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Benefits Guide for Active State Employees

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Benefits Guide for Active State Employees Powered By Docstoc
					benefits guide
for active state employees
effective january 1, 2008

Department of Management Services Division of State Group Insurance

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Notes

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Dear State of Florida Benefits Participant:
I am pleased to greet you as a new or returning participant in the State of Florida Group Insurance program. As a state employee, your public service plays a vital role in improving the lives of Florida’s citizens. YOU have the power to make a change! You also have the power to best care for yourself and your loved ones through the State of Florida Group Insurance Program. Each year, the Department of Management Services (DMS) Division of State Group Insurance offers an Open Enrollment period. During this period, you have the power to choose the most appropriate benefit plans for you and your family. Throughout the rest of the year, you will need to meet the criteria for a Qualifying Status Change (QSC) to change your coverage. A few examples of QSCs include the birth or adoption of a child, a marriage, or a divorce. Or, if you are a new hire, you have 60 days from the date you begin employment to enroll in state group insurance benefit plans. In this year’s Open Enrollment packet, we are including this Benefits Guide which provides information on all benefit plans including health and dental insurance, life insurance and supplemental insurance. Please take time to carefully review this information. Decisions regarding benefit plans affect you and your loved ones. To help you make the best decision, you will find the following items in this package: •	 •	 Your	Summary	of	Benefits...	showing	you	the	benefits	you	will	have	in	2008	UNLESS	you	make	a	change	 during Open Enrollment. This Benefits Guide which answers many of your questions about the types of coverage available to you as a valued state employee. It includes: •	 •	 Important	News	for	2008 A	dental	comparison	chart...	an	easy	way	to	compare	the	increased	dental	offerings	for	2008.

For assistance and information on benefit options, DMS offers the following resources: •	 •	 Visit	www.MyFlorida.com/myBenefits for a complete guide of insurance options, including a cost calculator, plan details and plan comparisons. Visit the People First Web site to take advantage of the self-service option, which is the easiest way to make your benefit elections. You will need your People First user ID and password to log in. Select the “Health and Insurance” tab for enrollment information and opportunities. Call	the	People	First	Service	Center,	toll-free,	at	(866)	663-4735.	Representatives	are	available	Monday	 through	Friday	from	8:30	a.m.	to	5:30	p.m.	EDT.	TTY	users	may	call	toll-free,	(866)	221-0268.

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We take pride in serving you while carrying out our mission to “Serve Those Who Serve Florida.” We encourage you to take an active role in making decisions regarding your benefits. Sincerely,

Michelle	Robleto,	Director Division of State Group Insurance

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Table of Contents
Important News for 2008 …………………………………………………… 5 Making the Most of myBenefits ……………………………………………… 6 Basic Definitions for myBenefits …………………………………………… 9 Enrollment and Eligibility for myBenefits ………………………………… 10 myBenefits = myHealth ………………………………………………… 13 Preferred Provider Organization (PPO)……………………………… 14 Health Maintenance Organization (HMO) ………………………… 18 Prescription Drug Benefits ………………………………………… 22 Supplemental Insurance Plans ……………………………………… 22 myBenefits = myLife……………………………………………………… 34 myBenefits = myWealth ………………………………………………… 36 myPrivacy ……………………………………………………………… 39 Special Notice About the Medicare Part D Drug Program ………………… 42 Table of CharTs PPO Benefits-at-a-Glance ………………………………………………… 16 Standard HMO Benefits-at-a-Glance ……………………………………… 19 Dental Plan Comparison Chart ………………………………………… 24-25

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Important News for 2008
The Division of State Group Insurance (DSGI) is extremely proud to present this benefits package to you. You have an impressive selection of benefits to choose from; review this book and carefully consider your personal benefit needs. Your benefits are a valuable part of your state employee compensation. For 2008, we are pleased to offer a new life insurance carrier and several new dental plans - in addition to the already extensive list of insurance choices. Here are highlights of the new offerings: •	 Minnesota	Life	Insurance	Company	will	be	the	new	carrier	for	life	insurance	effective	January	1,	2008.	The benefits remain the same, but you must submit a new beneficiary Designation form to Minnesota life identifying who your beneficiaries are. Forms are available on the People First Web site and at www.minnesotalife.com. We are introducing new enrollment tiers for dental benefits. These tiers offer expanded coverage options to better fit your needs. Please note, unless you were enrolled in “employee only” you	will	be	automatically	moved	to	Family	Coverage	for	2008. You can change this selection during Open Enrollment if there is a tier that better matches your needs. The new tiers are: •	 •	 •	 •	 Employee	Only Employee	+	Spouse Employee	+	Child(ren) Employee	+	Spouse	+	Child(ren)...	also	referred	to	as	Family	Coverage

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There	are	several	new	dental	carriers.	Read	this	guide	or	visit		www.MyFlorida.com/myBenefits to learn more about the dental options available to you and your family. Remember... Some supplemental products require additional enrollment steps: •	 Enrollment	for	some	supplemental	products	described	in	this	guide	requires	completion	of	both	the	state’s	enrollment	process	 and the carrier’s application form. Unless both are completed and any required form appropriately submitted, you will not be enrolled. •	 For those products that require medical underwriting, you may have to provide some information or pass some type of medical test before you are accepted for coverage. Coverage is not effective until People First receives approval and a full month’s premium has been withheld.
The state is unable to offer a supplemental vision product for the 2007 Open Enrollment for the 2008 plan year. We encourage you to take advantage of the vision benefits offered by your health insurance plan.

This guide summarizes your choices and explains the steps to sign up for coverage. For more	information	call	the	People	First	Service	Center	at	(866)	663-4735	(TTY	users	 866-221-0268)	or	visit www.MyFlorida.com/myBenefits. This guide also provides contact information for the different carriers, and you are encouraged to contact them directly with your questions or talk to company representatives at the Benefit Fairs scheduled during open enrollment. The plans and benefits descriptions included in this booklet are summaries and describe the options available to you. These are not intended to change or replace the express written terms of any policy, plan or coverage. Other Personal Services (OPS) employees are not eligible for the benefits listed in this publication.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Making the Most of myBenefits
Address Corrections
One of the most important ways to get the most out of your benefit options is to make sure that we have your correct and current address. It is extremely important for you to update your address and personal information via the Employee SelfService tool on the People First Web site at https://PeopleFirst.MyFlorida.com. If your address is not up-to-date, you may not receive important information, such as notification of Open Enrollment, benefit plan changes and documentation of proof of coverage.

Resources to Help You Choose
• • Benefits Guide The new myBenefits Web site at www.MyFlorida.com/myBenefits with convenient links to all our benefit vendors People First – the way to enroll online for most state benefits. Make sure you know your password or reset it by calling (866) 663-4735 or TTY (866) 221-0268.

The Importance of Choice
This year we have a new tool to help you review and understand your insurance options. The informational Web site, www.MyFlorida.com/myBenefits, provides easy access to publications, forms, information about coverage, descriptions of benefit plans, provider links, and other important information to make your choices easy to understand. •

2008 Enrollment Readiness Checklist
Use	this	checklist	to	help	you	make	your	benefit	choices	for	2008.	Step	6		includes	 important information about enrollment deadlines. step 1: review Your Medical Plan options

Through the state, you and your family have a variety of medical plans available. To decide what’s best for you: ▶ Consider the medical and prescription drug needs you and your family may have in 2008 1.	 Make	a	note	of	any	care	you	will	need	in	2008,	such	as	an	annual	physical,	suggested	surgery,	a	baby	on	the	way	or	 prescription drugs you take regularly. 2.	 Consider	the	medical	and	prescription	drug	care	you	received	in	2007.	Will	any	of	that	care	be	repeated	in	2008?	What	did	 it	cost? 3.	 If	you’re	currently in the Standard or the Health Investor PPO, review your claims for the last year by logging on to the “myBlueService” page on the BlueCross BlueShield of Florida’s (BCBSF) Web site. You need your user BCBSF ID and PIN	to	log	in;	if	you	haven’t	received	one,	register	using	your	Social	Security	number	and	birth	date.	If	covered	dependents	 authorize	you	to	see	their	claim	records,	gather	the	claim	history	for	the	entire	family	and	use	it	to	consider	what	your	2008	 expenses may be. ▶ Understand your medical plan options Most employees have four types of health plans to choose from: •	 A	standard	Preferred	Provider	Organization	with	statewide	coverage. •	 A	Health	Investor	Preferred	Provider	Organization	that’s	also	available	statewide. •	 A	standard	Health	Maintenance	Organization	Plan,	depending	on	where	you	live	or	work. •	 A	Health	Investor	Health	Maintenance	Organization	Plan,	again	depending	on	where	you	live	or	work. Use the myBenefits Web site to learn more about how the plans work and what they cover.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Compare your options The state offers a Medical Plan Cost Comparison Tool to help you compare what your total costs are likely to be under each of the medical plan options – including what you pay for care and what you pay to purchase coverage. The tool is available on the myBenefits Web site. Check out the doctors, hospitals and other medical professionals participating in each plan. The standard and Health Investor PPO plans both use the same network of BCBSF medical professionals. The provider networks	available	under	the	HMO	plans	will	vary	by	plan.	Remember:	With	the	PPOs,	you	receive	a	higher	level	of	benefits	 when you use network providers; with the HMOs, there are no benefits for care outside the network (except in emergency situations). There are links to the BCBSF Web site and all the HMO Web sites from the myBenefits Web site. If you decide to participate, enroll in the plan that is best for you. See Step 6 for more information on how to enroll. Consider the dental care you and your family will need in 2008. 1.	 Make	a	note	of	any	care	you	anticipate,	like	cleanings,	crowns,	fillings	or	orthodontia.	 2.	 Consider	the	dental	care	you	received	in	2007.	Will	any	of	that	care	be	repeated	in	2008?	What	did	it	cost? Understand your dental options Most	employees	have	an	expanded	set	of	options	for	2008	that	fall	into	one	of	three	categories:	 1.	 A	standard	statewide	dental	PPO	Plan	through	CompBenefits 2.	 Dental	indemnity	plans	–	through	Ameritas,	Assurant	and	American	Dental	Plan 3.	 Dental	HMOs	(DHMOs),	depending	on	where	you	live	–	through	American	Dental	Plan,	Assurant,	CIGNA,	 CompBenefits and UnitedHealth Care Use the dental plan comparison in this Guide or go to the myBenefits Web site to learn more about how the plans work and what they cover. Keep in mind that the services offered will vary; some plans do not include orthodontia, for example.

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step 2: evaluate the Dental Plans ▶

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Check out the dentists participating in each plan. There	are	links	to	plan	Web	sites	for	each	of	the	dental	plans	on	the	state’s	myBenefits	Web	site.	Remember:	With	the	PPO,	you	 receive a higher level of benefits when you use network providers; with the DHMOs, there are no benefits for care outside the network. Call your desired dentist or dental group to confirm that they are accepting new patients and will accept your insurance plan. Compare your options Once you narrow your dental plan choices based on where you live, the covered services and the dentists in their networks, use the Dental Plan Cost Comparison tool on the myBenefits Web site to compare your likely total cost under each of the options on your list. The tool adds up what you pay for care (based on services you think you will need) and what you pay to purchase coverage. If you decide to participate, enroll in the plan that is best for you. See Step 6 for more information on how to enroll. ask yourself: Will	I	have	out-of-pocket	costs	for	health	care	or	prescription	drugs?	What	about	expenses	for	child	care,	a	disabled	spouse	or	 elderly	dependents	who	need	care	while	I	work?	If	your	answer	to	either	question	is	yes,	consider	the	pre-tax	benefits	of	the	 reimbursement accounts.

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step 3: Consider reimbursement accounts (flexible spending accounts) ▶

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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learn more about the accounts. There is information in this Benefits Guide for Active State Employees and on the myBenefits Web site. Use the online flexible spending account estimator tools to calculate how much to contribute and the estimated tax savings. If reimbursement accounts are a good fit, enroll. See Step 6 for more information on how to enroll. learn more about your options. Most full-time employees are eligible for: •	 •	 Basic	term	life	insurance	with	Accidental	Death	and	Dismemberment	in	an	amount	based	on	employment	classification,	and Optional	term	life	insurance	from	one	to	five	times	base	annual	earnings,	up	to	a	maximum	of	$500,000	in	coverage.

step 4: review Your life Insurance options ▶

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Think about your family needs in the event of your death. What expenses would they have on an ongoing basis such as daily living expenses, college education, and what financial resources	would	they	have	to	draw	on?	 select your coverage amount and enroll. See Step 6 for more information on how to enroll.

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step 5: Consider supplemental benefits We offer a variety of additional benefits from hospitalization and intensive care coverage to cancer insurance, accident insurance and disability coverage that provides continuing income if a disability keeps you from working. ▶ ▶ ▶ learn more about these programs by visiting the mybenefits Web site. It includes copies of the brochures that describe these programs and links to the companies offering these plans. Consider your income protection needs. Most of these programs provide income benefits if you and/or covered family members suffer from illness or injury. If you decide you want to participate, enroll in the plan (s) that are best for you. See Step 6 for more information on how to enroll.

step 6: enroll Make	your	2008	benefit	selections	on	the	People	First	Web	site	or	by	telephone	through	People	First	or	by	completing	and	returning	an	 enrollment form. state employees participating in the spouse Program must submit a spouse Program enrollment form, available on the People first Web site. 1.	 For	annual	enrollment,	you	must	enroll	by	5:30	p.m.	eDT on october 26, 2007. 2.	 As	a	new	hire	in	2008,	you	have	60	days	from	your	date	of	hire	to	enroll,	or	60	days	from	the	start	of	a	new	term	of	office	if	you	are	a	 state	elected	official. 3.	 If	you	are	enrolling	in	2008	because	of	a	qualifying	change	in	status,	you	have	31	days	from	the	qualifying	status	change	to	make	 related benefit changes. For the death of a spouse or dependent or for a birth or adoption you have 60 days to make related benefit changes. Some of the supplemental plans require a second step and ask that you complete a separate application for medical underwriting and submit it to the insurance company for their approval. The medical underwriting questionnaires/forms are available on each company's Web site via links from the People First Web site.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Basic Definitions for myBenefits
•	 annual Maximum – Total dollar amount a medical or dental plan will pay during a calendar year toward the covered expenses of each person enrolled. Co-insurance – Co-insurance is a percentage you are required to pay for certain services you receive after meeting the calendar year deductible. Co-payment – Set dollar amount you pay for network doctor	office	visits	and	specified	in-network	preventive	care.	 No	other	fees	or	deductibles	apply. Deductible	–Total dollar amount you must pay for covered medical care each calendar year before the State Employees’ PPO Plan or the Health Investor PPO plan pays benefits for most services. Deductible does not apply to network preventive care and any services where you pay a co-payment rather than co-insurance. Some of your dental options also have an annual deductible – generally for basic and major dental care services. •	 flexible spending account (fsa) – Account that allows you to reimburse yourself with pre-tax dollars for eligible outof-pocket health care costs and/or the costs associated with caring for a dependent. With these accounts, you decide what you want to contribute before the start of a plan year. If you do	not	submit	claims	for	the	plan	year	by	the	April	15th filing deadline for the entire amount you had withheld, you lose the unused money. health Investor hMo and PPo – The state’s name for two of its medical options where you pay a higher deductible in exchange for: Lower	cost	to	buy	coverage	(payroll	deductions)	than	the	State	 Employees’ Standard PPO or the Standard HMO. The opportunity to have a Health Savings Account that can be used to pay eligible health care expenses with pre-tax dollars, and is partially funded by the state. health Maintenance organization (hMo) – A prepaid medical plan in which you agree to use a specific, more limited network of providers. health savings account (hsa) – An account associated with the Health Investor HMO and PPO that allows you to use pre-tax dollars to pay your share of the cost for eligible medical, dental or vision care services that aren’t covered by your medical or dental plan. When you are eligible for an HSA, the state makes a contribution to your account; you may also add your own contributions to your HSA. The HSA differs from an FSA in three ways: •	 • • You must be in a Health Investor medical option to contribute to an HSA. Any unused HSA funds at the end of a year carry forward to the next year; you may also take unused HSA balances with you if you stop working for the state. You must open a personal HSA bank account at Tallahassee State Bank by completing the HSA Bank Account Application on the People First Web site. lifetime Maximum – Combined total dollar amount the State of Florida medical plans pay toward the covered expenses of each person enrolled in the PPO plan while covered as an employee or an employee’s dependent. out-of-Pocket Maximum (medical plan) – Annual dollar limit an individual or family pays in medical co-insurance in a	calendar	year.	The	PPO	plan	pays	100%	of	eligible	expenses	 when you reach the out-of-pocket maximum. This feature provides financial protection for you by limiting your out-ofpocket expenses in a given calendar year. Pre-Determination of benefits (Dental) – A request you can submit to find out in advance how much the plan will pay for recommended dental care. This feature can be particularly useful in the PPO or indemnity dental plans where you pay a percentage of the cost. The process is not required but can help avoid surprises. Preferred Provider organization (PPo) – A plan offering discounted rates on services if you use providers in the network. If you use services outside of the network, you are reimbursed a smaller portion of the charges. Primary Care Physician – The health care professional who monitors your needs and coordinates your medical care, including referrals for tests or specialists. Provider Network – A group of health care providers, including physicians, hospitals and other health care providers, who agree to accept pre-determined rates when serving members. Qualifying status Change – A specific event or change meeting federal guidelines that allows you to make changes to your benefit elections outside of the annual Open Enrollment period. A QSC is a change in employment status (e.g., beginning or terminating employment with a new employer), loss of insurance coverage and certain personal status changes (e.g., marriage, having children or acquiring other new dependents). •	

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Enrollment and Eligibility for myBenefits
General Enrollment Information
We offer all benefit plans, other than the optional life insurance, on a pre-tax basis. This means, because you are an active state employee, your health insurance premiums are deducted from your paycheck before taxes are taken out. As part of our pre-tax offerings, federal regulations require us to conduct an Open Enrollment period once a year. During this time, you can make changes for the upcoming plan and	tax	year	beginning	January	1.	During	Open	Enrollment,	you	can	enroll	for	the	first	time,	make	changes	to	your	current	plans	or	cancel	 participation. Except for certain underwriting requirements of some supplemental insurance plans, you do not have to “qualify” to make changes during Open Enrollment. We encourage you to carefully consider all available options during Open Enrollment. Outside of the annual Open Enrollment period, state and federal regulations prohibit additions, changes or cancellations in pre-tax plans unless you experience a Qualifying Status Change (QSC) event. (See the Definition section for more information on QSCs.)

Enrollment Opportunities
There are three opportunities to make benefit elections: 1)	 	when	you	are	hired	as	a	new	employee 2)		 when	you	have	a	QSC	event 3)	 during	Open	Enrollment

Option 1 – Hired as a New Employee
If you are a newly-hired full-time or part-time employee, you have 60 days from the date you begin employment to enroll in state group insurance benefit plans. You can enroll on line at the People First Web site. If you do not enroll within 60 days from the date your employment began, you cannot enroll until the next Open Enrollment period. Choose your options carefully. Once enrolled, you cannot make changes until the next Open Enrollment unless you have a QSC event.

Option 2 - Qualifying Status Changes
If	you	have	a	QSC,	you	typically	have	31	days	from	the	date	of	the	QSC	to	make	any	changes	to	your	benefits	(like	enrolling,	increasing	 coverage or changing family status). You have 60 days from the date you make changes to your benefits to submit any required documentation. Currently, the following are some, but not all, valid QSC events: •	 Marriage	or	divorce	 •	 Death	of	a	spouse	or	dependent,	a	birth	or	adoption	(60	days	for	notice	rather	than	31	days) •	 Legal	guardianship	 •	 Change	in	dependent	eligibility	 •	 Change	in	employment	status	for	you,	your	spouse,	or	dependent:	 •	 •	 •	 Termination	of	spouse’s	or	dependent’s	employment	 Unpaid	leave	of	absence	longer	than	one	calendar	month	 Change	from	part-time	to	full-time	status	or	vice	versa	

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

If you have a QSC and want to change your benefits selections, complete the following steps: 1.	 2.	 Make	the	change	online	at	the	People	First	Web	site	within	31	days	of	the	event.	If	your	QSC	is	not	listed,	then	contact	the	 People First Service Center . Complete	all	required	forms	authorizing	the	change.	The	People	First	Service	Center	must	receive	the	required	enrollment	 forms	within	31	days	of	the	QSC	event.	If	the	forms	are	received	after	31	days,	your	change(s)	will	be	denied	and	you	will	not	be	 able to make changes until the next Open Enrollment. Provide	the	supporting	documentation	(e.g.	marriage	certificate,	birth	certificate,	divorce	decree,	etc.).	

3.	

(Note: To make an enrollment change based on a QSC, federal law requires the event to result in a gain or loss of eligibility for coverage, and general consistency rules must be met. For example, if you have family health insurance coverage and you get a divorce and no longer have dependents, you may change from family to individual coverage. However, you cannot cancel enrollment in health insurance because the QSC event only changes the level of coverage eligibility. Cancellation would not be consistent with the nature of the QSC event.)

Option 3 - Open Enrollment
We have Open Enrollment each year to give you an opportunity to review benefit plan options and make changes for the following plan	year.	It	is	usually	held	in	the	fall.	All	benefits	chosen	during	this	time	take	effect	on	January	1	of	the	following	calendar	year.	The	 benefit	plan	year	is	January	1	through	December	31.	Before	Open	Enrollment	begins,	we	mail	and/or	e-mail	notices	announcing	Open	 Enrollment dates so you can confirm your address, update your password and be ready to make your selections. We encourage you to take full advantage of this once-a-year opportunity to review your benefit plans and select the options that best meet the needs of you and your family.

General Eligibility Information
All active full-time or part-time State of Florida employees qualify for coverage under the benefit plans described in this guide. If you work part time, you should contact the People First Service Center to find out the cost of coverage since you will be paying proportionately more. OPS employees do not qualify for any of the benefits in this publication.

Dependents eligible for coverage:
•	 •	 Your	legal	spouse	 Your	natural	children,	legally-adopted	children,	and	 children placed in the home for the purpose of adoption in accordance	with	Chapter	63,	Florida	Statutes	 Stepchildren	 Foster	children	 Children	for	whom	you	have	established	legal	guardianship	 (Chapter	744,	Florida	Statutes)	or	court-ordered	temporary	 custody

•	 •	 •	

To ensure appropriate coverage, you must provide documentation for the dependent(s) you have added to your plans. This documentation can be mailed to:

If you do not provide documentation, you may lose coverage for your dependent. You or your dependent may also be responsible for any cost for services received while your dependent was listed as eligible.

State of Florida People First Service Center P.O. Box 6830 Tallahassee, FL 32314
You can also fax the information to (904) 828-6092.You must write your People First ID Number on the top right corner of each page of your fax.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Generally, children must be under the age of 19 and dependent on you for support. Eligibility for dependent children usually	ceases	at	the	end	of	the	month	the	child	turns	19	years	old,	but	over-age	dependent	children	and	children	with	disabilities	may	be	 covered	beyond	the	age	of	19.	 •	 Over-age	dependent	children:	From	age	19	through	the	end	of	the	calendar	year	when	the	child	turns	25,	children	must	 meet both of the following criteria to remain eligible dependents: •	 •	 •	 Must	be	dependent	on	you	for	financial	support,	and	 Must	either	live	with	you	or	be	a	full-time	or	part-time	student	

Children with disabilities: Children who have mental or physical disabilities are eligible to continue coverage after they attain these age limits when you enroll or while your family coverage is in effect, provided that they are incapable of selfsustaining employment because of mental or physical disability and are chiefly dependent on you for financial support and maintenance.

Spouse Program
When you and your spouse are active state employees, you are eligible for health insurance coverage at no cost to you. If you meet this criteria, you must take the following steps to enroll in the Spouse Program: •	 •	 •	 •	 You	and	your	spouse	complete	the	Spouse	Program	Enrollment	Form	located	on	the	People	First	Web	site	under	Health	&	 Insurance / Benefits Materials. Be sure to Identify all eligible dependents. Attach	your	marriage	license	to	the	enrollment	form	when	you	submit	it	to	the	People	First	Service	Center.	Include	your	People	 First ID number on each page. You	and	your	spouse	must	enroll	in	the	same	health	plan.	 You	and	your	spouse	must	agree	to	notify	the	People	First	Service	Center	within	31	days	of	becoming	ineligible	for	the	Spouse	 Program. Employees become ineligible for the Spouse Program due to one of the following: •	 •	 •	 One	or	both	terminate	employment	 In	the	event	of	a	divorce	 One	or	both	retire	

If the People First Service Center receives notification that one of you becomes ineligible for the Spouse Program, we notify the other spouse and instruct him or her to change to other appropriate coverage. If you fail to notify the People first service Center of your ineligibility for the program, you may be liable for incurred medical claims and any premiums paid by the state during the time you were not eligible.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

One of the most important benefits available to you from the state is health insurance. There are a number of things to consider before selecting a health plan. Keep in mind, one plan is not better than another; each plan simply offers different benefits. Carefully consider the health care needs of you and your family and review the comparisons and other materials available before making your selection.

myBenefits = myHealth
Things to Consider When Choosing Health Insurance
• While the core benefits between the PPO Plan and the HMO plans are similar, there are differences. PPO coverage has broader provider access. Both plans contract with networks of providers to deliver services. HMO plans require you to use an exclusive network of providers for services with very few options for using non-network providers. In the State Employees’ Standard PPO Plan, you have the option of using out-ofnetwork providers, but this may result in additional costs. PPO plans allow you to self-refer or visit specialists without approval from a primary care physician. Some HMO plans require you to first obtain a referral from your primary care physician to have your treatment by a specialist covered under the plan. All Standard HMO plans charge co-payments for visits. A co-payment is a fee you pay to visit a provider. The Standard PPO Plan has deductibles, co-insurance and co-payments. Health Investor PPO and Health Investor HMO plans have higher deductibles and co-insurance. Co-insurance is a percentage you are required to pay for certain services you receive after meeting the calendar year deductible. HMO plans typically provide care through regionally-based networks of providers; these plans cover out-of-network care only in emergencies. To enroll in an HMO, you must therefore live or work in its service area. If you choose an HMO, make sure coverage is available. The State Employees’ Standard PPO Plan uses a statewide network and offers outof-state coverage through the BlueCross BlueShield BlueCard™ Program. If you spend a lot of time traveling or do not live in Florida, the State Employees’ Standard PPO Plan may be more suitable to your needs. We recommend that you select a plan with providers you would feel comfortable using in the event that your current provider’s relationship with a plan ends. •

You may choose between four types of health plans: •	 the	State	Employees’	Standard	Preferred	 Provider Organization (PPO) plan, •	 a	Health	Investor	PPO	plan,	 •	 a	Standard	Health	Maintenance	 Organization (HMO) plan*, or •	 a	Health	Investor	HMO	plan.*	 *HMO coverage is only available if you live or work in the HMO’s service area. These are managed-care plans, which mean they have specific provider networks you are expected to use. If you use a provider outside of the plan’s network, you may have higher out-of-pocket costs. To get the maximum benefits from your plan, you may need to follow specific procedures before receiving care. If you work full-time, you pay the same premium whether you choose the State Employees’ Standard PPO or a Standard HMO. You pay the same reduced premium for the Health Investor PPO and the Health Investor HMO. Although part-time employees pay a higher contribution than full-time employees, their premium for each of the plans is the same. If you are a part-time employee, contact the People First Service Center or visit the People First Web site to learn how much your premiums will be. Please	note,	the	Florida	Legislature	decides	 how much insurance contributions are and may change the amounts during the course of a plan year.

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Carefully consider all of these factors.You should call the plans to learn more. The People First Web site provides links and contact phone numbers for all of the plans outlined in this guide. To further help you, the Agency for Health Care Administration has a Florida Health Plans Consumer Information Web site that evaluates all the health plans in Florida, with their findings posted at: http://healthplans.floridahealthstat.com.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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The following is a brief description of each type of plan.

Preferred Provider Organization (PPO)
The State Employees’ Standard PPO Plan is a self-insured health plan administered by BlueCross BlueShield of Florida, Inc. (BCBSF). As the administrator, BCBSF processes health claims, supplies the preferred provider care network and provides customer service. To learn more about BCBSF, contact them at (800) 825-2583 or visit www.bcbsfl.com. Pharmaceutical services are administered by Caremark. Caremark can be contacted by calling (800) 378-4408 or visiting www.caremark.com. Charges for the State Employees’ Standard PPO plan and Health Investor PPO plan include: •	 •	 Pre-negotiated	fees:	the	plan	negotiated	in	advance	with	a	network	provider	are	usually	lower	than	the	provider’s	actual	charge. Annual	Deductible:	a	yearly	amount	you	are	required	to	pay	first	for	certain	services	before	the	plan	starts	paying.	The	 deductible varies based on the network status of the provider you choose, either a network or non-network provider and the type of plan, either individual or family. Once your deductible is met, you will typically only pay your co-insurance or copayment. Co-insurance:	a	percentage	of	the	medical	costs	you	are	required	to	pay	for	certain	services	after	your	annual	deductible	is	met. Co-payment:	a	per	visit	fee	for	select	services.

•	 •	

The State Employees’ Standard PPO plan and Health Investor PPO plan rely on a network of providers contracted with BCBSF. When you need to see a provider, you have the freedom of choice to visit a network provider or a non-network provider. You should contact BCBSF Customer Service to find out if using a non-network provider will cost you more. Network	providers	include	physicians,	hospitals	and	other	providers	who	will	charge	you	no	more	than	a	pre-negotiated	fee	for	covered	

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

services. This fee is generally lower than the provider’s actual charge and you do not pay more than this pre-negotiated fee. Choosing a network provider saves you money. Non-network	providers	do	not	participate	in	the	preferred	provider	network.	hospital-based physicians such as radiologists, pathologists, anesthesiologists and emergency room physicians may be non-network providers. When you receive covered services from a non-network provider, you will have to pay higher non-network deductibles, co-payments and co-insurance costs. For these services, you will be billed directly by the provider for the difference between the amount BCBSF allows for a covered service and the non-network provider’s actual charge for that service. When care is provided by a non-network provider, the plan will pay the provider a formula-determined amount based on the type of service provided. The non-network provider’s actual charges often exceed these amounts. If that occurs, the enrollee will experience higher out-of-pocket costs than those associated with services from a network provider. You are responsible for checking to see if your provider is part of the BCBSF network before you receive service. Otherwise, you may have to pay more than you expected. You can find this out by searching the provider networks of the BCBS plans across the country through the BlueCard® Program. Even if you travel outside of Florida you receive the same coverage you would receive in Florida when a provider or hospital is part of the network. If	you	have	questions	about	the	BlueCard®	Program,	contact	(800)-825-BLUE	(2583).	You	can	learn	more	about	out-of-state	 participating	PPO	providers	by	calling	(800)-810-BLUE	(2583)	or	visiting	www.bluecares.com.

Vision Care Coverage
Discounted	coverage	for	exams,	glasses	and	some	corrective	surgeries	is	available	to	PPO	members	through	BCBSF’s	Enhanced	Vision	 Care	program.	You	pay	$40	for	eyeglass	exams	and	save	up	to	40%	off	retail	prices	for	frames	and	lenses.	You	can	also	take	advantage	 of	the	discounts	offered	through	the	TruVision	contact	lens	mail	order	service.	Use	your	ID	card	to	receive	discounts	at	participating	 providers including optometrists, ophthalmologists, opticians or optical retailers. You can find more details and participating providers by going to the “BlueComplements” information sheet on the Members site at www.bcbsfl.com	or	by	calling	(800)	825-2583.

Maximum Lifetime Benefit
The	State	Employees’	Standard	PPO	Plan	and	Health	Investor	PPO	plans	pay	a	maximum	of	$2	million	during	your	lifetime.			

Maximum Annual Out-of-Pocket Expenditures
The	State	Employees’	Standard	PPO	Plan	has	a	$2,500	(individual)	or	$5,000	(family)	annual	out-of-pocket	maximum	limit.		Your	coinsurance	amounts	count	toward	this	limit.	Once	you	reach	this	maximum	dollar	amount	in	a	calendar	year,	the	plan	will	pay	100	percent	 of your co-insurance or allowed amount for covered expenses for the rest of the calendar year. The	Health	Investor	PPO	plan	requires	you	to	pay	up	to	$3,000	(individual)	for	network	providers	and	$7,500	(individual)	for	nonnetwork	providers	each	year.	For	family	coverage,	you	pay	up	to	$6,000	for	network	providers	and	$15,000	for	non-network	providers	 each	year.	Once	you’ve	reached	this	maximum	dollar	amount	in	a	calendar	year,	the	plan	pays	100	percent	of	the	allowed	amount	for	 covered services for the rest of the calendar year. for the state employees’ standard and health Investor PPo plans, deductibles, office visit and er co-payments, non-covered services and/or supplies, per admission fees and provider charges exceeding the plan’s allowed amounts do not count toward the annual out-of-pocket maximum limit.

Pre-existing Condition Limitation
The	State	Employees’	Standard	PPO	plan	and	Health	Investor	PPO	plan	have	a	“6	month/12	month”	pre-existing	condition	limitation	 for new members. A pre-existing condition may be diabetes, asthma or some other condition that you or your dependent(s) have been diagnosed with or treated for during the 6 months before your coverage began. If you or your dependents have a pre-existing condition, the	State	Employees’	Standard	PPO	plan	and	Health	Investor	PPO	plan	will	not	cover	services	for	this	condition	for	12	months	after	your	 coverage begins. However,	if	you	and	your	dependent(s)	had	prior	health	insurance	coverage,	and	it	has	been	less	than	63	days	since	that	coverage	ended,	 you may be eligible to have all or part of the pre-existing condition limitation waived. If you would like to be excluded from pre-existing condition limitation, submit a “waiver of the pre-existing limitation” to the People First
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com 15

Service Center. You will need a Certificate of Creditable Health Insurance Coverage or Portability from your previous insurer which provides your covered family members’ beginning and ending dates of coverage. People First will review your information and contact you about your eligibility for a waiver.

PPO Benefits-at-a-Glance
state employees’ PPo
Covers care received in or out of network

You meet annual deductible
•			Individual •			Family What you pay for care received •			Doctor	office	visits			 •			Hospital	stay

Network

$250 $500 $15/visit	for	PCP;	$25/visit	for	specialists

Non-Network

$750 $1,500 40%	of	non-network	allowed	 amount plus amount between charge and allowed amount $500/admission	then	40%	of	 non-network allowed amount plus amount between charge and allowed amount

$250/admission	then	20%	of	 network allowed amount

•			Prescription	drug	(provided	by	Caremark) 					•			generic 					•			preferred	brand 					•			non-preferred	brand

Up to 30-day retail or 90-day mail order prescription
$10/retail;	$20/mail	order					Pay	in	full	and	file	a	claim $25/retail;	$50/mail	order					Pay	in	full	and	file	a	claim														 $40/retail;	$80/mail	order					Pay	in	full	and	file	a	claim																				

Preventive care; some routine physical exams, health screenings and immunizations

40%	of	non-network	allowed	 amount plus amount between charge and allowed amount; see preventive care. annual out-of-pocket co-insurance maximum (not including deductible, co-payments, cost of care not covered by plan) •			Individual	coverage $	2,500	network	&	non-network	combined •			Family	coverage $5,000	network	&	non-network	combined after your out-of-pocket co-insurance costs reach these maximums, for the rest of the	calendar	year,	the	plan	pays	100%	for	covered	co-insurance	in	most	cases,	up	 to the allowed amount

100%	of	allowed	amount; see preventive care.

In addition: •	 Network	co-payments	make	doctor	visit	and	prescription	drug	costs	more	predictable. •	 Plan	pays	100%	of	allowed	amounts	for	some	preventive	care	services	received	from	network	providers. •	 You	meet	an	annual	deductible	and	pay	a	co-insurance	percentage	of	most	other	costs. For more information, see the BCBSF-PPO Brochure that summarizes the State Employees’ PPO Plan on the People First Web site.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Health Investor Preferred Provider Organization
Like	the	current	State	Employees'	PPO	Plan,	the	Health	Investor	PPO	gives	you	flexibility	to	see	network	or	non-network	providers,	with	 a lower cost to you when you use network providers. If you are Medicare-eligible, the Health Investor PPO provides secondary coverage paying benefits after Medicare pays it's benefits.

Prescription Drug Benefit
Prescription drug benefits for the State Employees’ Standard PPO plan and Health Investor PPO plan are administered by Caremark, L.L.C.	Caremark	is	a	pharmacy	benefit	management	company	providing	your	comprehensive	prescription	benefit	management	services.		 To	learn	more,	call	(800)	378-4408	or	visit	www.caremark.com.

aDverTIseMeNT

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Health Maintenance Organization (HMO)
Each HMO is a self-administered, pre-paid health plan providing health services for people who live or work within the HMO’s service area. There is limited or no coverage for services outside their service areas except in limited circumstances. Carefully consider the HMO’s policy, especially if you have dependents who do not live in the service area. Do not choose your HMO plan only because a particular physician, physician group, hospital or other provider participates in a plan. At any point providers can leave the HMO. If this happens, you will have to choose a new provider from the network. If you continue to use the provider who is not part of the network, you will have to pay for services. You will not be able to change health plans simply because your doctor leaves the health plan, except during the annual Open Enrollment period. HMO plans focus on prevention, early detection and treatment of illnesses to reduce expensive and inconvenient hospital stays. There are no pre-existing condition exclusions or waiting periods. HMO coverage is not available in all Florida counties. To find out if your county offers HMO coverage, visit the People First Web site or call the People First Service Center. For some HMOs, you must choose a primary care physician within the HMO provider network. A primary care physician is the provider you visit for most of your health care needs. If you need to see a specialist for a specific concern, the primary care physician must make a referral for you. (Please note: You do not need a referral to see dermatologists, gynecologists, chiropractors, podiatrists or for emergency care.) If you decide to change your primary care physician, you must contact the HMO and complete the necessary paperwork. Some participating HMOs do not require referrals from your primary care physician, but you will need to use specialists in the HMO network. Primary care physicians and other providers vary among HMOs and the list can change at any time. You should contact the HMO and review the network providers. There is a list of the HMOs and their contact information on the People First and myBenefits Web sites. The	Agency	for	Health	Care	Administration	publishes	an	HMO	Report	Card	that	evaluates	the	services	provided	by	HMOs	in	Florida.	 Please visit www.floridahealthstat.com	and	select"Health	Plans,"		then	"HMO	Report."		It	can	also	be	obtained	by	mail	from	the	State	 Center	for	Health	Statistics	by	calling	their	toll-free	number	at	(888)	419-3456. Charges for HMO plans include: •	 •	 •	 Co-payment:	a	payment	for	office	visits,	rehabilitation	therapy,	emergency	room	visits	and	hospital	admissions	fees. Co-insurance:	a	percentage	of	the	medical	and	pharmacy	costs	you	are	required	to	pay	after	your	annual	deductible	is	met.		 Annual	Deductible	for	the	Health	Investor	HMO:	Aside	from	some	preventive	services,	this	is	a	yearly	amount	you	are	required	 to	pay	for	services.	The	annual	deductible	is	$1,250	individual	and	$2,500	family.	Once	your	total	annual	deductible	is	met,	you	 pay the co-insurance amount. Charges for the Health Investor HMO include:

Vision Care Coverage
Routine	eye	exams	are	covered	as	part	of	your	preventive	benefit	package	when	you	enroll	in	an	HMO.	HMO	plans	may	also	offer	 significant discounts on glasses, contact lenses and some corrective surgeries. Contact the HMOs available in your area to get details on the vision care discounts they offer.

Health Investor Health Maintenance Organization Plan
While the Health Investor HMOs cover all the same services and supplies as their traditional HMO counterparts, there are some key differences. Under the Health Investor HMO: •	 •	 If	you	contribute	toward	the	cost	of	your	coverage,	your	monthly	insurance	premiums	are	lower.	 If	you	or	your	covered	dependents	do	not	have	other	medical	coverage,	you	may	open	a	Health	Savings	Account		and	make	pretax contributions to it. You can use the HSA to pay out-of-pocket expenses like your deductible and coinsurance - now or in the future. For	specific	preventive	care	services,	there's	no	deductible.	

•	

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Standard HMO Benefits-at-a-Glance
standard hMos Covers care received in network only No annual deductible •			Individual	coverage $0 •			Family	Coverage $0 What you pay for care received •			Doctor	office	visits $	15/visit	for	PCP;	$25/visit	for	specialists •			Hospital	stay •			Prescription	drug 					•			generic 					•			preferred	brand 					•			non-preferred	brand Annual out-of-pocket maximum •			Individual	coverage •			Family	coverage Preventive care: routine physical exams, health screenings and immunizations at specified intervals $250/admission $10/retail;		$20/mail	order $25/retail;	$50/mail	order $40/retail;	$80/mail	order $1,500 $3,000 See the HMO’s certificate of Insurance for specifics for the HMO you are considering

View	a	list of the standard HMOs	offered	in	2008	and	the	areas	where	each	is	available.	The	2008	Benefit	Statement	you	receive	in	late	 September	2007	will	show	the	specific	HMO	options	available	to	you. aDverTIseMeNT

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Prescription Drug Benefits

All your health insurance options include comprehensive prescription drug coverage with two components: a network-based retail program and a mail-order pharmacy program. For	the	State	Employees’	Standard	PPO	and	the	Standard	HMO	plans,	retail	co-payments,	for	up	to	a	30-day	supply	are	$10	for	generic,	 $25	for	preferred	brand	name	and	$40	for	non-preferred	brand	name	drugs.	Co-payments	for	the	mail	order	program	for	up	to	a	90	day	 supply	are	$20	for	generic,	$50	for	preferred	brand	and	$80.00	for	non-preferred	brand	drugs.	You	will	need	to	have	your	doctor	write	 your	prescription	for	up	to	a	90-day	supply	to	take	advantage	of	the	savings	offered	by	the	mail	order	program. Preferred brand drugs are medications on the preferred drug lists supplied by Caremark, the pharmacy benefits administrator for the State Employees’	Standard	PPO	plan	and	Health	Investor	PPO	plan,	and	by	each	of	the	various	HMOs.	Non-preferred	brand	drugs	are	brand	 name medications that do not appear on any of the preferred drug lists. For the Health Investor PPO and Health Investor HMO, you must first satisfy the appropriate individual or family annual deductible. After	paying	this	deductible,	your	co-insurance	for	retail	and	mail	order	drugs	is	30	percent	for	generic	and	preferred	brand	drugs	and	50	 percent for non-preferred brand drugs. In all of the plans described above, if you request a brand name drug when a generic is available, you must pay the difference between the generic and brand name drug, plus the appropriate co-payment or co-insurance. If your physician writes on the prescription that the brand name drug is medically necessary, you will only pay the appropriate co-payment or co-insurance.

Supplemental Insurance Plans

The state offers you the opportunity to participate in optional “employee-pay-all” supplemental insurance plans. Like the other health plans, the premiums for these plans are deducted on a pre-tax basis (withdrawn from your paycheck before taxes are taken out). These plans are called employee-pay-all because you pay the entire premium. These supplemental, employee-pay-all plans are made available to you as a convenience. To learn more about each of these plans, visit the People First or myBenefits Web sites which list contact information for all of the plans.

Supplemental insurance products include:
•	 •	 •	 •	 Dental	Insurance	 Supplemental	Hospitalization	Insurance	 Cancer	and	Cancer/Intensive	Care	Insurance	 Accident	and	Accident/Disability	Insurance	

Most of these plans offer a variety of benefit and premium levels. Some pay you cash if you need hospitalization, are treated for cancer, spend time in an intensive care unit, have an accident, or become disabled. There are a number of options within each plan, so you can choose different levels of coverage for different premium payments.

Most of the Disability, Cancer and Cancer/Intensive Care insurance plans require medical underwriting, which means you may have to provide some information or pass some type of medical test before you are accepted for coverage. To enroll, you will need to submit applications to the companies directly in addition to enrolling online on the People First Web site. To enroll in Disability plans, you will need to first contact the company to find out what your premium will be and then submit your enrollment forms to the People First Service Center. You cannot enroll in a Disability plan on the People First Web site. You can enroll in the Cancer, Cancer/Intensive Care and Hospitalization plans on the People First Web site during Open Enrollment or as permitted by a QSC or when you are first hired. You must also submit separate applications to the companies.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Dental Plans
We offer a wide variety of dental plan choices. Each plan has different co-payments, services and providers. You should closely review these plans to determine which one will best fit the needs of you and your family. A comparison chart can be found at the myBenefits Web site and in this benefits guide. In addition to dental benefits, some dental plans also provide you with discounts for vision services. You should contact the plans directly to learn more. There are three types of plans and various company products to choose from:

Dental Health Maintenance Organizations (DHMO)
A DHMO (or more specifically, a pre-paid limited service plan) maintains affordable premiums and low out-of-pocket expenses through a network of participating general dentists. You will pay a co-payment. Before you enroll in a DHMO, make sure the plan has dentists in your area who are accepting new patients and can offer adequate appointment times. Do not choose a DHMO plan only because your dentist is part of the plan. At any time, your dentist might leave the DHMO and you will have to choose a new dentist from the provider network. If you continue to use a dentist who is not part of the network, you will have to pay for services. You cannot change dental plans based on provider preference, except during the annual open enrollment period. •	 American	Dental	Plan:	call	(866)	879-3630	or	visit	www.compbenefits.com/custom/adpstatemployees •	 Assurant:	call	(800)	277-2300	or	in	Tallahassee	(850)	386-2300,	or	visit	www.AssurantHealth.com •	 Cigna:	call	(800)	244-6224	or	visit	www.cigna.com	or	Capital	Insurance	at	(800)	780-3100,	www.capitalins.com. •	 CompBenefits:	call	(800)	943-6880	or	visit	www.CompBenefits.com.* •	 UnitedHealthcare:	call	(800)	980-0292	or	visit www.myuhcdental.com. *CompBenefits has two different DHMO plans for you to choose from, so be sure to request information about each plan.

Dental Preferred Provider Organization (DPPO)
A DPPO offers you discounted fees from a network of preferred dentists. •	 CompBenefits:	call	(800)	943-6880	or	visit	www.CompBenefits.com.

Dental Indemnity
A dental indemnity plan allows you to visit any dentist you choose and pays a percentage of usual charges for covered services. You will want to ask about these charges before receiving services. •	 Ameritas	Group:	call	(877)	721-2224or	visit	www.ameritasgroup.com. •	 Assurant:	call	(800)	277-2300	or	in	Tallahassee	(850)	386-2300,	or	visit		www.AssurantHealth.com. •	 American	Dental	Plan:	call	(866)	879-3630	or	visit	www.compbenefits.com/custom/adpstatemployees

Enroll in or Make Changes to a Dental Plan
Ways to Enroll:
1. Log on to https://PeopleFirst.myFlorida.com, or 2. Complete	the	state	Dental	Enrollment	Form	and	mail	it	to	the	 People	First	Service	Center,	P.O.	Box	6830,	Tallahassee,	FL	32314,	or	 fax	it	to	(904)	828-6092.	Be	sure	to	list	all	dependents	to	be	covered.	 3. Call	People	First	at	(866)	663-4735.

Note: To enroll in a DhMo or Prepaid Plan, you may need to select a dental facility from the company Web sites listed above. Do NoT enroll in a DhMo or Prepaid Plan before making sure there is a dental provider available to you.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Dental Plan Comparison Chart
You have more dental options than ever before as a state employee. This chart helps you compare dental plans so you can choose the one that best meets the needs for you and your family. The rows show how much you pay each month and the amount or percentage you would pay for the common services listed. The columns indicate the costs associated for each individual plan. “Cost above” means that you will pay for any cost higher than the amount listed below.

DENTAL CHOICES
Monthly Premiums Employee Employee + Spouse Employee + Child(ren) Employee + Spouse + Child(ren) Annual Deductible Calendar Year Maximum ***Preventive Care (no deductible) Periodic oral exam (ADA 103, 120) Bite-wing X-rays (ADA 274) Cleanings (Dental Prophylaxis – ADA 1110) Fluoride treatments (ADA 1201, 1203) Sealants (ADA 1351) Space maintainers (ADA 1515) ***Basic and Major Care (after deductible, if applicable) Complete series or panoramic X-rays (ADA 210/330) Amalgam fillings (ADA 2150) Composite resin fillings (ADA 2331) Root canal (ADA 3330) Periodontal surgery – gingivecotomy, per quadrant (ADA 4210) Root planing, per quadrant (ADA 4341) Surgical extraction of tooth, including wisdom teeth (ADA 7240) General anesthesia, each 30 minutes (ADA 9220, 9230) Crowns (ADA 2750) Fixed bridges (ADA 6240) Full lower denture (ADA 5120) Inlays and onlays (ADA 2520) Partial dentures (ADA 5214) Re-cement bridges, crowns, inlays (ADA 2920) Relining dentures (ADA 5730) Repairs to full dentures, partial dentures, bridges (ADA 5510) ***Orthodontia Care Child 24-month treatment fee (ADA 8670) Adult 24-month treatment fee (ADA 8670) $0 $0 $0 $0 $0 $0**

PPO
CompBenefits Plan # 4054 $26.82 $49.62 $55.44 $80.50 In-Network Out-of-Network Employee: $25 Employee: $50 Family: $50 Family: $100 $1,200/person You Pay: 20% 20% 20% 20% 20% 20% You Pay: $0 20% 20% 20% 20% 20% 20% 20% 50% 50% 50% 50% 50% 50% 50% 50% You 50%; $1,500 lifetime Pay: max benefit 50%; $1,500 lifetime max benefit 20% 50% 50% 50% 50% 50% 50% 50% 70% 70% 70% 70% 70% 70% 70% 70% Cost above $45 Cost above $32 Cost above $38 Cost above $238 Cost above $253 Cost above $52 Cost above $104 Cost above $80 Cost above $156 Cost above $151 Cost above $166 Cost above $123 Cost above $193 Cost above $12 Cost above $58 Cost above $32 Cost above $14 Cost above $20 Cost above $30 Cost above $11 Cost above $17 Cost above $174 Ameritas Plan # 4064 $8.84 $17.76 $23.12 $32.04 $50 $1,000/person

Indemnity
Assurant Plan #4074 $38.35 $73.63 $86.76 $114.77 $50/person; 3 per family $1,250/person in network; $1,000/person out-ofnetwork You Pay: $0 $0 $0 $0 $0 $0 You Pay: 20% 20% 20% 75%* 75%* 75%* 20% 20% 75%* 75%* 75%* 75%* 75%* 75%* 75%* 75%* You Pay: 50%; $1,000/child lifetime max benefit 100% American Dental Plan Plan # 4084 $14.74 $21.96 $23.30 $37.10 $50 $1000/person

Cost above $11.70 Cost above $16.20 Cost above $18.90 Cost above $15.30 Cost above $6.30/tooth Cost above $108

Cost above $23.40 Cost above $18 Cost above $22.50 Cost above $243 Cost above $51.30 Cost above $14.40 Cost above $61.60 Cost above $30.60 Cost above $180 Cost above $180 Cost above $129.60 Cost above $26.10 Cost above $79.20 Cost above $11.70 Cost above $32.40 Cost above $26.10

100% 100%

100% 100%

100% 100%

*75% for first year; 50% for subsequent years of consecutive coverage **limited to children under age 16 ***American Dental Association (ADA) codes are shown to help you more easily compare costs across plans.

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

For an online interactive tool that lets you compare your likely total costs under each option, go to www.MyFlorida.com/myBenefits. We’ve made every effort to accurately provide costs of each service; where this chart differs from the plan documents, the plan documents shall take the place of this chart.

Dental HMO/Pre-paid (In-Network Only)
CompBenefits Plan # 4004 $16.22 $31.98 $38.14 $48.70 $0 $0 $0 $0 $0 $0 $0 $0 UnitedHealthcare Plan # 4014 $10.91 $23.95 $29.90 $41.98 $0 $0 $0 $0 $0 $0 $0 $0 Assurant Plan #4024 $12.35 $19.99 $27.03 $31.69 $0 $0 You Pay: $0 $0 $0 $0 $10/tooth $60 You Pay: $0 $8 $10 $64 $39 $14 $27 $23 $150 $150 $320 $115 $354 $6 $18 $9 $0 $0 $37 $245 $375 $50 $80 $125 $245 $245 $325 $235 $425 $15 $85 $325 $0 $15 $45 $245 $120 $50 $100 $180 $265 $265 $335 $125 $380 $15 $60 $30 You Pay: $725 - 1,580 $725 - 1,580 $2,250 $2,350 $1,000 100% $1,700 $2,100 75% 75% $0 $0 $0 $280 $140 $70 $95 $145 $425 $425 $535 $380 $615 $40 $110 $70 $260 $95 $280 $10 $45 $15 $0 $0 $37 $240 $120 $45 $75 $15 $220 CIGNA Plan # 4034 $23.46 $42.14 $49.60 $60.18 $0 $0 $0 $0 $0 $0 $10/tooth $155 American Dental Plan Plan # 4044 $12.64 $21.20 $23.00 $32.98 $0 $0 $0 $0 $0 $0 $7/tooth $45

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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CompBenefits 2008 dual choice dental benefits for the State of Florida American Dental Plan (ADP) Prepaid and Indemnity Benefit Options
2008 Dental Plan Highlights
Prepaid/Select 15
• Most cost effective way to receive

Indemnity/Schedule B
• Freedom to see any dentist • Coverage for Type I, II and III services • Claims paid according to a stated benefit schedule • $50 calendar year deductible (waived for Type I services) • No waiting periods • $1000 calendar year maximum benefit • Vision, contact lens and hearing aid programs

dental care • Choose your own dentist from a list of participating general dentists • Many “no charge” benefits • Savings on every procedure • No deductibles • No maximum benefit limitations • No waiting periods • No claim forms • Child and Adult Orthodontia • Vision, contact lens and hearing aid programs

Please contact us at 866-879-3630 or visit our website at www.compbenefits.com/custom/adpstateemployees/

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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CompBenefits proudly offers two new and enhanced dental benefit options, as selected by the Department of Management Services Network Plus DHMO and Preferred Plus DPPO
2008 Dental Plan Highlights
Network Plus DHMO
• Includes 330 covered dental procedures

Preferred Plus DPPO
• In and Out of Network Benefits • Child and Adult Orthodontia • Endodontics (root canals), Periodontics (gum treatment), and Oral Surgery covered as Type II - Basic Services • In-Network Benefits not subject to balance billing over PPO provider’s contracted fee • Enhanced out-of-network benefits based on the 90th percentile of usual, customary & reasonable charge

• • •

• • •

at fixed co-payments Orthodontic coverage at fixed copayments for both children and adults Co-payments applicable with both General & Specialist Dentists No specialty referral pre-authorization required; members may “self refer” to Specialists Large network of providers with over 4,100 dentists statewide No office visit fee No waiting periods, annual maximums, deductibles, or claim forms to file

Please contact us at 800-943-6880 or visit our website at www.compbenefits.com/custom/stateofflorida/

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Supplemental Hospitalization Plans
Supplemental hospitalization plans pay for some of the hospital expenses not covered by your health insurance. These charges may include	the	hospital	deductible,	non-covered	room	and	board	charges,	co-payments	and	any	special	fees.	Alta	Health	and	Life	Insurance	 Company	(represented	by	Capital	Insurance	Agency,	Inc.)	and	Philadelphia	American	Life	Insurance	Company		(represented	by	State	 Securities Corporation) offer supplemental hospitalization plans. •	 •	 Alta	Health	and	Life	Insurance	Company:	call	(800)	780-3100	or	visit www.capitalins.com	Philadelphia	American	Life	 Insurance	Company:	call	(800)	227-2300	or	in	Tallahassee	(850)	386-2300,	or	visit	www.ssc-life.com. As	with	all	supplemental	plans,	be	sure	you	are	fully	informed	before	choosing	multiple	plans	of	the	same	insurance	type.

Enroll in or Make Changes to a Supplemental Hospital Plan
Ways to Enroll:
1. log on to https://Peoplefirst.myflorida.com, or 2. Complete the state hospital supplement enrollment form and mail it to the People first service Center, P.o. box 6830, Tallahassee, fl 32314, or fax it to (904) 828-6092. 3. Call People first at (866) 663-4735. Note: enrollment also requires a company application to be completed and sent to the company. These applications are not processed by People first.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Cancer, Intensive Care and Accident and Disability Plans
The	American	Family	Life	Assurance	Company	of	Columbus	(AFLAC)	offers	cancer	and	intensive	care	supplemental	plans.	Capital	 Insurance	Agency,	Inc.	represents	AFLAC.		To	learn	more,	call	(800)	780-3100	or	visit	www.capitalins.com. Go to the People First Web site to enroll online or complete the "Supplemental Cancer/Intensive Care" enrollment form and mail to the People First Service Center. Read	AFLAC's	brochure	for	additional	steps. Colonial	Life	and	Accident	Insurance	Company	offers	Accident,	Accident	and	Disability,	Cancer	and	Cancer	and	Intensive	Care	plans.	 To learn more, please visit www.coloniallife.com/florida or call: •	 •	 •	 North	Florida	(800)	858-0779	or	in	Tallahassee	(850)	962-2500 Northeast	Florida	(866)	684-4030	or	in	Jacksonville	(904)	655-5553 Central/South	Florida	(888)756-6701	or	in	Daytona	Beach	(386)	252-9806

Please note: You must meet with a Colonial insurance agent to complete the “Supplemental Accident/Disability Insurance” enrollment form located on the People First Web site. The agent must calculate, certify and write the required premium on the form, and then you will	mail	it	to	the	People	First	Service	Center.		Next,	you	must	send	a	completed	Colonial	Application	or	Service	Form	for	underwriting	 approval. If you pass, Colonial will notify People First and coverage will start the first day of the month following a full month’s premium being deducted. Changes to your insurance coverage can only be made when you have a QSC event or during the next Open Enrollment period.

Enroll in or Make Changes to a Cancer and/or Intensive Care Plan
Ways to Enroll: 1. Log on to https://PeopleFirst.myFlorida.com 2.	 Complete	the	Enrollment	Form	and	mail	it	to	 the	People	First	Service	Center,	P.O.	Box	6830,	 Tallahassee,	FL	32314,	or	 fax	it	to	(904)	828-6092. 3.	 Call	People	First	at	(866)	663-4735. Note:	 Enrolling	in	People	First	does	NOT	guarantee	 coverage. Enrollment in the Colonial Accident and Disability Plan requires assistance from an agent. Please see the Colonial contact information above.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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myBenefits = myLife
Life Insurance
We offer term life insurance, including an accidental death and dismemberment benefit, underwritten by Minnesota Life, to full-time and part-time employees. Minnesota Life is a new provider for 2008 and replaces Prudential Life. If you have been enrolled with the Prudential Life plan, you will be covered by Minnesota Life. Because of this change, you must submit a new beneficiary form. Forms are available on the People First Web site and also at www.minnesotalife.com.

Coverage & Premiums
The state pays all or part of the base life insurance premium for employees, depending on their classification. For most employees, coverage	is	one-and-a-half	times	your	annual	salary.	For	example,	if	you	earn	$30,000	a	year,	your	beneficiary	would	receive	a	$45,000	 benefit if you died. For Senior Management Service, University Senior Management (non-faculty), Selected Exempt Service, legislative employees	and	employees	of	other	certain	classes,	coverage	is	two	times	your	annual	salary.	That	means	if	you	earn	$30,000	a	year,	your	 beneficiary	would	receive	$60,000	if	you	die.	If	you	are	a	career	service	employee,	coverage	drops	to	half	(50	percent)	when	you	reach	age	 70.	If	you	work	part	time,	please	contact	the	People	First	Service	Center	to	determine	available	coverage	levels	and	premiums.	 You should complete your beneficiary form as soon as possible. Please note: Even if you previously submitted a beneficiary form to Prudential	Life,	you	will	need	to	submit	a	new	form	to	the	new	carrier,	Minnesota	Life.	If	a	beneficiary	is	not	designated	in	writing,	the	 proceeds will be paid according to the default beneficiary provisions of the policy in this order: your spouse, children, parents or the personal representative of your estate. Payments made to an estate, however, may result in a reduction in total benefits due to taxes and probate costs. be sure to complete your beneficiary form. aDverTIseMeNT

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Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Accidental Death and Dismemberment
Basic life insurance coverage includes accidental death and dismemberment coverage. Significant benefits may be available in the event of accidental	death	or	injury.	Payment	amounts	vary	from	25	to	100	percent	of	your	coverage.	You	may	be	eligible	to	receive	benefits	if	you	 lose the use of limbs in instances where no amputation is required.

Accelerated Death Benefit
The Accelerated Death Benefit, or “living benefit option,” provides you with an advanced benefit if you are diagnosed with a terminal illness	that	will	result	in	death	within	one	year.	You	may	be	eligible	for	up	to	100	percent	of	your	life	insurance	benefits,	with	a	maximum	 of	$1	million.	Upon	death,	the	balance	of	the	life	insurance	benefit,	if	any,	will	be	paid	to	the	named	beneficiaries.

Conversion Privileges
You will lose your life insurance coverage if you leave employment, become ineligible for coverage or neglect to pay the premium. If you	lose	your	coverage,	you	can	convert	some	or	all	of	the	life	insurance	to	an	individual	contract.	Regardless	of	your	age	or	health,	 you	can	purchase	a	whole	life	insurance	policy,	provided	the	conversion	request	and	premium	payment	are	made	to	Minnesota	Life	 within	31	days	of	group	plan	termination.	You	should	contact	Minnesota	Life	directly	for	the	conversion	forms	and	applicable	premium	 information.

Optional Insurance
If you are enrolled in the basic term life insurance plan, you can purchase additional term life insurance. You can add coverage from one to five	times	your	annual	salary,	up	to	$500,000.		This	plan	is	an	employee-pay-all,	post-tax	benefit.	When	you	start	working	for	the	state,	you	 can buy this optional coverage on a guaranteed-issue basis, meaning that you do not need to qualify or present evidence of insurability. If you choose to increase the optional coverage amount later, you can increase the benefit amount equal to your annual salary without medical underwriting. If you choose coverage above this amount, you’ll be subject to medical underwriting. If you declined optional life coverage when you were first hired but want to enroll during Open Enrollment, you will need to qualify or present evidence of insurability (pass medical underwriting). To	learn	more	about	Minnesota	Life	call	(888)	826-2756	or	visit		www.minnesotalife.com

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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Flexible Spending Accounts Program
We offer Flexible Spending Accounts (FSA) with three options for you to set aside a portion your income to pay for health and dependent care expenses. You can participate in any or all of the following fsa options: •	 •	 •	 Medical	Reimbursement	Account Limited	Purpose	Medical	Reimbursement	Account Dependent	Care	Account

Money to fund FSAs is deducted each paycheck on a pre-tax basis, reducing your federal income tax liability. You decide when you sign up how much you want reserved in your account for the year. As you have medical or dependent care expenses, you submit claims (receipts) for eligible expenses and are reimbursed from your account. You should carefully estimate how much money you will need in each selected FSA account for the year. If you do not submit claims for the plan year by the april 15th filing deadline for the entire amount you had withheld, you lose the unused money. There is no need to change the amounts of your FSA during Open Enrollment if you want to keep the same amounts. Your existing FSA(s) will continue at the same annual deduction amounts plan year to plan year, unless you want to change your contribution amount or cancel during Open Enrollment.

Medical Reimbursement Account
A	Medical	Reimbursement	Account	(MRA)	is	an	account	that	reimburses	you	for	eligible	medical	expenses.	The	minimum	to	open	 the	account	is	$60	per	year	and	the	maximum	is	$5,000	per	year.	If	you	have	a	Health	Savings	Account,	you	cannot	enroll	in	a	MRA.	 The entire amount in your account is available at the beginning of the plan year. That means you do not have to wait for the regular contribution	to	be	withheld	from	your	paycheck	before	you	submit	a	claim.	Example:	It’s	January	and	you’ve	had	$100	withheld	from	 your	paycheck	for	your	MRA.	You	have	to	get	an	x-ray	and	have	to	pay	$120	for	the	service.	You	submit	your	receipt	and	receive	$120	 even	though	there	is	only	$100	in	the	account.			 If you stop working for the state, you will not be reimbursed for services after you leave unless you make arrangements with the People First Service Center to continue the account(s).

eligible health Care expenses*
• • • • • • • • deductibles you pay as part of your or your spouse’s health care insurance plan co-payments for eligible medical bills after deductibles have been satisfied any qualifying amount you pay for eligible expenses after your maximum benefit has been paid other health care expenses not covered by an insurance plan that otherwise would be eligible for deduction on a federal tax return acupuncture ambulance services contraceptive devices (prescription only) dentures • • • • • • • • • • eye examinations, eyeglasses, and contact lenses and supplies hearing aids and batteries obstetric care orthodontia oxygen seeing-eye dog smoking cessation programs and prescription drugs hearing impaired equipped telephone wheelchair certain over-the-counter items, medicines or drugs

*This list is not exhaustive and there are many other expenses which qualify for reimbursement. 36
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

Ineligible Expenses*
The following is a list of expenses which are ineligible for reimbursement. •	 •	 •	 •	 •	 weight-loss	programs	and	appetite	suppressants	 anti-hair	loss	drugs	 cosmetics	and	toiletries	 health	club	(gyms,	exercise	programs,	etc.)	dues	 dental	procedures	to	whiten	the	teeth	(bleaching)

*This list is not exhaustive and there are many other expenses which do not qualify for reimbursement.

Limited Purpose Medical Reimbursement Account
A	Limited	Purpose	Medical	Reimbursement	Account	(LPMRA)	reimburses	you	for	dental,	vision	and	over-the-counter	drug	costs	 considered	tax	deductible	by	the	IRS	but	not	paid	by	any	health	plan.	The	minimum	to	open	the	account	is	$60	per	year	and	the	 maximum	is	$5,000	per	year.	Unlike	the	MRA,	if	you	have	a	Health	Savings	Account,	you	can	still	enroll	in	a	LPMRA. The entire amount in your account is available at the beginning of the plan year. That means you do not have to wait for the regular contribution	to	be	withheld	from	your	paycheck	before	you	submit	a	claim.	Example:	It’s	January	and	you’ve	had	$100	withheld	from	 your	paycheck	for	your	LPMRA.		You	have	to	get	a	new	pair	of	glasses	for	$140.	You	submit	your	receipt	and	receive	$140	even	though	 there	is	only	$100	in	the	account.			 If you stop working for the state, you will not be reimbursed for services after you leave unless you make arrangements with the People First Service Center to continue the account(s). For	more	information	about	qualified	expenses	and	other	FSA	provisions,	read	the	IRS	Publication	502,	“Medical	and	Dental	Expenses,”	 available at www.irs.gov.

Dependent Care Reimbursement Account
A	Dependent	Care	Reimbursement	Account	(DCRA)	reimburses	you	for	eligible	expenses	you	pay	to	take	care	of	a	dependent.	The	 minimum	to	open	the	account	is	$60	per	year	and	the	maximum	is	$5,000	per	year.	(Married	employees	filing	separately	have	an	annual	 maximum	deduction	amount	for	each	enrollee	of	$2,500.)	 At any given time, you can only be reimbursed for dependent care expenses up to the current balance amount in your account. Unlike MRAs,	the	entire	annual	deduction	amount	is	not	available	for	reimbursement	at	the	beginning	of	the	plan	year.	Only	the	amount	you	 have contributed to the account, less any claims paid, is available at any given time. Before you enroll, you should carefully compare the potential tax savings from this plan to the federal income tax credits available. In the following instances, you will generally reduce the amount of taxes paid by enrolling in this plan if: •	 •	 •	 You	file	a	federal	IRS	income	tax	form1040	EZ.	Because	there	is	no	line	to	deduct	dependent	care	expenses,	the	only	way	to	get	 a	tax	benefit	is	through	a	DCRA.	 You	and	your	spouse	file	taxes	as	“married,	filing	separately.”	The	IRS	will	only	allow	a	tax	credit	for	those	filing	as	“single,	head	of	 household” or “married, filing jointly.” Your	expenses	are	more	than	$2,400	for	one	dependent	or	$4,800	for	two	or	more	dependents.

Qualifying Dependents
A qualifying dependent is any person you take care of who lives in your home. Qualifying dependents include, but are not limited to: •	 •	 •	 a	parent a	disabled	person	or	 any	child	under	the	age	of	13.	

If you are divorced or legally separated and your dependent lives with you, you can claim work-related dependent or child care expenses. This is true even if you do not claim the dependent on your tax return.
Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com 37

Qualified Expenses
Qualified expenses are expenses for the care of dependents so you (and your spouse, if married) can work, look for work, or attend school. Qualified expenses include: •	 •	 •	 •	 •	 a	licensed	child	care	center	for	either	children	or	adults;	 an	after	school,	YMCA	or	summer	program;	 a	neighbor	who	cares	for	the	children	before	or	after	school;	 an	individual	who	provides	care	in	his/her	home;	or	 an	individual	who	provides	care	in	your	home,	such	as:	 •	 a	live-in	nanny,	 •	 a	Licensed	Practical	Nurse	(LPN)	or	assisted	care	provider	for	an	adult,	or	 •	 a	babysitter	

Expenses paid to the following providers do not qualify: •	 someone	who	can	be	claimed	as	the	employee’s	dependent	 •	 overnight	camp	 •	 charges	for	materials,	transportation,	and	other	charges	not	directly	related	to	the	care	of	the	individual	 You	will	need	to	supply	the	federal	tax	ID	number	or	Social	Security	Number	of	the	dependent	care	provider	when	you	file	claims	for	 dependent care expenses, and there must be adequate funds in the account for you to be reimbursed. For	more	information	about	qualified	expenses	and	other	FSA	provisions,	read	the	IRS	Publication	503,	“Dependent	Care	Expenses”	 available at www.irs.gov.

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myPrivacy
State of Florida Employees’ Group Health Insurance Program Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

The	Health	Insurance	Portability	and	Accountability	Act	of	1996	 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information, known as protected health information, includes virtually all individually identifiable health information held by plans — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices for the State of Florida’s Flexible Spending Account, and discusses administrative activities performed by the State for the State of Florida Employees’ Group Health Self-Insurance Plan (the self-insured plan) and for insurance companies and HMOs in the State Group Insurance Program (the insured plans). The plans covered by this notice, because they are all sponsored by the State of Florida for its employees, participate in an “organized health care arrangement.” The plans may share health information with each other to carry out Treatment, Payment, or Health Care Operations (defined below). The Plans’ duties with respect to health information about you The plans are required by law to maintain the privacy of your health information and to provide you with a notice of the plans’ legal duties and privacy practices with respect to your health information. Participants in the self-insured plan will receive notices directly from BlueCross Blue Shield of Florida (BCBSF) and Caremark (which provides third-party medical and pharmacy support to the self-insured plan); the notices describe how BCBSF and Caremark will satisfy the requirements. Participants in an insured plan option will receive similar notices directly from their insurer or HMO. It’s important to note that these rules apply only with respect to the health plans identified above, not to the State as your employer. Different policies may apply to other State programs and to records unrelated to the plans. How the plans may use or disclose your health information The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care Treatment, Payment activities, and Health Care Operations. Here are some examples of what that might entail: Treatment includes providing, coordinating, or managing health care by	one	(1)	or	more	health	care	providers	or	doctors.	Treatment	can	 also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the plans may share health information about you with physicians who are treating you. Payment includes activities by these plans, other plans, or providers to obtain premiums, make coverage determinations and provide reimbursement for health care. This can include eligibility determinations, reviewing services for medical necessity or appropriateness, utilization management activities, claims management, and billing, as well as “behind the scenes” plan functions such as risk adjustment, collection, or reinsurance. For example, the plans may share information about your coverage or the expenses you have incurred

with another health plan in order to coordinate payment of benefits. Health care operations include activities by these plans (and in limited circumstances other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include vendor evaluations, credentialing, training, accreditation activities, underwriting, premium rating, arranging for medical review and audit activities, and business planning and development. For example, the plans may use information about your claims to review the effectiveness of wellness programs. The amount of health information used or disclosed will be limited to the	“Minimum	Necessary”	for	these	purposes,	as	defined	under	the	 HIPAA rules. The plans may also contact you to provide appointment reminders or information about treatment alternatives or other healthrelated benefits and services that may be of interest to you. How the plans may share your health information with the State The plans will disclose your health information without your written authorization to the State for plan administration purposes. The State needs this health information to administer benefits under the plans. The State agrees not to use or disclose your health information other than as permitted or required by plan documents and by law. The plans may also disclose “summary health information” to the State if requested, for purposes of obtaining premium bids to provide coverage under the plans, or for modifying, amending, or terminating the plans. Summary health information is information that summarizes participants’ claims information, but from which names and other identifying information have been removed. In addition, the plans may disclose to the State information on whether an individual is participating in the plans or has enrolled or disenrolled in any available option offered by the plans. The State cannot and will not use health information obtained from the plans for any employment-related actions. However, health information collected by the State from other sources is not protected under HIPAA (although this type of information may be protected under other federal or state laws). Other allowable uses or disclosures of your health information In certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information describing your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made, for example if you’re not present or if you’re incapacitated). In addition, your health information may be disclosed without authorization to your legal representative.

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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The plans are also allowed to use or disclose your health information without your written authorization for uses and disclosures required by law, for public health activities, and other specified situations, including: •	 Disclosures	to	Workers’	Compensation	or	similar	legal	 programs, as authorized by and necessary to comply with such laws Disclosures	related	to	situations	involving	threats	to	personal	 or public health or safety. Disclosures	related	to	situations	involving	judicial	 proceedings or law enforcement activity Disclosures	to	a	coroner	or	medical	examiner	to	identify	the	 deceased or determine cause of death and to funeral directors to carry out their duties Disclosures	related	to	organ,	eye	or	tissue	donation	and	 transplantation after death Disclosures	subject	to	approval	by	institutional	or	private	 privacy review boards and subject to certain assurances by researchers regarding the necessity of using your health information and treatment of the information during a research project. Certain disclosures may be made related to health oversight activities, specialized government or military functions and US Department of Health and Human Services investigations

agreement), or unilaterally by the plans for health information created or received after you’re notified that the plans have removed the restrictions. The plans may also disclose health information about you if you need emergency treatment, even if the plans had agreed to a restriction. Right to receive confidential communications of your health information If you think that disclosure of your health information by the usual means could endanger you in some way, the plans will accommodate reasonable requests to receive communications of health information from the plans by alternative means or at alternative locations. Right to inspect and copy your health information If you want to exercise this right, your request to the plans must be in writing and you must include a statement that disclosure of all or part of the information could endanger you. This right may be conditioned on your providing an alternative address or other method of contact and, when appropriate, on your providing information on how payment, if any, will be handled. With certain exceptions, you have the right to inspect or obtain a copy	of	your	health	information	in	a	“Designated	Record	Set.”	This	 may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication, and case or medical management record systems maintained by a plan; or a group of records the plans use to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. In addition, the plans may deny your right to access, although in certain circumstances you may request a review of the denial. If you want to exercise this right, your request must be in writing. Within 30	days	of	receipt	of	your	request	(60	days	if	the	health	information	is	 not accessible onsite), the plans will provide you with: •	 •	 The	access	or	copies	you	requested;	 A	written	denial	that	explains	why	your	request	was	denied	 and any rights you may have to have the denial reviewed or file a complaint; or A	written	statement	that	the	time	period	for	reviewing	your	 request	will	be	extended	for	no	more	than	30	more	days,	 along with the reasons for the delay and the date by which the plans expect to address your request.

•	 •	 •	

•	 •	

Except as described in this notice, other uses and disclosures will be made only with your written authorization. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization for a plan that has taken action relying on it. In other words, you can’t revoke your authorization with respect to disclosures the plan has already made. Your individual rights You have the following rights with respect to your health information the plans maintain. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right for the Flexible Spending Account and for the State activities relating to the self-insured plan and insured plans.	Contact	the	Division	of	State	Group	Insurance,	PO	Box	5450,	 Tallahassee,	FL	32314-5450	to	obtain	any	necessary	forms	for	exercising	 your rights. The notices you receive from BCBSF, Caremark, and your insurer or HMO (as applicable) will describe how you exercise these rights for the activities they perform. Right to request restrictions on certain uses and disclosures of your health information and the Plan’s right to refuse You have the right to ask the plans to restrict the use and disclosure of your health information for Treatment, Payment, or Health Care Operations, except for uses or disclosures required by law. You have the right to ask the plans to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the plans to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request must be in writing. The plans are not required to agree to a requested restriction. And if the plans do agree, a restriction may later be terminated by your written request, by agreement between you and the plans (including an oral

•	

The plans may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The plans also may charge reasonable fees for copies or postage. If the plans do not maintain the health information but know where it is maintained, you will be informed of where to direct your request. Right to amend your health information that is inaccurate or incomplete With certain exceptions, you have a right to request that the plans amend your	health	information	in	a	Designated	Record	Set.	The	plans	may	 deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the plans (unless the person or entity that created the information	is	no	longer	available),	is	not	part	of	the	Designated	Record	 Set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal, or administrative proceedings).

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If you want to exercise this right, your request must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the plans will: •	 •	 Make	the	amendment	as	requested;	 Provide	a	written	denial	that	explains	why	your	request	was	 denied and any rights you may have to disagree or file a complaint; or Provide	a	written	statement	that	the	time	period	for	reviewing	 your	request	will	be	extended	for	no	more	than	30	more	days,	 along with the reasons for the delay and the date by which the plans expect to address your request.

•	

The	plans	must	abide	by	the	terms	of	the	Privacy	Notice	currently	in	 effect.	This	notice	took	effect	on	April	14,	2003.	However,	the	plans	 reserve the right to change the terms of its privacy policies as described in this notice at any time and to make new provisions effective for all health information that the plans maintain. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to a plan’s privacy policies as described in this notice, you will be	provided	with	a	revised	Privacy	Notice	through	posting	on	the	DSGI	 Web site or mailed to your last known home address. Complaints If you believe your privacy rights have been violated, you may complain to the plans and to the US Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. Complaints about activities by your insurer or HMO, or by BCBSF or Caremark, can be filed by following the procedures in the notices they provide. To file other complaints with the plans, contact the DSGI for a complaint form. It should be completed, including a description of the nature of the particular complaint, and mailed to the Division of State Group Insurance,	PO	Box	5450,	Tallahassee,	FL	32314-5450.	 Contact For more information on the privacy practices addressed in this Privacy Notice	and	your	rights	under	HIPAA,	contact	the	Division	of	State	 Group	Insurance	at	PO	Box	5450,	Tallahassee,	FL	32314-5450.	

Right to receive an accounting of disclosures of your health information You have the right to a list of certain disclosures the plans have made of your health information. This is often referred to as an “accounting of disclosures.” You generally may receive an accounting of disclosures if the disclosure is required by law in connection with public health activities or in similar situations listed in the table earlier in this notice, unless otherwise indicated below. You may receive information on disclosures of your health information going back for six (6) years from the date of your request, but not earlier than	April	14,	2003	(the	general	date	that	the	HIPAA	privacy	rules	 are effective). You do not have a right to receive an accounting of any disclosures made: •	 •	 •	 •	 •	 •	 For	Treatment,	Payment,	or	Health	Care	Operations;	 To	you	about	your	own	health	information;	 Incidental	to	other	permitted	or	required	disclosures;	 Where	authorization	was	provided;	 To	family	members	or	friends	involved	in	your	care	(where	 disclosure is permitted without authorization); For	national	security	or	intelligence	purposes	or	to	 correctional	institutions	or	law	enforcement	officials	in	 certain circumstances; or As	part	of	a	“limited	data	set”	(health	information	that	 excludes certain identifying information).

•	

In addition, your right to an accounting of disclosures to a health oversight	agency	or	law	enforcement	official	may	be	suspended	at	the	 request	of	the	agency	or	official.	 If you want to exercise this right, your request must be in writing. Within 60 days of the request, the plans will provide you with the list of disclosures or a written statement that the time period for providing this	list	will	be	extended	for	no	more	than	30	more	days,	along	with	the	 reasons for the delay and the date by which the plans expect to address your	request.	You	may	make	one	(1)	request	in	any	12-month	period	at	 no cost to you, but the plans may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request. Right to obtain a paper copy of this notice from the plans upon request You	have	the	right	to	obtain	a	paper	copy	of	this	Privacy	Notice	upon	 request. Changes to the information in this notice Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com 41

Special Notice About the Medicare Part D Drug Program
Please, read this notice carefully. It explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll
Medicare	prescription	drug	coverage	(Medicare	Part	D)	became	available	in	2006	to	everyone	with	Medicare	through	Medicare	 prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All approved Medicare prescription drug plans must offer a minimum standard level of coverage set by Medicare. Some plans may offer more coverage than required. As such, premiums for Medicare Part D plans vary and all plans should be researched carefully. The State of Florida Department of Management Services has determined that the prescription drug coverage offered by the State Employees’ Health Insurance Program (State Health Program) is, on average, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage. If you do decide to enroll in a Medicare prescription drug plan and drop your State Health Program coverage, be aware that you and your dependents will be dropping your hospital, medical and prescription drug coverage. If you choose to drop your state health Program coverage, you will NoT be able to enroll back in the state health Program unless a special open enrollment period for non-enrolled state of florida retirees is mandated by the florida legislature. If	you	enroll	in	a	Medicare	prescription	drug	plan	and	you	DO	NOT	drop	your	State	Health	Program	coverage,	you	and	your	eligible	 dependents will still be eligible to receive all of your current health and prescription drug benefits. If you drop or lose your coverage with the State Health Program and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. Additionally, if you go 63	days	or	longer	without	prescription	drug	coverage	that’s	at	least	as	good	as	Medicare’s	prescription	drug	coverage,	your	monthly	 premium	will	go	up	at	least	1%	per	month	for	every	month	that	you	did	not	have	that	coverage,	and	you	may	have	to	wait	until	the	 following	November	to	enroll.	

Additional information about Medicare prescription drug plans is available from:
• • Visit www.medicare.gov Your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, payment assistance for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you may call them at 1-800-772-1213	(TTY	1-800-325-0778).	 For more information about this notice or your current prescription drug coverage, contact the People First Service	Center	at	1-866-663-4735.	 Keep this notice. If you enroll in one of the plans approved by Medicare which offers prescription drug coverage you may need to give a copy of this notice when you join to avoid paying a higher premium amount (a penalty).

•

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Notes

Benefits Information: www.MyFlorida.com/myBenefits • Enroll and Make Selections: https://PeopleFirst.MyFlorida.com

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