Santa Rosa County School Board Employee Benefits 2013 Benefit Plan Year

Benefits Offered to Full Time Employees: Medical Dental Vision Basic and Supplemental Life Long Term Disability Flexible Spending Accounts- Health & Dependent Care Health Care Saving Accounts (if enrolled in HDHP) Tax Sheltered Annuities, Cancer & Life Retirement (Interim employees need to check with HR for coverage eligibility)

General Guidelines New employees must enroll for benefits within first 30 days of employment (exception – retirement) Enrollment for benefits via BenefitHelp on-line system (exception – retirement benefits) Benefits become effective the first of the month following one month of employment Benefits elected will be effective thru 12/31/13 Benefit plan year January 1 to December 31 Open enrollment conducted annually (November) for the following calendar year Benefits end on the last day of the month employment terminates Retirement plan must be selected before the end of the fifth month following his/her month of hire Will receive retirement information packet directly from FRS

Medical Florida Blue (formerly Blue Cross and Blue Shield of Florida) – 4 plan options Blue Options PPO #05773 (high option) Blue Options PPO #05301 (low option) Blue Options High Deductible Health Plans #05182 & 05183 (high option) Blue Options High Deductible Health Plans #05192 & 05193 (low option) Plan tiers Employee only Employee + Spouse Employee + Child(ren) Employee + Family Two Employee Family Cost of plan varies based on plan and tier elected School Board pays a large percentage of premium All four plans have the same provider network (Blue Options) All four plans offer out of the network and/or out of the area coverage Effective date of coverage is the first of the month following one month of employment. Example: Hire Date August 12, 2013; benefits begin October 1, 2013. Medical insurance premiums are pre-paid one month prior to the actual month of coverage (Payroll deduction in September 2013 pays the October 2013 monthly premium) Will receive a membership card in the mail

Blue Options PPO #05773 Flexibility to choose physicians from a network of providers that includes primary care and specialists Calendar year deductible (CYD) – in network $2,000 per individual and $6,000 family aggregate Office Visit Co-pays: $35.00 Primary Care and $65.00 Specialist Hospital Inpatient – $350 Per Admission DED + CYD + 30% co-insurance Preventive Care – 100% coverage in-network Annual Out of Pocket Maximum - $5000/$10,000 in-network per individual/family aggregate Reference plan summary for specific services and applicable co-payments Participating physician’s network available on-line @ www.bcbsfl.com Co-pay Prescription drug program included in plan (retail & mail order)

Blue Options PPO #05301 Flexibility to choose physicians from a network of providers that includes primary care and specialists Calendar year deductible (CYD) – in network $5,000 per individual and $10,000 family aggregate Office Visit Co-pays: $25 Primary Care and $45 Specialists (first six visits). After six visits subject to CYD + 30% coinsurance Hospital Inpatient – CYD + 30% co-insurance Preventive Care – 100% coverage in network Annual Out of Pocket Maximum - $7,500/$15,000 in-network per individual/family aggregate Reference plan summary for specific services and applicable co-payments Participating physician’s network available on-line @ www.bcbsfl.com Co-pay prescription drug program for Generics only included in plan (retail & mail order)

Blue Options High Deductible Health Plans 05182 & 05183 Calendar Year Deductible (CYD) – In network $2,500 single coverage $5,000 all other tiers (EE + Spouse, EE + Child/ren, EE + Family) The SRCSB makes an annual HSA contribution of $750 for single contracts and $1500 for family contracts. Co-insurance 20% after calendar year deductible is met (no co-pays) Preventive care not subject to the calendar year deductible or coinsurance – 100% coverage in-network Annual Out of Pocket Maximum - $5,000/$10,000 in-network per individual/family aggregate Reference plan summary for specific services and applicable coinsurance Participating physicians network available on-line @www.bcbsfl.com Prescription drug program included in plan (retail & mail order) subject to calendar year deductible.

Blue Options High Deductible Health Plans 05192 & 05193 Calendar Year Deductible (CYD) – In network $2,500 single coverage $5,000 all other tiers (EE + Spouse, EE + Child/ren, EE + Family) The SRCSB makes an annual HSA contribution of $750 for single contracts and $1500 for family contracts. Co-insurance 20% after calendar year deductible is met (no co-pays) Preventive care not subject to the calendar year deductible or coinsurance – 100% coverage in-network Annual Out of Pocket Maximum - $5,000/$10,000 in-network per individual/family aggregate Reference plan summary for specific services and applicable co-payments Participating physicians network available on-line @www.bcbsfl.com Prescription drug program included in plan (retail and mail order) subject to calendar year deductible. After CYD has been satisfied member responsibility is 20% of the cost of the prescription.

Health Savings Account (HSA) IRS eligibility guidelines: Covered by a high deductible health plan (HDHP) Not covered under another medical plan that is not a HDHP Not enrolled in Medicare Not eligible to be claimed under another person’s tax return SRCSB contributes $750 or $1500 to HSA (semi-annual deposits in January and July) HSA contribution pro-rated for new hires Employees may also make pre-tax contributions thru payroll deduction IRS annual contribution limits for 2013 - $3,250 single; $6,450 family. Catch up provision of $1,000 available age 55+. Funds can be used to help pay eligible medical expenses prior to meeting calendar year deductible. Unused funds roll over. Santa Rosa County Federal Credit Union is the School Board’s designated HSA Custodian. Can enroll in the HDHP and not open a HSA.

Special Enrollment Rights If you decline enrollment during the first 30 days of employment or during the annual open enrollment, you may be eligible to enroll at a future date for one of the following qualifying events: Marriage/Divorce Birth, adoption or placement for adoption Spouse’s job change Spouse’s open enrollment Loss of other health coverage Request to enroll or make changes must be made within 30 days of the qualifying event Contact Risk Management

My Blue Service Website for member self-service capabilities including: Request replacement ID card Health Dialog Blue 360 eMedicine Healthcare Advisor Claim status information Benefits information Online provider directory Request benefit booklet Forms center

Blue Dental Choice PPO Two dental plans to choose from High option – pays 100% for preventive care; 80% for basic care after CYD Low option – pays 80% for preventive care; 70% for basic care after CYD Major services – pays 50% after CYD under both plans Orthodontic services - pays at 100% after CYD under both plans up to a lifetime maximum of $1,000 Annual dental benefit maximum is $1,000 per person Flexibility to choose a dentist from a network of participating providers Dental network available on-line @ www.bcbsfl.com Reference plan summaries for specific services and applicable deductible and co-payments Participating providers will file claims for you. Non-participating providers may require you to bring a claim form with you to your appointment. Forms may be obtained from the Risk Management website or the BenefitHelp system. Employee pays premium Employees who decline health coverage may elect the low option dental plan that is paid in full by the SRCSB (does not apply to two employee families with health coverage) Available to employees and eligible dependents Will receive a membership card in the mail Florida Combined Life is the dental carrier

Vision Care Coverage for all routine eye care, including eye exams and eyeglasses (lenses and frames) or contacts Network of participating physicians to choose from Reference plan summary for specific services covered and applicable co-payments Employee pays total cost Available to employees and eligible dependents Will receive a membership card Davis Vision is the vision carrier

Basic & Supplemental Life Insurance The SRCSB provides all employees basic life and AD & D insurance in the amount of $50,000 Amount is $100,000 for employees who waive health coverage (Does not apply to Two Employee Families with health coverage) Employees may elect additional supplemental life insurance in $10,000 increments from $20,000 up to $300,000 Guarantee issue up to $200,000 if employee enrolls during the first 30 days of employment Evidence of insurability required for coverage in excess of $200,000 Late enrollments (after 30 days of employment or during annual open enrollment ) requires evidence of insurability for any amount Cost of additional supplemental life based on age ING is the life insurance carrier Designate primary and contingent beneficiaries on BenefitHelp

Flexible Spending Accounts (FSA) Section 125 of the Internal Revenue Code allows employees to have pre-tax amounts withheld from their paychecks placed into spending accounts. Reimbursement is made to the employee for qualified expenses. Employees have the option of selecting from two different types of FSA’s: Health care reimbursement account Dependent care reimbursement account Reference plan summary for covered expenses Plan year runs concurrent with health plan year (January – December) Maximum annual election $2,500 – Use it or lose it Three options for reimbursement: Pay with Flexible Spending Account debit card Submit claim forms and receipts File on-line at www.tasconline.com Total Administrative Services Corporation (TASC) is the FSA third party administrator for the School Board Employees who open a Health Savings Account (HSA) may not elect to participate in a health care flexible spending plan (IRS guidelines).

Long Term Disability Monthly benefit equal to 60% of your salary up to $5,000 Benefits start after 60 days of disability Benefits paid to age 65 Employee pays the total cost Rates based on age and salary Premiums waived during disability period Florida Combined Life is the LTD carrier.

Tax Sheltered Annuities Cancer, Life, Long Term Care Insurance Products available for individual purchase Payroll deductions for approved vendors List of vendors, agents and contact information on the Risk Management website

Florida Retirement System Two plans to choose from: Pension Plan Investment Plan The majority of your FRS retirement plan is funded by the School Board; a mandatory 3% pre-tax contribution is deducted from your payroll check each month and deposited into your retirement account with FRS. Must make a choice before the end of the fifth month following his/her month of hire Resources for information: Human Resources Website MyFRS.com (FAQ’s, brochures, forms, investment facts, Advisor Service and Choice Service) MyFRS toll-free Financial Guidance Line staffed by Ernst & Young financial planners and DOR counselors Employee workshops

District Liability Insurance Programs Insurance coverage for all School Board employees that includes: Comprehensive General Liability School Leaders Error and Omissions Sexual Harassment Sexual Molestation Exclusion for “intentional acts”

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