1. Risk Management & Insurance
BENEFlex 2017
Risk Management & Insurance

3. Rates are per pay period, 20 pay periods per year.
Use your $75 per pay period “No Health” Board credit on coverages marked with a diamond.
Board credits may not be used for Optional Term Life Insurance.

4. Rates are per pay period, 20 pay periods per year.
Use your $75 per pay period “No Health” Board credit on coverages marked with a diamond.
Short term disability must be elected in order to elect long term disability.
Monthly benefit is determined by your annual salary.

5. Terms and Definitions DEDUCTIBLE
You pay 100% of the cost up to the amount of the deductible*
CO-INSURANCE
You pay 20% of the cost up to the out of pocket limit
OUT OF POCKET LIMIT
Humana pays 100% of the costs after the costs reach $4000 for an individual, $8000 for a family
*All individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount.

6. Which Health Plan is Right for You?
HMO
NPOS
CDHP
Not required to stay in Network
Not required to select a PCP
No referrals necessary
Must meet a deductible
Must stay in Network
Not required to select a PCP
No referrals necessary
Must meet a deductible
Healthcare allowance provided
Must stay in Network
Must Select a PCP
No deductible - set co-pays for all services
Limited coverage area
Must get a referral to see a specialist

7. Pharmacy Benefits Rx4 Traditional replaces Rx3
Pay two co-pays for a 90 day supply at a participating pharmacy or mail order through Humana Pharmacy (after deductible on Tier 3 & Tier 4 medications).
Check our website for manufacturer programs that help with Rx costs!

8. With Doctor on Demand, you pay less than a visit to urgent care:
Staff HMO: $25 co-pay
NPOS and CDHP: $40 or 20% of $40 after deductible has been met.
Beginning January 1, 2017, see a doctor now from the comfort of your home!
Download the free Doctor on Demand app from the App Store or Google Play
or visit doctorondemand.com/humana

9. NEW: Compare, Choose, Save: Healthcare Bluebook
Download the free Healthcare Bluebook mobile app and start shopping for prices and facilities while you are with your doctor.
You can look up a Fair Price, compare provider prices,
and find the best value in your area.
Click the “Go Green to Get Green” banner and you’ll earn a $25, $50, or $100 reward (on select procedures) when you choose a Fair Price provider.
Log on to: pcsb.org/healthcarebluebook
Company Code: PCSB

10. PCS COVERAGE VS. THE HEALTHCARE MARKETPLACE
Pinellas County Schools health insurance coverage meets the standard for minimum essential coverage and is considered affordable under the Affordable Care Act.
Benefit eligible employees who enroll in the Marketplace plans would not be eligible for Advanced Premium Tax Credits (tax subsidy) and would not receive premium assistance.

11. Better health, great rewards- it's all part of Humana Vitality/go365!
Humana Vitality is a wellness and rewards program for employees enrolled in a Humana health plan that gives its members an opportunity to:
Set goals – create a personalized plan!
Earn Vitality Points™ and shop at the Vitality Mall with Vitality Bucks!
Learn the value of making healthy choices to experience personal results!
Employees reaching Silver Status or above by August 31, 2017, will be eligible for a premium credit during 2018!
Employee Only              $10 credit per pay period 
  Employee + Spouse      $15 credit per pay period
  Employee + Child/ren   $15 credit per pay period
  Employee + Family        $20 credit per pay period
Better health, great rewards-
it's all part of Humana Vitality/go365!

12. “No Health” Board Contribution
Use your $75 per pay period Board Credit for:
Dental
Vision
Accidental Death & Dismemberment Insurance
Short Term/Long Term Disability
MetLife HOSPITAL INDEMNITY (HIP)
Flexible Spending Account
Mark “Refuse” in box #1
Complete and sign page 2
EXAMPLE
Board Credit $75.00
Humana Comp Dental (2P) 13.74
Eye Med Vision (2P)
AD&D $50,000/Fam
Short Term Disability
$800/16 day
Long Term Disability $
MetLife HIP (2P)
Healthcare FSA
TOTAL USED $72.78

13. Dental Plans Comparison Chart
*Board Contribution (Flex Credits) may be used

14. Eye Med Vision Plan KEY FEATURES KEY FEATURES
Free coverage for employee only. May purchase coverage for dependents
Routine eye exam once every calendar year - $10 co-pay
Single vision lenses OR contact lenses once every calendar year
Frames once every two years
National retail and private practice optometrists & ophthalmologists
Standard plastic lens co-pay
$15
Contact lens allowance
$110 plus 20% off
balance over $110
Frame allowance
$110
RATES
Employee Only Free
Employee + 1 $2.83
Employee + Family $5.92

15. MetLife HOSPITAL INDEMNITY (HIP)
Box #4
The MetLife HIP pays a cash benefit when you or a covered dependent is hospitalized due to an accident or illness.
Covered Benefits:
Hospital Admission - $500
Hospital Confinement - $250 per day, 30 day maximum
Inpatient Rehabilitation Unit - $100 per day, 15 day maximum – Accident only
Pre-existing conditions limitations apply.
*Board Contribution (Flex Credits) may be used
Rates are listed on page 7 in the Beneflex Guide.

16. 13

17. Short Term/Long Term Disability

18. Prudential form required for employee coverage over $100,000
GUARANTEED ISSUE
FOR NEW HIRES
Prudential form required for employee coverage over $100,000
Prudential form required for spouse coverage

19. BENEFICIARY INFORMAITON
Employees must complete the beneficiary section for Board Life. Primary and Secondary beneficiaries must equal 100%:

20. Flexible Spending Accounts (FSA)
A Health Care FSA could save you money if you or your dependents:
Have out of pocket health expenses like co-pays or deductibles
Take Tier 3 or Tier 4 prescription medications and have an Rx deductible
Wear glasses or contact lenses
Need orthodontia care, such as braces or other eligible dental expense
A Dependent Care FSA provides pre-tax reimbursement of out of pocket expenses related to dependent care, if you and your spouse are working or in school and:
Your dependent children under age 13 attend daycare, after-school care or summer day camp

21. Flexible Spending Accounts (FSA)
You decide how much to contribute:
Health Care FSA: $200 - $2500
Dependent Day Care FSA: $200 - $5000
Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.
Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.
Funds available for Health Care expenses on January 1, 2016
Look for Humana Access Visa cards last week in December (plain envelope)

22. Dependent Eligibility
For Medical, Dental & Vision coverages:
Legally married spouse
Dependent children may be covered through end of calendar year in which they reach age 26
Family OTL and Dependent Child(ren) Life Insurance coverages:
Legally married spouse
Dependent children may be covered up to age 26:
A.) if they are dependent upon you for support: OR
B.) they are a full-time student
For Medical:
Dependent children up to age 30, please contact Risk Management at for further details and documentation.
DOCUMENTATION IS REQUIRED FOR DEPENDENTS
enrolled in health, dental or vision coverage:
marriage certificate for a spouse, birth certificates for children.
Photocopies are acceptable.

23. WHEN ARE MY BENEFITS EFFECTIVE?
Benefits are effective the first day of the month following 60 days of employment.
Example:
Hire Date Benefits Effective
8/ /1
4/ /1
You must turn in your Enrollment and Change form in person or by pony (interoffice envelope) to Risk Management and Insurance Department within 31 days of your hire date or full time position date.

24. 20 Payroll Deductions per year.
You pay for 12 months of coverage during the 10 month school year.
 You pay one month in advance.
Deductions include a portion for summer coverage.
Summer premium may be owed upon your initial enrollment or if you change benefits during the year.
If your deductions change during the year, you may owe premium or you may be due a refund.

25. 5

26. Employee Assistance Program
Stress (on & off the job)
Family & Marital problems
Divorce
Substance or Alcohol Abuse
Depression
Elder Care Referral
Legal Assistance Referrals
Health Advocate
Covers all eligible employees and family members
Up to 8 free counseling sessions per incident.(no co-pays)
Strictly confidential 18

27. Voluntary Products Convenient payroll deductions
Enroll anytime throughout the year after your eligibility begins - Group Legal Services may only enroll as a new hire or during annual enrollment
Met Life: Great rates for cars, recreational vehicles and motorcycles
MetLife – Auto/Motorcycle/Recreation Vehicle, and Veterinary Pet Insurance
Enrollment any time during the year through: Get Met 8 ( ) 20

28. Retirement Florida Retirement System (FRS)
You will contribute 3% of your gross pay
You must decide after receiving your packet from FRS in 60 days which plan to select
FRS Pension Plan
FRS Investment Plan
Tax Deferred Annuity Program
Defer up to 25% of pay, not to exceed $15,500 per year.
(If you turn age 50 or older this year, you can contribute and additional $5,000.)
NO contributions /matching funds from PCS 19

29. QUESTIONS
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Please do not ask questions of coworkers, school secretaries, department heads, principals. They may not have the answers that best meet your needs.
Instead, contact the
RISK MANAGEMENT BENEFITS TEAM
for the most accurate answer at
Or visit our website at