your salary on December 31, 2009 and your age January 1, 2010, calculate your monthly premium.

    YOUR COST PER $1,000                         City & County Members                                                   NTTA Members
    OF COVERAGE
     Age          Cost                  STEP                                             ENTER        STEP                                           ENTER
    Under 30 . . . . . . $ .10          1   Your annual salary on 12/31/09           $                1   Your annual salary on 12/31/09
    30-34 . . . . . . . . . $ .12                                                                         rounded up to next $1,000.             $
                                        2   Multiply the amount in Step 1 times
                                            .50, 1, or 2.                            $                2   Multiply the amount in Step 1 times
    35-39 . . . . . . . . . $ .14
                                                                                                          1, 2, 3 or 4.                          $
    40-44 . . . . . . . . . $ .18       3   Round to the next highest $1,000
                                            (Insurance volume amount).               $
    45-49 . . . . . . . . . $ .26                                                                     3   Divide amount in Step 2 by 1,000.      $
    50-54 . . . . . . . . . $ .38       4   Divide amount in Step 3 by $1,000.       $
                                        5   Your cost per $1,000 (use chart).        $
    55-59 . . . . . . . . . $ .58                                                                     4   Your cost per $1,000 (use chart).      $
    60-64 . . . . . . . . . $ .96       6   Multiply Step 4 amount by Step 5
                                            amount. This is your monthly                              5   Multiply Step 3 amount by Step 4
    65-69 . . . . . . . . . $ 1.56          premium.                                 $                    amount. This is your monthly
    70 and over . . . . $ 2.64                                                                            premium.                               $

Your actual paycheck deduction is based on your payroll frequency. To convert to bi-weekly cost, multiply the monthly premium amount by 12 and divide by 26;
for semi-monthly, divide by 24.
                                       24



             Carefully Consider Your Choices

               No matter how many times you’ve              • Find a Doctor in Your Medical Plan –
              been through enrollment, be                     Search for provider’s in your plan’s network
              sure to take advantage of all the               at www.pebcinfo.com. If you enroll in the
            information available to you. The                 EPO Plan, remember, it is the smallest
       information in this enrollment packet                  network and in-network benefits apply only
          and at www.pebcinfo.com is provided                 in the North Texas area (40 County service
          to help you compare your options and                area) or in HPN limited network areas
          choose the plans best for you and                   (Austin, San Antonio, Houston). If you use
          your family. Whether you are a new                  out-of-network providers, you will pay
         employee enrolling during your initial               a large portion of the cost.
enrollment period or choosing benefits during
annual enrollment, carefully consider more than             • Cost
your monthly premium cost when choosing
your benefits.                                                Some people make the mistake of
                                                              thinking the least expensive plan is the
                                                              least out-of-pocket cost plan. That may not
Are You Enrolled in the HMO Blue                              be the case. Consider your premium cost
Plan in 2009?                                                 and your estimated medical expenses as
or                                                            you determine your plan choice. Each
Are You an Employee of a New PEBC                             medical plan choice has an annual out-of-
                                                              pocket maximum limit, but out-of-network
Employer Group?                                               costs, copays and deductibles are not
                                                              included when calculating the limit. Once
Take a look at the booklet Changing Your Medical              you reach your annual out-of-pocket
Plan – for New PEBC Groups and HMO Transition                 maximum, the plan pays 100% of the cost
included in your Enrollment Packet. It will provide           after copays (out-of-network not included).
you valuable information as you consider your 2010
options. The information below will also assist you.
                                                        You Will Not Find the Perfect Plan
Evaluate Your Health Plan Choices                       . . . but if you take some time to learn about each
    • Compare Your Medical Plan Options                 plan and compare the features - you will find the
      Compare the features of the EPO Plan and          plan that best meets your family’s needs today.
      PPO Plan. You can evaluate each plan based        Choose wisely.
      on the services you use most (e.g. doctor’s
      office visits, inpatient care, outpatient
      services). Remember, prescription drug                        Problem With a Claim?
      benefits are the same in both the EPO
                                                           •   Never yell. It just makes it more difficult
      Plan and the PPO Plan.
                                                               for the person on the other end of the
                                                               telephone.
    • Estimate & Compare Medical Expenses
                                                           •   Never assume anything. Always get
      Estimate how much you would pay out-of-                  the facts.
      pocket under each plan so that you can see           •   Contact the correct resource. You should
      how each impacts your budget.                            contact your medical or dental plan if you
                                                               do not understand how your claim was
    • Estimate Health Care Expenses                            paid.
      Estimate how much to set aside in a                  •   Refer to your EOB first and always have
      Health Care FLEX Spending Account.                       it available if you question how a claim
      The FLEX account allows you to set aside                 was paid or how much you owe your
      pre-tax dollars to pay for eligible health care          doctor.
      expenses. Those dollars are available to you         •   Providers often bill you at the same time
      on your effective date. This is a great way              a claim is submitted.
      to make sure you have money available for            •   Keep notes, including the telephone
      out-of-pocket costs. If you select a FLEX                number and name of the person with
      Debit Card, you can use it to pay copays,                whom you spoke.
      deductibles, and other eligible expenses.
                                                                25



Understanding the Explanation of Benefits (EOB) Form
An EOB Form is a very important document! You should keep your EOB forms. You and your
provider receive an EOB that shows the detail connected to each claim. EOB forms differ from
one company to the next and are sometimes revised. You should carefully check all EOB
forms you receive. If you do not understand the information, or if you believe a mistake
occurred, you should immediately contact the plan’s Customer Service Department.

Why Keep Your EOB Form?
       - If there is a question about a particular claim, the EOB shows how the claim was paid.
       - The EOB shows the amount of the claim that is your responsibility and the amount paid to
         your provider. You may not know how much you owe without the EOB.
       - The EOB shows how much (if anything) your provider must “write off” (discount) due
         to your group medical plan participation. You are not responsible for this amount.
       - If you have secondary coverage, you need the EOB to submit a claim to your
         secondary carrier.
       - If you are enrolled in a FLEX Spending Account, the EOB is the best document to submit
         as claims substantiation. The EOB has all of the required elements needed for FLEX
         reimbursement purposes.
       - Information about benefit limitations or exclusions (if applicable).
       - Who to call if you have questions about your claim.


Coordination of Benefits – Non-Duplicating Plan
If you or your enrolled dependents are covered by more than one plan (such as your spouse’s group
plan), the plans coordinate benefits with the benefits you receive from other group health plans.
This ensures that benefits are coordinated to avoid duplication of payment. This also ensures that
your total benefit amount is no larger than the amount you would have received from the
PEBC plan.
To coordinate benefits, one plan must be “primary” and pay benefits first. If you
and your family are covered by only one plan, that plan is primary. Your
Employer Plan, (the EPO Plan, PPO Plan, or PEBC Dental Plan), “the Plan” is
primary for you if you are an active employee or covered by COBRA,
regardless of your age or your Medicare eligibility. (See Medicare rules
for end-stage renal disease exceptions.)                                        Who
You will periodically receive a Coordination of Benefits Form from   Pays              First?
HealthSmart – even if you do not have other coverage or if you
completed the form before. This is an important check to make sure
the Plan is correctly paying as the primary plan. Please complete the
Form and return it quickly to avoid claim payment delays.
If your spouse has coverage through your Plan AND his or her employer’s plan,
your Plan is primary for you and secondary for your spouse.Whenever the Plan is secondary, the Plan
pays the difference between what the primary plan paid and what your Plan would have paid if the
other plan didn’t exist, except that you will never be reimbursed more for the same expenses under
both this Plan and the primary plan, than this Plan would have paid alone. This means if the primary
plan allowable amount for each service is greater than this Plan, this Plan will pay nothing.
For a child covered under both parents’ plans (each parent covered under their own employer plan)
the plan that covers the parent whose birthday comes first in the calendar year is primary. In a
divorce situation, the plan of the parent with custody usually pays benefits first, unless a court order
places financial responsibility on the non-custodial parent.
                                                                 26



                                                                      HIPAA Title 1 - Election of Exemption
                                                                      (continued)

                                                                      5. Parity in the application of certain limits to mental
                                                                         health benefits. The Plan’s mental health benefits have
                     Notices                                             annual and lifetime maximums. Mental health benefit
                                                                         limitations are defined in the Plan Documents. Mental health
                                                                         services are not covered the same as other health benefits
                                                                         except for serious mental illness, as defined in the Plan
                                                                         Documents.

                                                                      6. Mandated reconstructive surgery benefits following
                                                                         mastectomy. Even though the Plan is exempt, it is the
                                                                         intent of the Plan to satisfy the provision set out in HIPAA
                                                                         relating to surgery benefits following a mastectomy, based
HIPAA Title 1 - Election of Exemption                                    on medical necessity.
Title 1 of the Health Insurance Portability and Accountability        Any covered family member (an employee or a dependent
Act of 1996 (HIPAA) imposes certain requirements on group             covered under this Plan - Members), who loses coverage
health plans. This notice is to inform you of an election that has    under the Plan, or who would have lost coverage had they not
been made by each Employer (Plan Sponsor) participating in            elected to have the COBRA continuation coverage, will be
the Public Employee Benefits Cooperative of North Texas               provided with a HIPAA certificate of creditable coverage.
(PEBC) that affects how HIPAA applies to the EPO and the PPO
Medical Plans (the Plan).                                             Members are automatically provided a certificate of creditable
                                                                      coverage upon loss of coverage. Members can also receive a
For purposes of HIPAA, the Plan is a “non-Federal governmental        certificate of creditable coverage before losing coverage, or up
plan.” HIPAA applies special provisions to those non-Federal          to 24 months after losing coverage upon request, by contacting
governmental plans that are self-insured, allowing the Plan           the Employer’s Human Resources Department.
Sponsor to elect to exempt the Plan from certain provisions of
this Federal law.                                                     HIPAA Title 2 - Privacy and Security
The Plan Sponsor has elected to exempt certain self-insured           Title 2 of HIPAA requires self-funded health plans to comply
portions of the Plan from all of the following requirements to        with certain regulations concerning the privacy and security of
the fullest extent permissible. None of these requirements will       personally identifiable health information that the plan collects
apply with respect to any self-insured portion of the Plan.           or maintains about its enrollees. A copy of your Employer’s
                                                                      privacy notice can be found at www.pebcinfo.com.
1. Limitations on pre-existing conditions exclusion
   periods. Even though the Plan is exempt, employees and             The Women’s Health and Cancer
   dependents will not be subject to pre-existing conditions
   limitations.                                                       Rights Act of 1998
2. Special enrollment periods for employees (and                      The Plan provides special rights for eligible Plan participants
   dependents) losing coverage under another plan and                 receiving mastectomy benefits under a federal law called the
   adding dependents to this Plan. Even though the Plan               Women’s Health and Cancer Rights Act of 1998. If you or
   is exempt, employees and dependents will be able to enroll         an eligible dependent covered by this Plan is receiving
   if they have a Qualified Change in Status Event during the         mastectomy benefits and elects breast reconstruction in
   Plan year as described in the Plan Documents.                      connection with the mastectomy, Plan coverage will include:
                                                                      • Reconstruction of the breast on which the mastectomy
3. Prohibitions against discriminating against individual               was performed;
   participants and beneficiaries based on health status.
   Even though the Plan is exempt, no individual will be              • Surgery and reconstruction of the other breast to produce a
   declined coverage or charged a higher rate based on a                symmetrical appearance; and
   medical condition.                                                 • Prostheses and treatment of physical complications at all
                                                                        stages of the mastectomy, including lymphedemas.
4. Hospital stays for mothers and newborns. Even though
   the Plan is exempt, it is the intent of the Plan to satisfy the    Coverage will be provided in a manner determined in
   provisions set out in HIPAA relating to duration of hospital       consultation between the attending physician and the patient.
   confinement for a mother and newborn following the birth           This coverage is subject to the same deductibles and
   of a child, based on medical necessity.                            coinsurance levels that apply for other benefits under the Plan.
                                               Visit
Visit www.pebcinfo.com to view            www.pebcinfo.com
detailed benefit information. The
PEBC Web site is easy to navigate!
Locate a provider, order pharmacy
refills, view detailed plan information
and much more.

				
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