SCHOOL BOARD OF CLAY COUNTY Annual Enrollment Plan Year

Annual Enrollment Highlights Passive enrollment = July 27 – August 21 All current elections roll over into with no AE change, except FSA. Employees must re-enroll and make new FSA elections NEW HSA Medical Plan Option There are 3 medical plan options available through Florida Blue PCP required for new HMO and HSA enrollees Without PCP designation, one will be assigned If currently enrolled in the HMO, current PCP will remain on file (PCP entered during AE will not overlay Florida Blue PCP on record) Update Beneficiaries for Life Insurance Verify beneficiary shown or collect new assignment Spouse Life and Child life beneficiary is the employee 2

Benefits 101 – New Hires All full-time (0.6 of an allocation) contracted employees are eligible for benefits. Coverage becomes effective on the first day of the month after you complete 45 calendar days of employment, provided you enroll and submit any required forms to the Insurance Department before your effective date of coverage. The Board provides a comprehensive benefit program, and the cost of benefits are partially paid by the Board. Review your options now and make your elections soon. Deductions for coverage begins two pay periods in advance. If you delay your enrollment, you could have a double deduction from a single paycheck. 3

Read your Benefit Guide Your Benefits Guide contains details about each plan. Read it and have it hand when you’re ready to enroll. Note the page numbers for where to find more information in the Benefits Guide. 4

Benefits Overview Medical Election? YESYES YESYES Plan A NONO NONO Plan B 5

Dependent Child Eligibility Children by birth, marriage, adoption, or legal guardianship – Pg. 6 Under age 19 Medical Dental Vision Life Insurance (if not married or disabled) Accident and Injury Whole Life Critical Illness Age and full time student Medical Dental Vision Life Insurance (If not married or disabled) Accident and Injury Whole Life Critical Illness (age 24) Age not a full time student Medical Dental Vision Accident and Injury Whole Life Critical Illness Florida Mandate Medical Only for Age Unmarried Not eligible for other coverage No children Florida resident or Full Time Student 6

Is your Spouse a School Board of Clay County employee? 7 Yes, and we both need medical coverage You both will be considered Plan A. Notify the Insurance Department so your enrollment is processed correctly. You may choose which of you will have deductions taken from your pay Yes, but only one of us needs medical coverage The spouse who needs medical coverage will be Plan A. The spouse who does not need medical coverage will be Plan B. Don’t elect coverage for your spouse under any plan.  You may not elect Spouse Life Insurance because under the Life Insurance policy, you may not be covered as an employee and a dependent.  Only one of you may cover your dependent children. Life Insurance

Plan A Benefits Medical Plan – Pg. 21 Contributions are new and subject to change Rates printed in the Benefit Guide are subject to Collective Bargaining If rates change, all employees will be notified and may be given an opportunity to modify coverage Board provides Basic Life Insurance $20,000 – Pg. 49 Plan A Employee pays 100% of all other benefits Medical Gap – Pg. 33 Accident and Injury – Pg. 34 Dental – Pg. 41 Vision – Pg. 43 Short and Long Term Disability – Pg. 53 8

Plan B Benefits No Medical Coverage Board provides Basic Life Insurance $50,000 – Pg. 49 Board pays 100% for Employee Only coverage in the following plans: Accident and Injury – Pg. 34 Dental – Pg. 41 Vision – Pg. 43 Short Term Disability – Pg. 53 Long Term Disability – Pg. 53 Employee pays Dependent portion: A&I, Dental, and Vision; not available without EE election Dependent Spouse and Child Life 100% voluntary 9

Florida Blue Medical Plans HMO, PPO, HSA – Pg HMO and PPO have $3,000 Annual Deductible HSA has $1,500 Annual Deductible Preventive Care covered 100% All copayments apply to Out of Pocket Maximums Copayments for most services Referrals are not required to see a Specialist HMO In-Network coverage only Requires designation of a Primary Care Physician (PCP) PPO In- and Out-of-Network national provider access PCP designation not required HSA In-Network coverage only Deductible applies for all services Copayments for prescriptions apply only after deductible has been met. Requires designation of a PCP Participants may choose to contribute to a Health Savings Account through payroll deductions 10

Florida Blue Networks/PCP The three plans have different networks HMO and HSA – BlueCare network PPO – BlueOptions network (also called Network Blue) HMO and HSA require all covered members to designate a Primary Care Physician Employees can log on to and search under “Find a Doctor” using the residence zip code. If PCP is not collected at time of enrollment, then the member will be assigned a PCP by Florida Blue based on their zip code Only for new enrollees – current PCP assignments will not change Member will receive a letter notifying them of the PCP that has been assigned with instructions to change Employees should watch for the letter and contact Florida Blue immediately if they wish to change 11

Medical Gap Insurance MUST be enrolled in a “Major Medical” Plan SBCC Medical or Spouse’s group medical plan Excludes Medicare, TRICARE, and CHAMPUS Pays based on what appears on the Explanation of Benefits from the Major Medical Plan Two Plans – Based on Inpatient Benefit – Pg. 33 KemperGap 3000 KemperGap 1500 Outpatient = 50% of Inpatient Benefit $350 Ambulance coverage for Accident only 12

Dental Plan Delta Care Prepaid Plan – Pg Requires election of Primary Care Dentist No out of network coverage Lower cost per pay period Delta Dental PPO Plan – Pg Broader network of dentists In and out of network coverage 13

Vision Plan Vision Care Plan with Humana – Pg. 43 Coverage for exams, lenses, and frames or contact lenses In and Out of Network coverage Includes coverage for Lasik Members receive an ID card 14

Flexible Spending Accounts FSA with Health Equity – Pg Healthcare Flexible Spending $2,500 Annual Maximum contribution Debit Card provided to all participants Most medical claims passed through Florida Blue claims system can be automatically substantiated Members can view balances, submit claims online, and provide substantiation documentation if necessary at Not eligible if enrolled in the HSA Medical Plan Dependent Care Flexible Spending $5,000 Annual Maximum Child Care or Elderly care 15

Health Savings Account 16 * Participants 55+ = $1,000 additional “catch up contribution” permitted Employee OnlyFamily Coverage55+ Participants* IRS Annual Limit$ 3,350$6,650$1,000 “catch-up” Per 20-pay$167.50$332.50$50 Individually owned account - Pg. 12 Must be under age 65 and enrolled in the HSA Medical Plan The most an individual may contribute into an HSA is based on the level of medical coverage elected. Deposited balance may be used to pay eligible medical, prescription drug, dental, and vision expenses. Funds rollover each year and balance earns interest.

Term Life Insurance Basic Life – Pg. 49 Plan A - $20,000 Plan B - $50,000 Supplemental Life – Pg New Employees may elect up to $100,000 in Employee Life Insurance and Spouse Life Insurance without answering medical questions Elections over $100,000 require completion of Evidence of Insurability questionnaire Plan A may elect up to a total of $180,000 Plan B may elect up to a total of $150,000 Employee and Spouse rates are age banded based on Employee’s age as of October 1, 2015 Child flat rate for $5,000 or $10,000 Children who are married and/or disabled are ineligible Verify / Update Beneficiaries 17

Annual Enrollment Opportunity Supplemental Term Life – Pg Employees may increase Voluntary Life by $10,000 without submitting Evidence of Insurability (EOI) during Annual Enrollment New elections and increase more than one increment require EOI Plan A may elect up to a total of $180,000 Plan B may elect up to a total of $150,000 Employee and Spouse rates are age banded based on Employee’s age as of October 1, 2015 Child flat rate for $5,000 or $10,000 Children who are married and/or disabled are ineligible Evidence of Insurability required if electing coverage for the first time or for Employee Life in excess of $10,000 18

Disability Short Term Disability – Pg EOI is required for Plan A employees who are not currently enrolled and electing coverage for the first time EOI is not required if changing from Plan B to Plan A Long Term Disability – Pg EOI is required for Plan A employees who are not currently enrolled and electing coverage for the first time EOI is not required if changing from Plan B to Plan A 19

Voluntary Benefits Accident and Injury – Pg. 34 Paid by Employer 100% for Plan B Employee Only Sickness Rider for all enrollments Interest Sensitive Whole Life – Pg. 58 Employee Spouse Child Specified Critical Illness – Pg. 60 Employee Only Employee + Spouse 20

Key Dates First Day of Enrollment = July 27 Last Day to Enroll = August 21 First payroll deduction = September 15 Effective Date of Coverage = October 1 21