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BP BROCHUREWARD COUNTY T'Ic scilool, sys-rEm Tabte of Contents Open Enrollment Timeline...... ... ........................... ---- ....... - ......... What's New for January 1........-- .......... ...... --- ..... .......... ----2 Important Things to Remember... .... ................ -- .......... ---- ....... 4 Quick Enrollment Reference Guide .....-.. ... --- ..... ...... -- ... .......... 6 General Open Enrollment Information..,.:. - ......... — .::::........7 Special Enrollment Period ....... .. . ....... - ....... — ...... --Al Continuation of Coverage (COBRA) .............. ...... —13 The VIP Program:. .... --- ........ — ...... ........... ........ ..........16 NCAS Traditional, Alternate & Indemnity Medical Plans.. ....:..:....18 Aetna Open Choice PPO Medical Plan...- ....................... --20 Aetna Select HMO Medical Plan . ... -- ...... ................ 22 CareFirst BlueCholce HMO Open Access Medical Plan... .......::........24 Kaiser Permanente Select HMO Medical Plan... .... ...::........26 United Health care Choice Open Access Medical Plan .......... ...... 28 Medical Benefits Indemnity/PPO Comparison Chart.... —......:;....30 Medical Benefits HMO Comparison Chart:: -- ........................ .::..,:36 Dental Benefits—.. ......... ...... - ... .......... ------.42 Vision Care Benefits... ., ...., ..... ...... --- ........... —.---45 Voluntary Benefits...... .... ................. -- ..........49 Short Term Disability Benefits .... ................. ...... ... — ......... ........ 50 Long Term Disability Benefits ..... .. ............... ......... -- ....:..::..... :52 Flexible Spending Accounts (Dependent Care and Health Caro!.....53 Medical Rates., ..... .... --- .......... -- ......... ..................... ... ... ,57 Dental and Vision Rates- ....... ......... ...... ..... .59 Benefits Open House Dates ....... ............................... ...... -- ....... .60 Notice of Privacy Policy and Practices,.::.. ......... ... ----61 HCPSS Important Contacts ...................... . ........ ............66 Benefits Plan Contact Information ...................... .............................67 Glossary of Terms ........... ... -- .......... ........... ..... 68 2021 Benefit Plan Choices The purpose of this Open Enrollment Guide is to give you basic information about your benefits options and how to enroll for coverage or make changes to existing coverage. This guide is only a summary of your choices and does not fully describe each benefit option. Please refer to your Certificates of Coverage provided by your health plan carriers for important additional information about the plans. Every effort has been made to make the information accurate; however, in the case ofany discrepancy, the provisions of the legal documents willgovern. Now%aro ComityPuiilic School System � — bene 'ts —Cnr r6ent ( deTor Active -Emp ogees U m a 3 _ N TO: HCPSS Employees Eligible for Benefits FROM: Benefits Office RE: Annual Open Enrollment for Group Benefit Plans - Plan Year 2011 October 4, 2010 — October 31, 2010 It's open enrollment time! The Annual Oven Enrollment Period is October 4 _ October 31, 2010. During this time, we recommend you review the benefits being offered by HCPSS and the plans you are enrolled into determine if you should make any changes. The Benefits Enrollment Guide highlights the array of benefits available to employees. You may access the Benelogic on -line enrollment system at home or work through the Benelogic website at www:hcpss. benelogic.com to update your personal information and to elect / change / cancel medical, dental, vision, flexible spending accounts (medical and dependent care), long -term disability, and benefits credits. If you do not wish to make any changes, your current benefit elections will continue for year 2011, unless you go on -line through benelogic and make changes. However, all employees who plan to enroll in the medical and /or dependent care flexible spending accounts must go on -line and make a new election for the Plan Year 2011. Your current FSA deduction will not carry over to plan year 2011. Health Care Reform update The Patient Protection and Affordable Care Act (the Affordable Care Act), the health reform law that was signed by President Obama on March 23, 2010, provides many new important protections for consumers who have or who are seeking private health insurance. " Grandfathered Status" Many of the protections stated in the Patient Protection and Affordable Care Act (the Affordable Care Act) apply differentlyto health plans that existed on the daythe lawwas enacted, known as "grandfathered plans," than they do to newer plans that were enacted after the law was enacted. HCPSS has elected to be a "grandfathered health plan" under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted. As a °grandfathered health plan' we are not subject to certain consumer protections of the Affordable Care Act that may apply to other plans. However, as a result of being a "grandfathered" plan under health care reform, there are a number of provisions that are required. The following changes were made to our HCPSS health benefit plans effective 01/01/2011. * Dependents are eligible for health coverage under all of our health plans up to age 26 provided that the dependent(s) is not eligible for health insurance coverage through their own employment. There will be no lifetime maximums. Individuals whose coverage ended by reason of reaching a lifetime limit tinder the plan are eligible to enroll in the plan. Benefits Plan Changes - Please refer to the enclosed benefit chartand /or the Benefits Enrollment Guide for the covered service amounts. Cardiac Rehabilitation has been added to the CareFirst Blue Choice Open Access HMO and WAS Plans. Mental Health Coverage for outpatient care has changed for United Healthcare, and Kaiser. * Over- the - Counter medications require a prescription to be reimbursed through the medical flexible spending account. The debit card cannot be used for these transactions. Premiums/Contributions Changes Medical premiums have increased due to rising cost of healthcare and utilization. The premiums for all dental and vision plans will remain the same for plan year 2011. The Board's contribution will also change to 87% of the monthly health premium for full -time and part -time employees effective 01/01/2011. All new full -time and part -time employees hired on or after 07/01/2011 will receive a board contribution of 85% towards their monthly health premium. Howard County Public School System Benefits Enrollment Guide for Active Employees Dependent Eligibility Audit Employees who add new dependent(s) to their health benefit plans during the open enrollment period and throughout the benefits calendar year as a result of a qualifying event will be required to provide verification of their newly enrolled dependent(s). The verification of eligible dependent(s) will be conducted by Secova, Inc., an independent third party that specializes in dependent validation. You will receive an information packet from Secova, Inc. with instructions on how to submit verification materials and how to access their call center after the open enrollment period. The Secova call center will be available to assist you with dependent eligibility questions or questions about removing coverage for ineligible dependents. Voluntary Benefits To enroll/ change/ cancel Short-Term Disability, Accident, Cancer or Critical Illness Insurance coverage offered through Aflae during open enrollment, please contact Pam Dinterman directly at (410) 207 -5341, or email Pamela_dinterman@Lis.aflac.com. Please refer to the section on Voluntary Benefits within the guide. To enroll /change /cancel Supplemental Life or Whole Life with Reliastar, please contact The Farmington Co. at 1 -800- 621 -0067 Long Term Disability Coverage If you did not enroll in Long Term Disability (LTD) at the time of hire, you may choose to enroll in LTD coverage offered through The Standard during the annual open enrollment. However, you will be required to mail a completed Medical History Statement to The Standard by November 30, 2010. Employees will be able to download/ print the Medical History Statement when enrolling in LTD coverage online through Benelogic. Once your application has been processed and reviewed by The Standard, you will receive a notification of approval / denial of LTD coverage. The deduction for LTD coverage will begin the first of the month following notification of approval from The Standard. Insurance Cards Employees will receive new ID cards by January 1, 2011, only if you made any changes to your name or coverage level for medical, dental and /or vision plans. Please note that there is no vision insurance card for the Vision Service Plan (VSP). Benefits Open House Events To learn more about the health, dental, vision, flexible spending accounts (medical and dependent care), disability, voluntary benefits, 403(b) tax sheltered annuity programs, and 457(b) deferred compensation program, please attend one of the Benefits Open House Events on the dates listed below. Date Time Location Tuesday, October 12th, 2010 12:30pm — 6:00pm Board Rooms A & B (Central Office) Monday, October 18th, 2010 12:30pm — 6:00pm Board Rooms A & B (Central Office) Wednesday, October 27th, 2010 12:30pm- 6:00pm Board Rooms A & B (Central Office) Representatives from all of our plan providers will be present at the Benefits Open House Events to provide information and answer questions. In addition, the Benefits Office staff will be onsite to answer questions or to assist with enrollment. During the Benefits Open House Events, employees will also have the opportunity to enroll in voluntary benefit plans offered through Aflac and Reliastar. The effective date for all coverage(s) is January 1, 2011. The first deduction will begin January 7, 2011. Please review the Retiree Benefits Enrollment Guide carefully, and if you have any questions contact the Benefits Office. We will be happy to assist you Susan Callaway (410) 313 -6710 susan_callaway @hcpss.org Cynthia Harrison (410) 313 -1564 cynthia_harrison @hcpss.org Jeeni Griffin (410) 313 -6713 jeeni_ griffin @hepss.org Fax: (410) 313 -1531 oward County PA c School System .��, ." BenefiYS EnrolC mel "nt Guicle for Active Emproyees I r° 1 0 m m a O n m M Important T in s to er ® Open Enrollment Period is October 4 -31, 2010. * Review the Benefits Enrollment Guide for Important information / changes. im If you are not making any changes to your current benefit elections, they will continue for plan year 2011 unless you go online and make changes. 0 To .learn more about the benefits offered by HCPSS for health, dental, vision, flexible spending accounts, disability, voluntary benefits, 403(b) tax sheltered annuity programs, and the 457(b) deferred compensation program, please plan to attend one of our planned Benefits Open House Events, held at the Central Office Board Rooms A & B between 12:30pm - 6:00pm on the following dates. > Tuesday, October 12, 2010 > Monday, October 18, 2010 > Wednesday, October 27, 2010 Carrier representatives will be present to provide information and to answer any questions. In addition, the Benefits Office staff will be onsite to answer questions or to assist with enrollment. mThe Open Enrollment period to enroll in the Voluntary Benefits plans offered though Reliastar and Aflac is October 4 - November 30, 2010. Enrollment is not online. To enroll in the Volunta ry Life Insurance Plans offered through Reliasta r during the Open Enrollment Period contact The Farmington Co. at 1- 800 - 621 -0067. > Whole Life Insurance with Long Term Care Rider > Supplemental Life insurance up to 1, 2, 3 x annual salary To enroll in the Voluntary Benefit Plans offered through Aflac during the Open Enrollment Period contact Pamela Dinterman at (410) 207 -5341 or e -mail Pamela dinterman @LIS.aflaC.COm. > Accident Insurance > Cancer Insurance > Critical Illness Insurance * If you are an existing employee and you wish to enroll in (LTD) coverage offered through The Standard during open enrollment, you will be required to mail a completed Medical History Statement to The Standard by November 30, 2010. New hires will not be subject to the medical history requirement if they enroll within the first 30 days of HCPSS employment. * To enroll in short term disability coverage offered through Aflac contact Pam Dinterman directly at (410) 207 -5341 or email Pamela_dinterman @us.aflac. com. You DO NOT have to select a Primary Care Physician (PCP) for the following HMO medical plans: > Open Access Aetna Select HMO Plan > United Healthcare Choice HMO You MUST select a PCP for the following medical plan: > CareFirst Blue Choice HMO Open Access FA You MUST select a center for the Kaiser Permanente Select HMO plan. Review your life Insurance Beneficiary designations on Benelogic and make changes if necessary. Review you personal information (name, address, phone number, date of birth, etc) and update information if necessary. ® All medical, dental, vision, flexible spending accounts, disability, and voluntary benefits deductions are based on 20 pays. Howard County Public School System � � � �� Benefits Enrollment Guide For Active Employees * Dependent eligibility verifications will be required for any new dependents added to your benefits during open enrollment. The services will be provided by Secova,lnc. All benefits elections take effect on January 1, 2011. Payroll deductions begin January 7, 2011. Please review the Benefits Enrollment Guide carefully, as it contains important information. Howard Co. o.unty rCIG is Schoo( System � �� Benelite.Enr�o�7menY taus eTor Active Employees M a 0 4 v 0 s ao 0 A 3 m 3 6 rD M Quick Enrollment Reference Guide To become covered by the plan, other than during Open Enrollment, you must enroll onlinewithin 30 days from your hire date. How to Enroll in Benefits * To enroll/change/waive medical, dental, vision, flexible spending medical accounts, Dependent care, Life & LTD coverage(s) visit www.hcpss.benelogic.com, * Enter your Employee ID Number = Located on your pay stub. * Enter your Password = Last 4 digits of your social security number. * You will be prompted to change your password (if you log into Benelogic website again, you will need this new password). * If enrolling in CareFirst BlueChoice HMO Open Access, you will have to select a Primary Care Physician for you and your Dependents. PCP may be changed by contacting BlreChoice and will be effective the first of the following month in which the change was updated. M If enrolling in Kaiser Permanente Select HMO, you will have to select a Kaiser Center. Anv Ouestions? * Follow the instructions on the screens to enroll in your 2011 benefits. * Click on the "Finish" button to save your elections. * Review your confirmation statement. * Print your confirmation statement for your records. F,oW,arR`ounty Public —blic School —System --'----Benefits —Enrollment Guide for A—diveEmployees N General Open Enrollment Information Eligibility All Active Employees regularly scheduled to work at least 17.5 hours per week are eligible for the benefits. Food Service Workers regularly scheduled to work at least 15 hours per week are eligible. Any Employee working less than 15 hours per week is not eligible. An Employee on an authorized leave -of- absence, as required by the Family and Medical Leave Act (FMLA) of 1993, shall be classified as eligible. The Employer will continue to pay its share of the premium as long as the Employee is on FMLA leave, If an Employee qualifies as both an Employee and a Dependent, such person maybe covered as an Employee or Dependent, but not as both. If both husband and wife are Employees, their children will be covered as Dependents of the husband or wife, but not of both. Dependents Eligible Dependents are: a. A Spouse- A husband or wife, of the opposite sex, carder a legal marriage or qualified Same -Sex Domestic Partner; b. An unmarried /married Dependent child regardless of student status until the end of the birth month in which he or she reaches age 26; c. An unmarried /married Dependent child who is incapable of self - support because of mental retardation, mental illness, or physical incapacity that began before the child reached age 26. Proof of incapacity must be received by HCPSS within 30 days after coverage would otherwise terminate. Additional proof of disability maybe required from time to time; d. Any child of a Participant who does not qualify as a Dependent under subsections b and c, solely because the child is not primarily dependent upon the Participant for support so long as over half of the support of the child is received by the child from the Participant pursuant to a multiple support agreement. A Spouse or child in the armed forces of any country is not eligible for coverage. The term "Dependent child" means any ofa Participant's: a. Biological children; b. Legally adopted children or children placed in the Employee's home pending final adoption; e. Stepchildren who permanently reside in the Employee's household and are Dependent on the Employee for more than half of his or her support; d. Foster children (provided the foster child is not ward of the state); e. Children who are under the legal guardianship of the Employee; f. Children for whom the Employee is required to provide health care coverage under a recognized Qualified Medical Child Support Order g. Children of the Employee's "Same -Sex Domestic Partner who permanently reside in the Employee's household and are Dependent upon the Employee for more than half of his or her support.' The term "Domestic Partner" means a person of the same sex who: a. Has registered with the Employee as a Domestic Partner in a jurisdiction which allows for such registration; or b. Has shared the Employee's" permanent residence for no less than 12 months; and c. Is financially interdependent with the Employee and can provide documentation of at least two of the following: common ownership or lease -hold interest in property; common ownership of a Howard County Public Schoo( System — .., - " °ienefits -tnrofCment Gui` e foriCcti Eme pCoyees 9 General Open Enrollment Information motor vehicle; a joint bank or credit account, designation as a life insurance or retirement plan beneficiary, beneficiary in the Employee's will; assignment of durable power of attorney; or any other proof deemed to show financial interdependence; and d. Is no less then 18 years old; and e. Is not a blood relative that would be prohibited by legal marriage; and E Is not currently legally married to or separated from another person; and g. Has not applied under a health benefit program sponsored by any other Employer; and h. Would, if legally permissible, marry one another. Cost of Coverage for Same -Sex Domestic Partnerships The Employer portion of the premium for Domestic Partner coverage to coverage for a Domestic Partner is taxable income to the Employee and will be included as part of W -2 compensation and the Employee's Domestic Partner's portion of the premium will be paid with after tax dollars. Age Limits Dependent children are covered through the end of the birth month until age 26 for all medical, dental and vision plans. Please refer to page 7 for the definition of eligible Dependent. Coverage Effective Date for Eligible Employees/ Dependents Coverage is effective on the first of the month following date of hire. A Food and Nutrition service Employee's coverage effective date is the first day of the month following the Employee's completion of 30 days of continuous employment with HCPSS. To become covered by the Plan other than during the Open Enrollment, you must enroll online within 30 days from your eligibility date. Please refer to page 6 for the Quick Enrollment Reference Guide. Open Enrollment information Online Information about all benefit plans can be found on the School's intranet, and on carrier website addresses as listed on page 66 of this workbook. Changes to Benefits Coverage due to Qualifying Event An Employee may change his election during the Plan Year when any of the following change in qualifying event: is A change in employment status, including termination or commencement of employment the Employee, Spouse, or Dependent. The Employee or Spouse has a significant change in health coverage attributable to the Spouse's employment. 0 A reduction or increase in hours of employment by the Employee, Spouse, or Dependent, including a switch between part -time and full -time, a strike Howard County Public chool System -'---- Benefits Enrollment Guide For Active Employees is General Open Enrollment Information (continued) or lockout, or commencement or return from an unpaid leave of absence. A change in legal marital status, including marriage, death of Spouse, divorce, legal separation or annulment. A change in the number of Dependents, including birth, adoption, placement for adoption, or death of a Dependent. w Your Dependent satisfies or ceases to satisfy the requirements for unmarried /married Dependents, due to attainment of age, or any similar circumstances as provided in the health plan under which the Employee receives coverage. Health coverage is being offered through his /her employment. A change in the place of residence or work of the Employee, Spouse, or Dependent. A judgment, decree or order resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified medical child support order) that requires accident or health coverage for an Employee's child. The Employee can change his election to provide coverage for the child if the order requires coverage under the Employee's plan; or, the Employee can make an election change to cancel coverage for the child if the order requires the former Spouse to provide coverage. * Eligibility for Medicare or Medicaid (other than pediatric vaccines). Howard County Puii(Ic Schoo -S sfe— - ---' Benefits EnroT[ment -Gu -ae or AcRve ��EmpCoyees IKE General Open Enrollment Information If an eligible Employee takes FMLA leave, as defined by the Family and Medical Leave Act (FMLA), due to one or more of the following: a. The birth of a son or daughter of the Employee and in order to care for such son or daughter; b. The placement of a son or daughter with the Employee for adoption or foster care; c. To care for the Spouse, or a son, daughter, or parent, of the Employee, if such Spouse, son, daughter, or parent has a serious health condition; d. A serious health condition that makes the Employee unable to perform the functions of the position of such Employee; e. In addition, HCPSS will provide Military Family Leave in compliance with the National Defense Authorization Act. For more information contact Human Resources at (410) 313 -6695. If he or she terminates his or her coverage in the Plan due to "a" - "e ", he or she will be able to re- enroll in the Plan within 30 days upon return to active employment at the conclusion of a period not to exceed that defined by the FMLA. This Employee will not be subject to Pre- Existing Waiting Period provisions. Leave of Absence (Other than Family and Medical Leave Act Absence) If an Employee does not qualify for FMLA and continues on an approved unpaid leave of absence, the Employee will be required to pay 100% of the Plan cost beginning the first of the following month after FMLA leave ends or the last day worked. Upon returning from an approved leave of absence, HCPSS will pay its share of the plan cost the first day of the month following the month in which you return to work. Uniformed Service under USERRA A Participant who is absent from employment with the Employer on account of being in "uniformed service" as that term is defined by the Uniformed Services Employment and Reemployment Rights Act of 1994 ( "USERRA ") may elect to continue participation in the Plan. The coverage period shall extend for the lesser of 24 months or until the Participant fails to apply for reinstatement or to return to employment with the Employer. The Participant shall be responsible for making the required contributions during the period in which he is in "uniformed service." The manner in which such payments are made shall be determined by the Plan dministrator in a manner similar to that of FMLA Leave. Notwithstanding anything in this Plan to the contrary, with respect to any Employee or Dependent who loses coverage under this Plan during the Employee's absence from employment by reason of military service, no Pre- Existing Condition exclusion or Waiting Period may be imposed upon the reinstatement of such Employee's or Dependent's coverage upon reemployment of the Employee unless such Pre - Existing Condition exclusion or waiting period would have otherwise applied to such Employee or Dependent had the Employee not been on military leave of absence. liowara County " Public School Systein�� ..au.�w.,.,.. Benefits Enrollment Guide for Active Employees M Special Enrollment Period Special Enrollment Period means a period, other than an open enrollment period, duringwhich an Employee or Dependent may enroll in the Plan. Special enrollment periods apply to Employees and Dependents that lose their medical coverage. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains a mandate that allows Employees and Dependents to enroll in a group health plan even if they elected not to enroll when they could have. It is called the special enrollment period. Under this mandate, a plan must provide a special enrollment period when an individual who declined coverage when initially offered because he or she had other coverage, subsequently loses that coverage. This do -over scenario is also available to an individual who becomes a Dependent of an Employee through marriage, birth, adoption, or placement for adoption. Conditions for Special Enrollment An Employee or Dependent is eligible to enroll during a special enrollment period if each of the following applicable conditions is met: a. When the Employee declined enrollment for the Employee or the Dependent, the Employee stated in writing that coverage under another group health plan or other health insurance coverage was the reason for declining enrollment. b. When the Employee declined enrollment for the Employee or Dependent under the Plan, the Employee or Dependent had either: m COBRA continuation coverage under another plan that has been exhausted, or other coverage that has been terminated as a result of loss of eligibility for the coverage or because employer contributions toward that coverage were terminated. Note: For this purpose, loss of eligibility for coverage includes a loss of coverage as a result of legal separation, divorce, death, termination of employment, reduction in the number of hours of employment, and any loss of eligibility after a period that is measured by reference to any of the foregoing. Thus, for example, if an Employee's coverage ceases following a termination of employment and the Employee is eligible for but fails to elect COBRA continuation coverage, this is treated as a loss of eligibility. However, loss of eligibility does not include a loss due to failure of the individual or the Participant to pay premiums on timely basis or termination of coverage for cause (such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan). In addition, Employer contributions include contributions by any current or former Employer (of the individual or another person) that was contributing to coverage for the individual. Length of Special Enrollment Period The Employee is required to submit a Benefit Change Form and a written enrollment request (for the Employee or the Employee's Dependent) within 30 days after: ® The exhaustion of the other coverage; Termination of the other coverage as a result of the loss of eligibility for the other coverage; ® The termination of employer contributions toward that other coverage; or The date of marriage, birth, or adoption or placement for adoption. if Enrollment Period The effective date of enrollment for an Employee and /or Dependent requesting coverage under a group health plan during a Special Enrollment Period will be as follows: a. In the case of a loss of alternative coverage or of a marriage, on a date specified by the Administrator that is not later than the first day of the month, on or after the date the completed request for enrollment is received in the Benefit Office. b. In the case of a Dependent's birth, adoption or placement for adoption, on the date of such birth, adoption or placement for adoption. Health Insurance Portability Accountability (HIPAA) The Health Insurance Portability and Accountability Act (HIPAA) places limitations on a group health plan's ability to impose pre- existing condition exclusions, provide special enrollment rights for certain individuals, and prohibit discrimination in group health plans based on Howard County _uf; C$CfWgl System "' — a�a W - Be6e6fs Enro ment Guide WActive [ mp of "gees Special Enrollment Period health status. We are electronically transmitting data to our vendors for eligibility purposes. The vendors and Howard County Public Schools are in compliance with the HIPAA requirements. No personally identifiable information may be released to a third party. For more detailed information, please go to our website at www.hcpss.benelogic.com or www.hepss.org /Employees /benefits. When Coverage Terminates Employee Employee coverage shall automatically terminate immediately upon the earliest of the following dates, unless the covered Employee elects Continuation of Coverage: a. The last day of the month in which employment terminates; b. Except in the case of certain leaves of absence, the last day of the month in which the Employee ceases to be eligible, unless a later date applies under "c" below; c. With respect to any Employee whose employment terminates after he or she completes a school year, August 31 of the Plan Year in which that school year ends; d. The date this Plan is terminated (if Continuation of Coverage not available); e. The date the Employee receives the maximum lifetime benefits provided by the Plan; f. With respect to any coverage requiring Participant contributions, and with respect to which Participant contributions are discontinued, the period for which the Employee fails to make any required contribution; g. Except to the extent required by law, when the covered Employee enters the military, naval or air force of any country or international organization on a full -time active duty basis other than scheduled drills or other training not exceeding 1 month in any calendar year. Dependent Dependent coverage shall automatically terminate immediately upon the earliest of the following dates, unless the Employee or covered Dependent elects Continuation of Coverage: a. The last day of the month in which the Dependent ceases to be an eligible Dependent as defined in the Plan; b. The last day of the month in which the Employee's coverage under the Plan is terminated, unless a later date applies under "c ". c. With respect to any unmarried /married child, living with the Employee, or who is more than 50% dependent upon the Employee for support, until the end of the birth month in which he or she reaches age 26. d. With respect to any coverage requiring Participant contributions, and with respect to which Participant contributions are discontinued, the period for which the Employee fails to make any required contribution; e. The date the Plan is terminated (Continuation of Coverage not available); f. The date the Dependent receives the maximum lifetime benefits provided by the Plan; g. Except to the extent required by law, when such Dependent enters the military, naval or air force of any country or international organization on a full -time active duty basis other than scheduled drills or other training not exceeding 1 month in any calendar year. Certificate of Creditable Coverage Each terminating Participant will receive a Certificate of Creditable Coverage, certifying the period of time the individual was covered under this Plan. For Employees with Dependent coverage, the certificate provided may include information on all covered Dependents. If you have any questions or need to request a Certificate of Creditable, please contact the insurance company for a copy. lloward County Public School System �� Benefits Enrollment Guide �for Active Employees (i Continuation f Coverage (COBRA) A covered person may continue coverage for a period of 18, 29 or 36 months, at his /her own expense, pursuant to the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA), as amended, if coverage under the Plan would otherwise terminate because of a life event known as a "qualifying event ". After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary" as follows: a. Termination of Employment A covered Employee, Spouse and Dependent child (qualified beneficiary) may elect to continue coverage under this Plan for up to 18 months, if their eligibility ends due to one of the following qualifying events: a. The covered Employee is terminated (for reasons other than Gross Misconduct *); b. The covered Employee's number of hours of employment is reduced. c. The covered Employee resigns. *Gross Misconduct is defined as the deliberate and willful violation of a reasonable rule or policy of the Employer, governing the Employee's behavior in performance of his or her work, provided srichviolation has harmed the Employer or other Employees or has been repeated by the R. nployee. despite warning or other explicit instruction from the Employer. Employees may also be terminated for cause, such as fraudulent claims submission. Disability Extension A qualified beneficiary may elect to extend coverage an additional 11 months, up to a maximum of 29 months, for himself /herselfand non disabled family members who are entitled to COBRA Continuation Coverage, if he is disabled (as defined by Title II or XVI of the Social Security Act) at the time of the qualifying event or at any time during the first 60 days of COBRA continuation coverage and is covered for Social Security Disability Income benefits. The Qualified Beneficiary must send the COBRA Administrator a copy of the Social Security office's disability determination letter within 60 days after the latest of (and in no event later than the end of the 18th month of COBRA coverage): a. The date of the Social Security Administration's disability determination; b. The date on which the qualifying event occurs; c. The date on which the qualified beneficiary loses coverage; or d. The date on which the qualified beneficiary is informed of the obligation to provide the disability notice. If the Social Security office determines that the qualified beneficiary is no longer disabled, the COBRA Administrator must receive a copy ofthe Social Security office's letter within 30 days after it determines that he is no longer disabled. Please send the required documentation to the COBRA Administrator. Please contact the Benefits Office for the address of the COBRA Administrator. 2e Loss of Dependent Eligibility A covered Dependent may elect to continue coverage under this Plan for tip to 36 months, if his or her coverage ends due to any of the following qualifying events: a. The covered Employee dies; b. The covered Employee is divorced or legally separated; c. The covered Employee becomes eligible for and elects Medicare benefits; d. A Dependent child ceases to be a Dependent (as defined by the Plan). The Employee or covered Dependent must notify the Plan Sponsor as follows: Notice Obligations A covered Employee, Spouse or Dependent is responsible for notifying Howard County Public School System of the Employee's divorce or legal separation, or of the Employee's child losing Dependent status. The qualified beneficiary must notifythe Plan Sponsor within 60 days of the date of the event or the date on which coverage would terminate, whichever is later. Written notification must be provided to the Benefits Office. The qualified beneficiary may be required to complete a "COBRA Qualifying Event Notification Form" and attach official documentation, which substantiates the event. If you do not have access to a form, please provide the Howard County Public School System with the following information in writing and attach a copy of official documentation: Employee name, identification number, beneficiary name, address, telephone number, date of event, and description of event. Failure to give notice within 60 days of the event can result in COBRA coverage being forfeited. Howard Schoot —' W -- — '�a'ene its CnFo ment Guide for Active Emp ogees M n Continuation Coverage (COBRA) D Multiple Event Extension If a covered Dependent elects the 18 month continuation following an event shown in Part 1 and later becomes entitled to a 36 month continuation due to an event shown in Part 2, then that covered Dependent may continue coverage for up to 36 continuous months from the date of the first qualifying event. For example, because the Employee is terminated, an 18 -month continuation is elected for a covered Dependent. Before the 18 -month period has ended, the covered Dependent reaches the maximum age to be covered under the Plan. This is a second qualifying event. In order to extend Continuation of Coverage up to 36 months from the original Continuation of Coverage effective date, the Dependent must notify the Benefits Office in writing, within 60 days of the second event or the date coverage ends (whichever is later). Written notification must include: beneficiary's name, identification number, address, telephone number, date of event, description of event and a copy of official documentation substantiating the event (if divorce or legal separation.) Election A covered Employee can elect COBRA coverage for himself or herself and /or his or her covered Dependents. In the event that an Employee with family coverage does not elect COBRA coverage for his or her Dependents, such coverage may be elected by the Dependents. No Spouse or child is entitled to continuation coverage unless that individual was a covered Dependent under the Plan on the date before any of the above qualifying events except for the following: m A Qualified Beneficiary includes a child born to or placed for adoption with a covered Employee during the period of COBRA coverage. An election on behalf of a minor child can be made by the child's parent or legal guardian. To continue coverage, the Employee or Dependent, hereinafter called a Continuee, affected by the qualifying event must make written election by the 60th day following: a. The last day of coverage; or b. The date he is sent notice of the right to continue coverage; whichever is later. Within 45 days of the election date, the Continuee must pay the required monthly premium for the COBRA coverage period prior to the election. The 18 or 36 month continuation period will begin on the earliest of the above qualifying events. Monthly Premium The due date for the monthly premium is the first day of each coverage month and COBRA allows 30 days from the dire date 4o send the premium to the COBRA Administrator, Jasper and Company. The monthly premium will not exceed 102% of the total monthly cost (determined by the Plan on an actuarial basis) for coverage of a similarly situated active Employee. However, when a disabled Continuee extends coverage beyond 18 months, the monthly premium will increase to 150% of that total average monthly premium. The monthly premium is subject to change at the beginning of each Plan Year. Payment of Claims No claim will be payable under this COBRA provision, until the COBRA Administrator receives the applicable monthly premium for the Continuee's coverage. Termination Coverage under the COBRA provision will terminate on the earliest of the following: a. The date on which the Employer ceases to provide a group health plan to Employees; b. The date the Continuee first becomes, after the date of the election, covered under any other group health plan (unless the plan contains pre- existing condition exclusions or limitations that are not reduced by creditable coverage); c. The date the Continuee first becomes, after the date of the election, covered for Medicare benefits; d. The date the Continuee fails to make timely payment of the monthly premium under the Plan; e. For a disabled Continuee who extends coverage beyond 18 months, the first of the month which begins 30 days after the Continuee is no longer considered disabled as defined by Social Security regulations; f. The end of the applicable 18, 29 or 36 month period. In no case will coverage continue beyond 36 months from the original qualifying event, even if a second qualifying event occurs during the COBRA coverage period; g. For cause, such as fraudulent claims submission, on the same basis that coverage could be terminated for similarly situated active Employees. Cloward County Public School System Benefits Enrollment Guide for Active - Employees �� Continuation of Coverage (COBRA) MMMMEM Loss of Coverage is Due to... Your employment ending for any reason (except gross misconduct) or your hours are reduced so you are no longer eligible for medical, dental, vision and the healthcare spending account. You or your covered Spouse or Dependent is disabled (as determined by Social Security Administration) at the time of the qualifying event, or becomes disabled during the first 60 days of COBRA continuation. Your death Your divorce or legal separation You become entitled to Medicare Your covered child no longer qualifies as a Dependent ITo—Zd County Public Schoot System Nm m m Y" Benefits Enro ment Gui d a for Active I mp oyees I a 1 o, Howard County Public School System's VIP Program What is "The VIP "? The Variety of Insurance Program, VIP, is our approach to health insurance and other fringe benefits in the Howard County Public School System. It lets you choose the benefits you want by controlling a large portion of the dollars you and the school system spend on your benefits. Not all Employees have the same need for benefits. Benefit needs depend on: Age. * Size of family. Number of family members who work. The VIP Program works like this: You have a choice of 8 medical plans: * NCAS Traditional Medical Plan (not available to Employees hired on or after July 1, 1993) * NCAS Alternate Medical Plan is Aetna Open Choice FPO CareFirst B1ueChoice HMO Open Access Aetna Select HMO Kaiser Perin anente Select HMO United Healthcare Choice HMO 0 No Medical Plan You can choose not to belong to any plan if you are covered by other health insurance, for example, through your Spouse. When you make your choice from the medical plan options, you receive Benefit Credits. Some choices offer more Benefit Credits than others since they cost less to provide. You can use the Benefit Credits to buy other benefits offered under the VIP Program: NCAS Current Dental Plan * NCAS Alternate Dental Plan Delta Dental PPO * Vision Service Plan (VSP) NCAS Vision Care Plan is Health Care Spending Account ff Dependent Care Account ai Benefit Credit Refund If you decide not to take any medical plan coverage, you get the most Benefit Credits. When should you choose no VIP medical coverage and receive $750 /year in Benefit Credits? m If you have coverage under another Plan. 0 If you are married to another Howard County Public School System Employee who does choose medical coverage. Your Benefit Credits are just like dollars in terms of what they can buy. But unlike the dollars you receive in your paycheck, Benefit Credits are not taxed when you use them to purchase dental, vision and Flexible Spending Accounts (medical & Dependent care). If you are currently using some of your pay for benefit- related items (such as eyeglasses or child care), you can now arrange for these items to become part of the school system's benefits, which are not taxed. By paying careful attention to the tax aspects of the VIP Program, you may be able to reduce your income and Social Security taxes. Pre -Tax Contributions —A Way to Purchase Additional Benefits If you add up the price tags for all the options you want and the total cost is greater than your Benefit Credits, you will make up the difference by using part of your salary to pay for benefits. Floward County Pabtic School Syste Benefits Enrollment Guide for Active Employees Otd Program (Only Available to Current Old Program Employees) The Medical and Dental plans offered in the old program differ from the plans offered under the VIP Program. Refer to the comparison chart below. Payroll deductions for health benefits under the old program are after -tax purchases. Under the old program, you pay no more than 10% of the medical premium, 10% of the individual dental premium and 100% of the Dependent dental premium in after -tax dollars. However, under the VIP, the School System is also paying 90% of the medical this year plus giving you Benefit Credits to use for other benefits. Once an Employee elects to participate in the VIP, he /she will not be allowed to participate in the old program. VIP vs. the Old Program If after reading this booklet, you decide you do not want to receive your benefits under the VIP Program, you may continue your current coverage withoutjoining the VIP, if that plan is still offered. To remain under the system, you Available Benefits NCAS Traditional Medical Plan NCAS Alternate Medical Plan Aetna Open Choice PPO Aetna Select HMO CareFirst BlueChoice HMO Open Access Kaiser Permanente Select HMO UnitedHealthcare Choice HMO Current Dental Plan Delta Dental PPO Alternate Dental Plan VSP -Vision Plan NCAS Vision Care Plan Health Care Spending Account Dependent Care Spending Account Benefit Credit Refund "Not available to Employees hit red on or after July 1, 1993. may continue only in the medical and /or dental coverage offered under the old program. In this option no additional benefits are available. Employee Assistance Program (EAP) The Howard County Public School System has contracted with Business Health Services (BHS) as the service provider for all employees for the Employee Assistance Program. The EAP provides employees and their household members with free, confidential assistance to help with personal or professional problems that may interfere with work or family responsibilities and obligation. Services are available 24 -hours a day, 7 -days a week via a toll -free nationwide number, I- 800 - 327 -2251. Employees and their household members can receive up to three (3) counseling sessions (which includes assessment, follow -up and referral services) per person, per problem episode, per year. Wellness resources and health tips are also available via the BHS website, www.blrsonline.com. ffoward CauntyvpubTj_ School System W R" Benefits Enrroo ment Gu de for Active Employees M W to a -o iv n s 0 m E Z n D cn rD a w v o� Both the Traditional Medical Plan and the Alternate Medical Plan are self- insured programs. Both are administered by NCAS. NCAS pays claims using usual, customary and reasonable (UCR) reimbursement rates. A charge is usual if it is the fee most frequently charged by a provider for a particular service or supply. * A charge is customary if it is within the range of fees usually charged for the service or supply by providers of similar training and experience in the same location. a A charge is reasonable when it is usual and customary or when it is justified by unusual circumstances (such as a complex surgical procedure.) Some hospitals and /or physicians may balance -bill the member for charges in excess of the UCR rates. To alleviate this problem, NCAS is able to access the CareFirst BlueCross B1ueShield (CareFirst) provider network. There are two different networks, both of which include hospitals, physicians, laboratories, home health agencies, and other providers. The larger network, the CareFirst Participating Network, includes all Maryland hospitals and over 21,000 health care providers throughout Maryland and surrounding states; the CareFirst Preferred Provider Network (PPN) also includes all Maryland hospitals and over 19,000 providers. NCAS will still be the claims administrator. The CareFirst providers are loaded into its claims system - the claims will not go through CareFirst, but will go directly to NCAS. CareFirst has negotiated agreements with these providers in an effort to help manage costs. Participating physicians have agreed to accept payment based on a predetermined fee schedule and not "balance bill" you for charges in excess of the fee schedule. Other professional providers have agreed to negotiated rates, which are less than what they would normally charge. These networks are available to all Employees and their eligible Dependents. Any time you use the services of a provider participating in one of the networks, the provider will file a claim on your behalf. When you showyour NCAS health care identification card, the provider will recognize you are entitled to network benefits since the card will also show the CareFirst logo. The physician cannot "balance bill" you for any amounts beyond the set allowance except for any deductible or coinsurance amounts required by the plan. A complete listing of all CareFirst PPN providers is available on the internet at www.carefirst.corn under Provider Directory. You are not required to use a CareFirst provider. However, it will be to your advantage since there is little or no paperwork to complete and it can result in cost savings for you. If you have any questions about the CareFirst networks, please contact the Benefit Office. NCAS will not pay any claim that is submitted more than I year after the expense is incurred. Advanced Care Management Nationwide Better Health is the Utilization Review vendor for HCPSS. The following integrated services are offered: Utilization Management * Case Management Maternity Management FA Disease (chronic condition) Management As part of the Nationwide Better Health program, registered nurses will answer your questions about your condition, help you better manage a condition and improve your quality of life. Nationwide Better Health Resources and Tools When you're going into the hospital, have a chronic condition, pregnant, undergoing treatment or have a general question call Nationwide Better Health at 1- 800 -315 -2031 within 24 hours. 0 Nationwide Better Health will review your Physician's recommendations based on the medical information supplied and accepted standards. Nationwide Better Health will notify your doctor or hospital of your certification approval within 24 hours. Howard County Public School System � '� "� � Benefits Enrollment Guide for Active Employees I CAS Traditional and Alternate Indemnity Medical Pleas A customer service representative may call you to schedule a one -on -one telephone appointment with your personal nurse at a time convenient for you. During your scheduled appointment, your nurse will ask you some general questions about your health. (Remember this is confidential and information about these calls will never be made available to your Employer). ® The nurse will send a letter to you that briefly explains the program. You will also receive a medical records release form that allows Nationwide Better Health to communicate with NCAS, only if you wish. * Once this program begins, you will be speaking with your nurse on a regular basis. Your nurse can answer any questions you may have about your condition, provide educational information and literature, and give you tips for staying healthy. Prescription Drug Discount Lard A prescription drug program is available to all Employees and their Dependents enrolled in either the Traditional or Alternate Medical Plan. The discount drug program is offered through Express Scripts and provides prescription drugs at discounted prices. Over 99x/0 of all pharmacies in Maryland participate in this program as well as 50,000 pharmacies nationwide. The claims procedure is as follows: Present your WAS card with the Express Scripts logo to a participating pharmacy at the time of purchase to receive discounted prescription rates. You will need to pay for the entire prescription and keep your itemized receipt. Submit a claim form complete with supporting documentation to NCAS. Prescription drug benefits are available under the Major Medical portion of your plan. Eligible prescription drug expenses are reimbursed at 80% of the discounted fees upon satisfaction of the $100 calendar year individual deductible or $200 calendar year family deductible. If you do not utilize the Express Scripts card or if you obtain your prescription from a non - participating pharmacy, you still have prescription drug benefits available. However, you will not be getting your prescription at the discounted rate. There is also a mail order feature to this program. This service may be used to purchase a 3 or 6 month supply of medication, primarily maintenance drugs, at a discounted rate. Once again, pay for the entire Howard Ctir�(yPnG_J Sc_0 System- '--- ''- -- --- Benefits Enroliimenf Guile por Active Emp o-yees Z n CL v v sv a w v v 0 m CL n w v w The Aetna Open Choice PPO plan gives you two ways to seek care. You have the freedom to visit any of the approximately 80,000 physicians, over 550 hospitals, and over 6,500 pharmacies "in our Mid - Atlantic region network or you can visit any doctor, anywhere— without a referral. Find A Doctor Within Our Nationut Network To find out if a physician participates in our extensive national network of doctors, you can use Aetna's online provider directory. If you need a printed directory, you can call Member Services at the toll -free number on your ID card. In addition, you can tell which doctors participate in Aexcel ®, our high - quality performance network of designated Specialists by the blue stars next to their names. DocFind@ DocFind allows you and your family members to search for physicians by: ® City, state and zip. Specialty. Hospital affiliation. * Provider name. * Gender. You can also get extra information, like: * Which plan each doctor accepts. Medical schools attended. Board certification status. Languages spoken. You can also get information about office locations, handicap access, maps and driving directions. Howard County public School System � � � � � Benefits Enrollment Guide for Active Employees W Aetna Pharmacy Management We manage national network of approximately 59,000 participating pharmacies in all 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. For your added convenience, we feature home delivery of prescription drugs through Aetna Rx Home Delivery ®. Resources at Your Fingertips There are several ways to get assistance with your plan. Online Services Aetna Navigator'' is Aetna's secure member website and is available 24 hours a day, 7 day a week. From Aetna Navigator ", members can: Check to see the status of a claim. Compare hospitals in the area or anywhere in the country, See and compare medical costs and prescription prices. Learn how to stay well by making healthy lifestyle changes. Learn about hundreds of health conditions by looking through an online health care encyclopedia and read health information from Harvard Medical School. Interactive Personal Health Record Your secure online personal health record stores and continuously updates your health history. It also reminds you to get needed preventive care and brings critical healthcare messages to your attention. You can even print out your health profile to share it with your doctor. Member Services Member Services is available at the toll -free number on your Ill card from 8:00 a.m. — 6:00 p.m. EST. If you prefer self - service, you can access our voice - activated telephone system 24 hours a day, 7 days a week. Nurse Line Aetna's Informed Health® Line is staffed around -the -clock with registered nurses who provide callers with free information on prevention strategies, self -care skills, chronic medical conditions, and complex medical situations. They can also provide follow -up information and can perform research where appropriate. The toll -free number is (800) 556 -1555. Additional Features Online Healthy Living Programs, including Fitness Planner, Walking Tracker, Diet Manager, Meal Planner, and Food Journal. * Informed Care Decisions, a decision - support tool that provides the latest clinical information for more than 40 diseases and conditions. * An online Health Assessment which serves as a tool for members to evaluate their family history, personal health status, and lifestyle choice. * Wellness Counselor to provide health coaching services to members who complete an online health assessment. sr Discounts on Jenny Craig@ Weight Loss programs and products. *. Access to the GlobalFit' network of more than 2,000 fitness clubs at preferred rates. Vision and hearing discount programs. Discounts to over- the - counter vitamins, dietary supplements, and natural products. * The Beginning Right Maternity Management Program "Give your baby a healthy start by enrolling in the Beginning Right"' Maternity Management Program Pregnant? Thinking about becoming pregnant? Let our Beginning Right Program Help Call 1 -800- CRADLE -1 (1- 800 -272- 3531)" hloward Comity Public Sc{ oal System µ W m �" Bene its Enro map ent Gui eor Active Emp oyees W The Open Access Aetna Select HMO plan gives you the freedom to seek care from any of the approximately 80,000 physicians, over 550 hospitals, and over 6,500 pharmacies in the Mid - Atlantic region. There is never a need to file a claim form. Your doctors handle all medical claims. Your Primary Care Physician Your Aetna plan gives you the choice to visit any doctor in the Aetna network, without a referral. Or you can choose a primary care physician (PCP) for you and your family. Working with a PCP gives you a chance to visit a doctor who will get to know your personal health care needs. Find a doctor within our national network To find out if a physician participates in our extensive national network of doctors, you can use Aetna's online provider directory. If you need a printed directory, you can call Member Services at the toll -free number on your ID card. In addition, you can tell which doctors participate in Aexcel®, our high-quality performance network of designated Specialists by the blue stars next to their names. DocFind(,) DocFind allows you and your family members to search for physicians by: City, state and zip. Specialty. * Hospital affiliation. Provider name. VA Gender. You can also get extra information, like: Which plan each doctor accepts. Medical schools attended. in Board certification status. m Languages spoken. You can also get information about office locations, handicap access, maps and driving directions. Aetna Pharmacy Management We manage a national network of approximately 59,000 participating pharmacies in all 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. For your added convenience, we feature home delivery of prescription drugs through Aetna Rx Home Delivery ®. 4 Howard County Public School System Benefits Enrollment Guide for Active Employees Resources at Your Fingertips There are several ways to get assistance with your plan. Through our Online Services: Aetna Navigator" is Aetna's secure member website and is available 24 hours a day, 7 days a week. From Aetna Navigator, members can: Check to see the status of a claim. rA Compare hospitals in the area or anywhere in the country. See and compare medical costs and prescription prices. IN Learn how to stay well by making healthy lifestyle changes. Learn abort hundreds of health conditions by looking through an online health care encyclopedia and read health information from Harvard Medical School. Interactive Personal Health Record Your secure online personal health record stores and continuously updates your health history. It also reminds you to get needed preventive care and brings critical healthcare messages to your attention. You can even print out your health profile to share it with your doctor. Member Services Member Services is available at the toll -free member on your ID card from 8:00 a.m. —6:00 p.m. EST. If you prefer self - service, you can access our voice- activated telephone system 24 hours a day, 7 days a week. Nurse Line Aetna's Informed Health Lime is staffed around- the -clock with registered nurses who provide callers with free information on prevention strategies, self -came skills, chronic medical conditions, and complex medical situations. They can also provide follow -up information and can perform research where appropriate. The toll - free number is (800) 556 -1555. Additional Features Online Healthy Living Programs, including Fitness Planner, Walking Tracker, Diet Manager, Meal Planner, and Food Journal. Informed Care Decisions, a decision- support tool that provides the latest clinical information for more than 40 diseases and conditions. An online Health Assessment which serves as a tool for members to evaluate their family history, personal health status, and lifestyle choice. * Wellness Counselor to provide health coaching services to members who complete an online health assessment. w Discounts on Jenny Craig® Weight Loss programs and products. * Access to the GlobalFit" network of more than 2,000 fitness clubs at preferred rates. Vision and hearing discount programs. Discounts to over - the - counter vitamins, dietary supplements, and natural products. m The Beginning Right Maternity Management Program "Give your baby a healthy start by enrolling in the Beginning Right'"' Maternity Management Program Pregnant? Thinking about becoming pregnant? Let our Beginning Right Program Help Call 1- 800 - CRADLE -1 (1 -800- 272 -3531) ilaoar3"CounCy Public School' System ---'— Benefit!�'Enro Imeiit Guide foc X'cUve EinpToyees N A m d N a ro n_ 0 m a n v v w El You're committed to taking care of your family's health. Now, it's time to choose a health plan with that same level of commitment. CareFirst BlueChoice, Inc. is a health maintenance organization (HMO), where our mission is your health. CareFirst BlueChoice HMO Open Access, from CareFirst BlueChoice, Inc., (CareFirst BlueChoice) aims to keep you healthy by emphasizing prevention, early detection and early treatment. We work with you to help prevent illness and we encourage you to seek care when it is needed. You can select your doctor from a network of physicians, Specialists and hospitals located throughout Maryland, Washington, D.C. and Northern Virginia — so now you can visit a doctor where you live, where you work or anywhere in between. Designed for today's health conscious and busy families, CareFirst BlueChoice offers one less thing to worry about during your busy day. As a member of CareFirst BlueChoice, you'll enjoy the protection of one of the area's leading health care insurers. So when your family's health is at stake, shouldn't you choose Blue? Open Access Means No Referrals Traditional HMO plans require you to obtain a written referral from your PCP before seeing a Specialist. However, CareFirst BlueChoice has an Open Access feature. This means you have direct access to CareFirst BlueChoice Specialists without first obtaining a written referral from your PCP: Large Provider Network The CareFirst BlueChoice provider network includes 17,000 doctors, Specialists and hospitals serving Maryland, Washington, D.C. and Northern Virginia, so you can choose a doctor where you live, where you work or anywhere in between. Preventive Services CareFirst BlueChoice HMO Open Access provides coverage for preventive services such as PAP tests and routine prostate screenings — all covered under your predictable copayment. Emergency and Urgent Care Each CareFirst BlueChoice doctor provides 24- hour -a- day availability so you are never out of reach of your PCP. If the condition is serious, but not life threatening, call your PCP and he or she will give you instructions on what to do next. Your doctor may suggest that you visit an urgent care center. Urgent care centers are walk -in medical facilities equipped to handle minor emergencies. Urgent care centers allowyou to be seen more quickly than emergency rooms and most have evening and weekend hours. A list of participating urgent care centers can be found in the Provider Directory or at www.carefirst.com. In a life threatening emergency, such as chest pain, unconsciousness or severe bleeding, we encourage you to go immediately to the nearest emergency room or call 911. Maternity and ell-Child Care CareFirst BlueChoice HMO Open Access provides coverage for prenatal and postnatal visits as well as childhood immunizations and check -ups. We aim to start your children on the road to good health before they are born. Our Great Beginnings program for expectant mothers is designed to complement the prenatal care and education you receive from your doctor. When you enroll in Great Beginnings you will receive information related to your condition and your baby's development. A Great Beginnings nurse will contact you during each trimester to see how you are feeling and to answer your questions. We believe in giving baby and mother a healthy start, and want to encourage mothers to take advantage of these important services. Coverage When You Travel Out -of -area coverage is limited to emergency care only. However, members and their Dependents who plan to be out of the CareFirst BlueChoice service area for at least 90 consecutive days can take advantage of the Away from Home Care' Program, which allows temporary benefits through another Blue Cross and Blue Shield affiliated HMO. This special plan provides coverage for routine Howard County Public School System e� 4 � Benefits Enrollment Guide For Active Employees M services and is perfect for extended out -of -town business or travel, semesters at school or families living apart. For more information on Away from Home Care, please call Member Services at (866) 520 -6099. No Paperwork CareFirst BlueChoice provides direct reimbursement to your doctor, which means no hassles or claims to file. Your Primary Care Physician (PCP) Establishing a relationship with one doctor is the best way for you to receive consistent, quality health care; therefore, you must select a PCP at the time of your enrollment into CareFirst BlueChoice. Your PCP can: Provide basic medical care — treating illness and providing preventive care, Maintain your medical history, Work with you to determine when you should see a Specialist and assist in the selection of a Specialist. You may choose a doctor who specializes in family practice, general practice, pediatrics or internal medicine as your PCP. Your entire family may select the same doctor, or each member may choose a different doctor, based on each person's age or medical needs. When completing your enrollment application, be sure to select a PCP for you and each of your family members. To ensure that you have the most current provider information, we encourage you to visit our online provider directory at www.carefirst.conr. No Referrals Needed for Specialists You don't need a referral form if you visit a Specialist from among those listed in your CareFirst BlueChoice provider directory. (Please note, CareFirst BlueChoice approval is required for services like mental health and substance abuse treatments, non - emergency hospitalizations and outpatient hospital services, among others.) Tway from Home Care° You have access to routine and urgent care when you're away from home for 90 consecutive days or more. Whether you're out of town on extended business, travel or attending school out of the area, you'll have access to your HMO benefits. You'll have coverage when you see a provider of an affiliated Blue Cross and Blue Shield HMO (Host HMO) outside of the CareFirst BlueChoice, Inc. service area (Maryland, Washington, D.C., Northern Virginia). When you receive care, you'll be considered a member of the Host HMO and will be responsible for the copay benefits under that plan. Your copay benefits may be different than when you're in the service area. You won't have to complete claim forms and are only responsible for out -of- pocket expenses such as copays, deductibles, coinsurance, and the cost of non - covered services. CareFirst BlueChoice, Inc. will communicate this information to you when your Away from Home Care application has been accepted Discounted Dental coverage is offered through The Dental Network (TDN). Options Save up to 50% on fitness club memberships, weight loss programs, hearing care services and laser vision correction, as well as alternative therapies such as acupuncture, nutrition counseling, massage therapy or yoga. dioward County Pub(ic.Scliao(Systein �Benefits1nro anent Guide for AZt_Pe EmpCoyees In Who is Eligible to Enroll? * Full -time and eligible part -time Howard County Public School System Employees. Eligible Dependents (Spouses and Dependent children) of the above. Kaiser Permanente is a Health Maintenance Organization (HMO) that provides members with a full range of medical care benefits including preventive care services. Members of Kaiser Permanente must select a Primary Care Physician (PCP) from the over 800 physicians who practice in the District of Columbia, Northern Virginia, and Maryland, including Howard and Baltimore counties, or may select one of the community participating Primary Care Physician. It is important that you choose a PCP when you enroll, as this doctor will act as your good- health advocate and coordinate your care. If you do not choose one when you enroll, Kaiser Permanente will select a PCP for you from those doctors who practice in a medical center nearest to you home. You will be able to change your PCP for any reason at any time by contact the Kaiser Permanente member services department. Kaiser Permanente Physicians For help in choosing a primary care physician, review the physicians listed in the Kaiser Permanente Provider Directory or online, at'www kp.org. The list of Kaiser Permanente physicians also includes where the physician went to school, where they did their residency, their board certification and if they speak any foreign languages. This information should help you select a physician that best matches the needs of you and your family. You may select a PCP for yourself and each member of your family. You can opt to have a single physician for your entire family or choose a different physician for each family member. Your PCP will work with you to coordinate your care, referring you for specialty care as needed and acting as your good health advocate, guiding you through the preventive care services aimed at keeping you healthy through all your stages of life. What You gust Pay For Medical Services Hospital care coordinated through your Kaiser Permanente PCP or your community -based PCP is covered in full. Office visits for illness or preventive care require a $10 per visit copay. Emergency room visits require a $50 copay, which will be waived if you are admitted to the hospital from the emergency room. Prescription Benefits Prescriptions are $5 per prescription for generic or $15 brand name drugs, if filled at a Kaiser Permanente medical center: $11 for generic and $27 for brand name drugs for up to a 60 day supply, if filled at a participating community pharmacy. A mail order program is also available, which allows you to receive up to a 90 day supply of maintenance drugs for a single copay. When you fill your prescriptions at a Kaiser Permanente Medical Center pharmacy, you will pay the smallest copay amount. Prescriptions can also be filled at participating community pharmacies, such as Giant®, Safeway @, Rite Aid ®, Target ®, Wal- MartO, and K- Mart @. Prescription copays are higher when filled at participating community pharmacies than when you obtain your drugs at a Kaiser Permanente medical center. Members are also able to order prescription refill online though the members- only section of Kaiser Permanente Web site, www.kp.org, Floward C0untyPnbticSchool5ystem Benefits Enrollment Guide for Active Employees M Kaiser Permanente HMO Discounted Dental Coverage is offered through Dominion Dental. Wetmess Services Kaiser Permanente offers a variety of services aimed at preventing illness. Your PCP can encourage you to attend the "Be Well" classes offered in the Kaiser Permanente medical centers. The list of the classes offered is printed in your provider directory and includes topics such as asthma management for children, heart failure, pediatric weight management, prenatal care /breastfeeding, prenatal care, smoking cessation, managing high blood pressure and more. Members can also access a number of online services that Kaiser Permanente offers: weight complications management, smoking cessation and relaxation. At www.kp.org /liealthylifesyles, members can lean how to balance weight management based on their own sources and symptoms of stress, a person plan to help decrease dependency on cigarettes. Other Plan Features Ka iser Permanente is the sponsored by health plan that covers eligible Dependent children up the end of the year they really reach age 26, regardless of student status. When your Dependent children age off your Kaiser plan, they can choose to continue to receive their care through Kaiser Permanente by enrolling on their own through the Kaiser Permanent for Individuals and Family plan. You can find more information on receiving this individual coverage only at www.kp.org. * For children up to age 5, the copay for PCP visits are waived (PCP visits are covered in full). * $ 0copayforpreventive services (i.e.mammograms, age - based immunizations, routine physical, well - women examinations, etc.) ® Kaiser Permanente offers discounted programs for alternative medical services acupuncture, chiropractic and massage therapy are some examples of those services. Managed Health Services are coordinated through the plan (Contact (410) 6710; 1564; 6713 for assistance). Kaiser Permanente offers discounts to members on new health club membership when theyjoin through Global Fit. Just go to www.globalfit.cam /Kaiser. * Discounts on WeightWatchers memberships are also available through Kaiser Permanente. Members can get discounts on community meetings, online subscriptions and the new Weight Watcher At Home Kit. For more information, go to www.kp.org /weightwatchers. Your health manager online - sign up today at www;kp.org. Access your personal health record 24/7, 365 days a year. Some of the exciting features on -line: email you doctor's office, reviewlab results, schedule medical appointments, review referrals, order prescription and much more. Check it out today at wwwAp,org and start managing your health! Kaiser Permanente Medical Centers and After Hour Services: Kaiser Permanente medical centers have multiple specialties under the same roof. Most have primary care services, such as pediatrics, obstetrics /gynecology and internal medicine, and specialty care services in the same location. Most Kaiser Permanente medical centers also provide services including laboratory, radiology, and pharmacy in a single convenient location. For specialty referrals from Kaiser Permanente physician, the Specialist is often available within the same medical center or another area Kaiser Permanente medical center. Kaiser Permanente maintains a 24 -hour, 7 day/week Medical Advice help line that is staffed by registered nurses who are available to answer urgent, as well as routine, medical questions over the telephoner Eight of the Kaiser Permanente medical centers also service as Urgent Care After - Hours centers. The Towson and Woodlawn Medical Centers, as well as others in Maryland and Northern Virginia, have Urgent Care After -Hours services. On weekends and holidays, members who need to be seen due to an urgent medical condition can call the Appointments Line and arrange an urgent care appointment at one of the designated Urgent Care centers. The hours available for these urgent care centers can be found in the provider directory. Haward County public School System µ — ' -- � ��v�"� �-- . —' -Be eefifs7tnro m-ent Game for Active Employees NM >s w a w n 0 n 0 m CL n v v ni UnitedHealthcare offers an open access Choice Benefit Plan with access to approximately 520,000 doctors and 4,700 hospitals nationally. 1. Choose from any doctor or other health care professional in our network. No referral needed. Remember, our network is big, but it doesn't include every doctor. Before you visit a doctor, check to make sure he or she is in our network and evaluated by the UnitedHealth Premium program. You can find the most up -to -date information about participating primary and specialty doctors and hospitals by checking the directory at wwwanyulic.com. 2. Pay a copayment (if applicable) at the time of your visit for an illness or injury. It's important to know that a copayment normally isn't needed when you see your doctor for preventive care, such as an annual physical, screenings or immunizations. 3. Your network doctor will take care of filing any UnitedHealthcare claim forms for you. You may receive a bill in the mail for any amount not covered by your benefit plan. If more than one health insurance plan covers your medical services, we work together with the other plan. This is called "coordination of benefits." For more information, log on to www.myuhc.com or call the Customer Care number on your member ID card. Customer Service The Customer Service Department is open Monday- Friday, 8 a.m. to 8 p.m., to answer your questions. Customer Service can be reached at the number listed on your ID card. On -litre Services Find adoctor, Specialist or other health care professional that's right for you, plus urgent care and hospital locations. View detailed information about your coverage, including any applicable copayments and deductibles. Print a temporary ID card or order a replacement. Estimate your medical expenses with our health care cost calculator. View your claim history and payments. * Read hospital performance reviews. Take advantage of wellness tools and information. Learn more about your pha rmacybenefit and costs associated with your prescription medications. ® Locate a pharmacy close to your work or home. Your Benefits Most services are covered at 100° /wafter a $10 PCP or $15 Specialist copay. Please refer to the UnitedHealthcare Health Benefits Summary for additional details. Medication Options Together with your physician, you can select brand name and generic medications from your plan's Prescription Drug List (PDL). The PDL is an important tool in identifying the drugs that provide the greatest value and lowest out -of- pocket costs for you. It categorizes drugs into copay tiers (Tier 1, Tier 2, etc.). The copay tiers reflect the copay level you are required to pay under your pharmacy benefit, with Tier 1 set at the lowest out - of- pocket costs. lloward County Public School System m mM Benefits Enrollment Guide for Active Employees Unit d Healthcare Choice Open Access Plain The PDL offers a wide choice of brand name and generic drugs that are reviewed by physicians and pharmacists on our National pharmacy and Therapeutics Committee. The list is reviewed and revised regularly in keeping with new medical evidence and information. Additionally, the United States Food and Drug Administration (FDA) approves all drugs, including generics, which means you can be confident that whatever medication you choose, it meets the strict guidelines set by the FDA. You can review the PDL online at wwwanyuhc.com. Not only can you see the Tier assignments for individual drugs, you can also review information about each drug and lower cost alternatives. United Healthcare NurseLine Services Call NurseLine and speak with a registered nurse to: IN Better manage an illness or injury. Recognize urgent and emergency symptoms. Locate doctors and hospitals in your area that meet criteria for quality and efficiency. Understand medication interactions and how to reduce your prescription costs. Connect with resources for pregnancy, cancer, diabetes, asthma, heart disease and more. UnitedHeatthcare'Wellness Resources and Tools Whether you want to eat right, exercise more, stop smoking or just relax, you have a wide range of resources to help you stay healthy. Even better, these are already included in your benefit plan. Get started today by visiting www;myuhc.com. Health assessment and personalized report Complete an online questionnaire to help assess your overall state of health. Once completed, you receive immediate and confidential results from an online personalized report, plus suggestions for improving your health. Health improvement tools and programs Choose from many online personal "Take Action" guides to help you develop skills to improve your health and well - being. Plus, you can enroll in an online 6 -week Health Living Program. These programs focus on helping you make lifestyle changes. Personal health record Find all the information about your health conditions, medications, medical procedures and lab results in one place. Discounts Save 5 to 60% on thousands of wellness products and services, including certain health care services not covered by your benefit plan. These include alternative medicine, cosmetic dentistry, laser eye vision correction, hearing services, long -term care services and more. Libraries Find information on a wide range of health and wellness topics, plus quizzes, calculators and charts. Topics include: addiction, family, fitness and nutrition, healthy aging, pregnancy, preventive medicine and more. Wellness e -Neves The Way You Want It Our "Healthy Mind; Healthy Body" e- newsletter allows you to choose the wellness information that best fits your daily life. You will receive articles from leading doctors who have appeared in TV programs such as "Oprah" and magazines such as "Health ". We also showcase members like you who have improved their health through lifestyle changes and with care provided thorough our network. Issues are sent to your designated email address each month. Sign up today by visiting www.ahc.com /rnyhealthnews. Baby on the Way At no extra charge, expectant mothers can find help through all stages of pregnancy with the Healthy Pregnancy Program. To enroll, call 1- 800 - 411 -7984 between 8 a.m. and 11 p.m. CST, Monday through Friday, or visit www.healthy- pregnancy.com for more information. It's best to enroll within the first 12 weeks of your pregnancy, but you can enroll through week 33 of your pregnancy. [Toward founty NblicSchool System �' ��" � ��" �� ' � "'� Benefits Enr "'oTlmenf Guide ' f67 -4Ei ve CFm T yees ME m a v a E CL tP a 0 0 n a a 0 0 n a w FI Howard County Public School System Ind tnn1'ty /P O ptl'on The purpose of this Open Enrolbnent Guide is to give yon basic information about your benefits options and how to enroll for coverageormake changes to existingcoverage. Thisguide is onlya sit rnrnary of your choices and does not fidlydesa ibe each benefit option. Please refer to your CertifscatesofCoverage provided by yoarheal th plan carriers for importmuadditional information about theplans. Everyeffart has been made to make the information accurate; however; in the case of arty discrepancy, the provisions of the legal documents will govern. Howard County ('uul ployees 0%, 20%, 50% depending on service provided 100% 80% after the deductible 80% after the deductible 80% after the deductible 100% January 1,, 2011 - December 31, 2011 $1,000 Individual $3,000 Family Unlimited 80% after the deductible 80% after the deductible 80% after the deductible 80% after the deductible TT6vZ—rdT7oL Zy l�TWOOGZ § 7f, Active —t i WPTO -y- e, FS M • P" Howard County Public t System IndemnityIPPO Options Skilled Nursing /Rehab Facility Care (Precertification required) 100% Dialysis /Radiation /Chemotherapy Dialysis, 80% after the deductible; Radiation /Chemotherapy; SOU% Hospice (Precertification required) 10011 — 1st Prenatal Visit 1 80% after the deductible Pre- and Postnatal care and delivery Routine Nursery Care— Sterilization /Reverse Sterilization (inpatient precettification required) Artificial Insemination (AI) (Pretreatment authorization required) InVitro Fertilization (IVF) maximum of 3 attempts up to $100,000 lifetime maximum (Preauthorization required) 1-00%------- 100% Sterilization: 100%; �_ Reverse Sterilization is not covered Same as any other medical condition Same as any other medical condition Durable Medical Equipment 80% after the deductible;(preauthorization Required) Diabetic Supplies 80% after the deductible Prosthetic & Orthopedic Devices (Preauthorization required 80% after the deductible (preauthorization Required) for lower limb prosthetics, customized braces and upper limb prosthetics; Subject to medical necessity) The purpose of this Open Enrollment Guide is to give you basic iriforrraertiora abotat yotir betaefts options and hose toenail for coverage or make ehanges to existing coverage, This guide is only stanunaiyof your choices and floes not friitpriescribeeach benefit option. Please refer toyour Certificates of Coverage provided 11y3orar heeaith plena carriers fora mportantadditionalinformationabouttheplaairs. pveryefforthas' beenmadetomaketheinfomzationaccurarte, however, in the case ofanydiscrepanry,theprovisions of the legal documents willgovern. Howard County Publickk School System v � � wau Benefits Enrollment Guide For Active Employees 100% 80% after the deductible 100% 80% after the deductible 80% after the deductible 100% Same as any other medical condition Same as any other medical condition 80% after the deductible 80% after the deductible January 1, 2011 - December 31, 2011 80% after the deductible limited to 120 days per calendar year 80% after the deductible 80% after the deductible 80% after the deductible Rno/- after thp r1prijirtihio 80% after the deductible ---------- — 11 1 Same as any other medication condition. I irnitnei tai A rmirriac nftrantmont nor Untima 80% after the deductible (To a maximum of tl A M11 nor wo n A I-- -- .. —.1— —P.H.— (depending on nature and place of service) 80% after the deductible (Prosthetic Devices & Orthopedic Braces Precertification not required. Subject to medical necessity) R'6ww nty Pub—tic School System — -- Benefits 1 11 ............. i ' ' e— f o —rActive '-'—Em""p6ogees IN I. W n 0 0 to `,, J i W Indemni'tyIPPO i (continued) Ambulance 80% after the deductible Kidney, Cornea, Bone Marrow Transplants (Precertification required) 100% Heart, Heart -Lung, Lung, Pancreas, Liver Transplants 100% (Precertification required) Cardiac Rehabilitation 100% Hearing Aids Not covered mupu I ILL UIU DU f061MI LIM U t�UUI..tIUW Discount Dental Not covered Vision Not covered The purpose of this Open Enrtrifrraent Gaide is tog ve you basic information about your benefits optionsand holy to enroll for coverage or make changes to existingraverage. Thisguide is onlya sununaryof1varchoices apiddiies notfullydescribeewch benefitoption. Pl easerefertoyourCertificatesofCoverageprovid er!byyourhealthplancarriers for important additional inforniation about the plans. Every effort has been made to make the information accurate; however, in the case of anydiscrepancy, the provisions of the legal documents will govern. -Pub Iic r Aug» e �,.�a. _ G fo _,m�, uas ilr��rarrl Catant liC Schaal ysterr� Benefits Enraltmrwttt fitlide tar Active �mplayees 80% after the deductible 80% after the deductible 80% after the deductible 100% Not covered 80% after the deductible Not covered Not covered January 1, 20111 - December 31, 2011 80% after the deductible 80% after the deductible 80% after the deductible 80% after the deductible Hearing aids 80% after deductible to a maximum of $1,400 per ear during any 36 month period for a child up to age 19. Hearing exam not covered. Acupuncture therapy includes services provided by ,a licensed acupuncturist covered at 100% no copay subject to R&C Not covered Not covered MNU c School —System Benefits Enro�[-m-e"-nt"G—,u"i,ae—for —Active Employees IR (D 1 AC r-) 0 EA 0 t! In r 4 Calendar Year Deductible (include over 65 and under 65) None 100 °f4 Well Child Visit /Immunization $10 copay for PCP /$15 copay for Specialist (immunizations covered in full if part of Well visit) ......, . Routine Adult Physical _ ........ _......... ._. $10 copay for PCP /$15 copay for Specialist — - -- - - Routine Gynecological Exam $10 copay for PCP /$15 copay for Specialist Routine Mammogram Covered in full PSA Testing (Prostate Screening) $10 copay for PCP /$15 copay for Specialist The purpose of this Open Enrollment Guide is to give you basic infortnatim about your benefrrs optionsatnd hose to erarall for coverage at, make changes to existingcoverage. This guide is only astnimaryof vur choices and does notfull y describe each bene15toption. Please refer toyourCertificatesofi ;oven providedbypin- hetahhplancarriers for briportant additional information about theplans. Fveryeffort has been made to smite the information accurate, hutvevet; in thecaase of any discrepancy, the provisions of thelegal docanaents willgoverrt. Howard County Public School System Benefits Enrollment Guide for Active Employees January , , None None None 100% 100% except as otherwise indicated 100% except as otherwise indicated $2,000 Individual / $6,000 Family $2,000 Individual / $6,000 Family $3,500 Individual $9,400 Family Unlimited unlimited Unlimited $10 copay (7 exams in the fi rst 12 months of life, $10 copay for PCP Covered in full 2 exams in the 13th -24th months of life; 1 exam per 12 months thereafter to age 18) $10 copay (one exam every 12 months) $10 copay for PCP Covered in full $10 copay for Well Woman/ $10 copay for Well Woman Covered in full $15 copay for all other visits Covered in full Covered in full Covered in full (1 exam per calendar year age 40 and over) $10 copay (one exam per calendar year for $10 copay for PCP 1$15 copay for Specialist Covered in full males age 40 and over) M3 rr Cc"'6'n'tymP"'c't 1 circa l y t rr� zWn fl v m wY Benefits Enro m "ent G'u"i a for Active Empfo-yees zs Surgical /Anesthesia Diaalysis /Radiation /{ _._ ..... ...... ....... .. Outpatient Magnos Loverea in run Covered in full Covered in full Emergency Room $50 copay (waived if admitted) Ureent Care Center $15 copav Inpatient Covered in full Outpatient $15 copay The pu rpose of this Open Enrollment Gtaide is togive you basic information a bout yotrr benefits options and how to enroll for coverage or make changes to existingcoverage. This guide is only a scrnunary of your choices and rues riot foliy describe each benef t option. Please refer to your Certificates of Coverage providerd by }rota health pleat carriers far importam additional information about the plans. Everyeffort has been made to nrakethe inforrruation accurate; however, in the case of any discrepancy, the provisions of the legal documents Trill govern. Howard County Public School Systern Benefits Enrollment Guide For Active Employees Covered in full $10 copay for PCP /$1I, Covered in full Im a January , r 31, 2011 0 $50 copay (waived if admitted) non - emergency use not covered $15 copay; non-urgent service not covered WMErmorMESSENEEMEM Covered in full Covered in full MINIESSEEREMEM $50 copay, (waived if admitted) Covered in full $10 per visit for individual therapy $5 per visit for group therapy tic v and gaunt l tri ii cho+al yst rr7 Bene >s r4 menk Guide far AE Ve CWpGo ens In Howard County Public School System HMO Opt-ions (continued) Ambulance Covered in full Kidney, Cornea and Bone Marrow Transplants Covered in full Heart, Heart-Lung, Lung, Pancreas and Liver Transplants Covered In full (Preauthorization required) C A; e Rehabilitation Covered in full ar Hearing Aids Covered in full up to $1,400 every 36 months for one hearing aid for each hearing impaired ear (ages 0-18); Options discount program (ages 18+) Acupuncture Not covered Vision $10 copay at Plan designated vision centers. Discounts on glasses and contact lenses at Plan designated vision centers. Discounted Dental Care Preventative/RestoFative Services at discounted rates, includes orthodontic care Options Discount Program: N Fitness club memberships N Jenny Craig w Weight Watchers OntineO wAtternative therapies such as massage, acupuncture, nutritional counseling, personal training, yoga, spa services and more, 11 Laser vision correction; contact lenses * Hearing care-, hearing aids as Eldercare services To learn more detailed information about the options program. Visit www.carefirst.com/options. The purpose of this Open Enrollment G aide is to give you (7asici?iforitiatioriabojityoiii- benefits optious and how to enroll jor coverage or makechaages; to existing coverage, This guide is only surnmaryofyour choices and does not fully describe each benefif option. Pieaseiefet-toyoiii-Certifirates ofCm era geprovided byyourheafth plan carriers for important additional info rration about theplans. Every effort has been madeto make the information accurate, however, at thecase ofauydiscrepancy, the provisions of the legal documents will govern. Howard County Public School System Benefits Enrollment Guide for Active Employees January 1, 2011 - - December 31, 2011 Covered in full (includes air ambulance) ; _ .� Covered in full Covered in full v. Covered in full. The Nation Excellence al Medical Excllen Covered in full (Preauthorizati��muNrm__m on is required, M .. Applicable cost shares will apply based on (NNME) unit will arrange transplant services by a member must use an approved facility) place and type of service - pre - authorization facility that is part of the Institutes of Excellence required at approved facilities (IOE) transplant network. Covered in full. The National Medical Excellence Covered in full (Pre authorization is required, Applicable cost shares will apply based on (NME) unit will arrange transplant services by a member must use an approved facility) place and type of service - pre - authorization facility that is part of the Institutes of Excellence reouired at aDDroved facilities (KlE)transplant network. Cardiac rehab covered as a physician's office visit $15 Copay, 60 visits per calendar year $15 copay - for up to 12 weeks or 36 sessions when provided in an office setting or a freestanding cardiac rehab center. Copay would apply. Cardiac rehab should be covered under outpatient hospital benefits only when provided in the outpatient hospital setting; Cardiac rehab guidelines give the frequency and duration Para meters. Does not track towards STR max. Covered in full; t aid to a maximum of $1,400 per ear during any 36 month period for child to age 19, Precertification not required Acupuncture therapy includes services provided by a licensed acupuncturist covered at 100% no copay subject to R &C Routine eye exam covered after $15 copay (one routine eye exam every 12 months) Not covered mm Save on Jenny Craig programs and products with the Aetna Weight Management discount program. n Save again —on fitness club memberships within the GlobalFit network. Massage therapy, acupuncture, chiropractic care, diabetic counseling and natural products all cost less through the Aetna Natural Products and Services program., a Pay less for hearing exams and hearing aids; through the Aetna Hearing discount program. ff You and your family can pay less for eyeglasses, contact lenses, LASIK and more. Use your Aetna Vision Discounts at participating LensCrafters, Target Optical, Sears Optical and Pearle Vision locations. 50 °1 of eligible expenses up to $1,400 (per hearing aid for each hearing- impaired ear every 36 months, up to age 18) $15 copay, 12 visits per calendar year — $15 copay Not covered - - Up to age 18 - no charge (limited to a maximum of $1,400 per hearing aid per ear, or $2,800 for a single device that provides hearing to both ears, every 36 months) Not covered $10 Copay pervisit (PCP) $15 copay per visit (Specialty) 25% discount from plan providers on frames and tenses and 15% discount from plan providers on initial pair of contact lenses $30 copay preventative dental care services, discounted fee schedule for all other procedures Please refer to website, www.myuhc com, for a GlobalFit (fitness clubs„ Nutrisystem, discount services. at -home fitness equipment) www.globalfit.com' Weight Watchers (discounted weight management options) www.kp.org /weightwatchers ChooseHealthy (discounted services for chiropractic, acupuncture, massage therapy & other supplements) www.kp.org/chooseheatttiy 16 rd 6 ri lllic S5 Benefits Enrolment Gui e for Active Employees NCAS Dental Plans MICAS will provide administration of the Current and Alternate Dental Plans. The plan highlights for the Current and Alternate Dental Plans are outlined in the chart below. WAS pays claims using usual, customary and reasonable ( CR) reimbursement rates. Some dentist's fees exceed the UCR fees established by NCAS. `r Dentists have the right to bill you for any balance in excess of your normal copayment. In order to reduce yo►rrrior -of- pocket expense, we recommend that you select a dental provider within the Guardian Rental PPO. Access the Guardian's Provider Online Search at wwwa NCASAcom where you can easily find a participating dentist in your dental plan. Primarily crowns Primarify root corral alaerapy Primarily denturesIbridges Orthodontics (far mernhers atrder age ii only) �,�> wzuu �> , ��u � , ».n H x. x _ o,r� x�t uide f . w.e. - e hi��a�►rd i�c�unt uirlic clruol ysterr� �e►►efts iwrsrallrnent Guide for Active Enr►pluyees Delta of fees. They won't balance bill over Delta Dental's approved amount. Professional Treatment Standards m Delta Dental reviews utilization patterns and office practices to ensure that Delta Dental dentists meet professional standards for safety and quality of care. The Delta Dental PPP program allows you the freedom to visit any licensed dentist, including a dentist from our Delta Dental Premier indemnity network. However, there are advantages to visiting a Delta Dental.PPO network dentist instead of premier or non -Delta Dental dentist. Consider the information below: Patient's share is the roinsuraner /copayrnent, any r+enrainingdeductible, any amount over the annual rrraxirnum and arty services your platy does not cover. If pif visit non network dentist, Delta Dental swill send the benefztpay rzentdirectly toyom You are responsible for paying, the rrorr rretsvork detrtist's total fee, which may include amounts in excess of your share of your plan's contract allowance. Navuari—county FCblic School System Benefits Enrol went Gui or Active Emp ©yees C7 It (continued) Alan benefit structure, limitations or exclusions, consult Diagnostic and t �'`~j� tF'.'i} Tiv'ta i�`Sl it }"s'7 °/ your company's benefits representative for the provisions Preventive Benefits,t to {k #i fat specified in your Group Dental Contract. Oral examinations, ,yak {�l {�kt3o-%t routine cleaningsax -rays k�i��tf fluoride treatment, space`{ fl , z {f Who's Eligible Primary enrollee, Spouse and maintainers, sealants eligible Dependent children to the �tk�;trykk= end of calendar year that Dependent Basic Benefits rkk{ � � k��pp ��'t�,��k�� .kY� {iQ ik4 � 1 } � St 90% turns 25. Fillings, posterior composites Deductibles $25 per person / $75 per family iy�t'r��t; {{ (per calendar year) Major Benefits t {tkt£2Y ti k1 { }y 50% Inlays, onlays and cast 2 �k'i {f 4k�t t s ij'f Y� 4l Deductible Waived Yes restorations For Diagnostic & Preventive? Endodontics r4 iy�Cr rYi t tY41(P= 80% Root canals Pl ii5�,r ri i y tick Annual Maximum The maximum benefit paid per calendar year is $1500 per person Perlodontics �p�s�Y {�1k�L�� }�� /�� { ��= Bit°! Gum treatment Contact Information .� Oral Surgery �y ds Rrl ty rt 14 ;SY�,4z i [kYt t }}j 80% Incisions, excisions, Delta Dental ofPenns Pennsylvania y surgical removal of��,it, "7 Customer Service tooth including simple g p �ttk www.deltadentalins.com extractions 800-932-0783 Prosthodontics � � � �1' ; }z'kf 50% (Business Hours: 8 a.rn,— $ p.m. EST) Bridges, dentures, Claims Address implants One Delta Drive, Mechanicsburg, PA 17055 Crowns I qP R SIMMONS { � 6t} °lo *�� }1P r {v 1 1 {t r m # LlilntatlOrisorivez rtti gF et'lodsna a h l Tfot'sottiebet7e � its ;soiiieset'Vlcesttlfl Y bt'. . . Orthodontic Benefit 50✓ excluded Plea wreerro figurEvzdenceof'comu eoldStontlear PlanDescri Description ' � � � children for , valtingperiodsanda list of benefit limitations and exclusions. "* Pees it re based art PPO fees for in- network- dentists and PPO fees for oat of Orthodontic Maximum �ykf�'��s kkj � netim- kdentests. Reimbursement is aidonDe ltaDentalrantractallowances �� t �� t�l��t Lifetime and notnecessari ly each dentist's actualfees, Other f e��i e, l{ Service Denture Repair � { ct� et i ati�i � covered at kka r.,i Vd tau=t gUlle5 WT nlJlle thefCAQAlT;9 lldlt Mtn 9:. Whlr`r teener doenAt btA fitil ptirletwo tet stof t�Aompo msatfuww to p teriPaiemc 1m oner f oval rat, s#cWtoi ro our inns red Members ree efi o77ees MAy be sq Y basiedo0l a waflety of Piseelfrtt 0t"rdhafthmi torb of feel-for-sortescre P:tymoett, Rotary or capetalJori, ftnolos m be u*td with fho$rr varaters types ofysymond rrss# herds -tt ai' Yt' )eaa!dey3raadaptlanaJTof & r t%nabdutowrt uulEtstasavy° saa„ $ enelhods otpoyfall phytkians, or Aryw want tokreowwf4hreerbod is,Y apply to your physkisa »pietsot if 10014oforrehi s Delta pentsdat 8#0431WIJ or wlite trn Rrtta Dool,tt of Patwrtsytraerta ttae P#Aj Pef** Motharatfsbarrg rn,tJ to P" PAJ7035 tGrratrol lhat I hv tw ➢Y V4, rrtatBP t¢ ➢t5 ny hilt Carwa B to derl yl, drtir erfelal (W gird. §'s;kla for ,Vr Alut aa�4 #4tfaii ° tk� fy � �t iDl ifb #UlI i'h dLf➢1id'f.I LEl t6 s'tv11Yifik v'teb'i'C9 °8Y I4R1a'brt.bt9o-bt(I }'„F[Li fild9 n3 +f'C �t�r3C. bG1111',v Q^9 F-":il aCltsit � t 9ri5 :1 C`ri i+ tVGa 4k s,. lit PAJrV4 n4l DOI It De 14t1I PPO and ?Fa [E,9 Caw^ I e !calf. ^r Wt, aaa 4 rY4lkrl.. CAP pelt.] 0+w..`M41 01 pellnNylyltlt of ,A of EEC yeat etrw e n.r � ".._.,. $. �., ,,..�,..�.�k:.w.�.a.........,.. ,�.'e ..........�e ,a ilm el, p,clYE w a e 1pArrg °. frou'Ribl'i` 111 20% 4la:mi �r.iti'44iita0wdellu*+Id k ,eww�m+u� :�.w�,:��xx raeren �;mu�.�eara �, +r a�x wa .. =�W.ne,;; �,µ,�b:.rw:w�, mv�..t�,�rr3v s �� ,..�,� ✓.u+u:,:.�f mmn��.w r,�m>rrr � �.:x,..';3.� .a�ur't��* iw a�.ry .'sue �scusvo w�mra�:x�vw Howard County Public School System Benefits Enrollment Guide for Active Employees Service Vision Vision Service Plan doctors take the time to get to know you and your eyes. Through a WellVision Exam1', our doctors look for more than just vision problems. They can detect signs of serious health conditions like diabetes, high blood pressure, and high cholesterol too. VSP doctors are located nearby and most offer weekend and evening appointments. Plus, all of our doctors offer eyewear choices you'll lave. Before selectingyour eyewear, ask your doctor what is fully covered by your VSP plan. The following chart summarizes the main benefits of your plan: Extra savings and stirs Prescription Glasses Contacts ** Laser Vision Correction * ** ttrstt**rxP'hFU� {'r wzaa 1s Si{ , {? it 5 r(xY izn P 4fii2 „ttkll'k$ra, 4(i >1fI'M N ftr>> Pcat iettts choosing corrtracts rise their eligibility for a frame and lenses. Materials are provided at the castarnary fees. Your VSP donor trarrstget prior rapprov al front VSP for?medically trecessary rorttact lenses, Cttrreiat corrtact letrs users unsay qualify for a special prograarrt that includes a contact lens evaluation and initial supply of replacement leases. Available front any VSP doctor within 12 months ofyonr lust eye exam. Lash vision correction (PRKandLASIK oirgery) is available, shrough contracted laser centers. Must seeaVSPdoctor .Porareferral.Call888- 354- 4434for-inforiuiatiant. �,;,� ��— ,��tt 'Or— �—,,� �� „�� l�ovrard ��rlw P�aial` €c Cllool yst m Benelits Enrollment Guide ,Active Nfl-p gees 2 �Ll. 0 rn F Your VSPO'VIslon Care Plan Benefits That's it! We'll handle rest—no ID card or claim forms to complete. Please Howard County Public School Systern Benefits Enrollment Guide for Active Employees How the VSP Works 'W-zi a'Rit uhlic ch cal y t rr� Benei"its Euro mint Gui a 6 6mpF6y IM NCAS Vision Care The plan benefits under NCAS vision plan will not be changing for year 2011. Schedule erg Vision Exam ... Usual, Customary, and Reasonable (UCR) Charge (only. Provider may balance -trill for charges in excess ofUCR: Note: The Vision Care Program entitles you to payment once in any 12-month period" for glasses or contact lenses, not both. "Example: If you gat new glasses on November 1 of the current year, your next }pair of glasses (or contacts) would have to be purchased on November 1 of the following year or after to be covered. Following cataract sargeryor when visual acuity is correctable to at least 20170 in the better eye only by of contact lenses: �,�� p� �x ��m �n �. �;r� ,� „��, llowa_rc{ County] Pub c cl_caol system Benefits Enrollment Guide for Active Employees Dismemberment Life & Accidental Death & Offered through i tar HOPSS offers eligible employees life insurance accidental death and dismemberment insurance (AD & D) at no cost to the employees through ReliaStar Life Insurance Company. The amount of life insurance is equal to the employee's current annual salary. Voluntary Life Insurance Policies HCPSS offers two Life Insurance policies that employees may purchase through the convenience of payroll deductions: Premier Whale Life Insurance with Long Term Care Rider with Restoration and Extension of Benefits Supplemental Group Term Life Insurance with Portability as Employees may apply for up to $500,000 of Whole Life coverage. You will have to provide Evidence of Insurability (EOI), subject to approval by ReliaStar Life Insurance Company. ss Spouses may apply for up to $250,000 of Whole Life coverage. Your spouse will have to provide Evidence of Insurability (EOI), subject to approval by ReliaStar Life Insurance Company. Children may apply for $12,500, $15,000, $20,000 or $25,000 of Whole Life coverage. Your children will have to provide Evidence of Insurability (EOI), subject to approval by ReliaStar Life Insurance !Company. is New Hires enrolling within 30 days of the date of hire will be guaranteed coverage of the lesser of $100,000 or the amount of coverage that $20 a week will purchase for your age. Your spouse and children may apply for coverage even if you are not electing coverage. Premiums are guaranteed to be fixed for the life of the policy. The policy builds guaranteed cash value Supplemental Group Term Life Insurance with Portability This is a term policy that provides affordable protection for short terra needs. Coverage may be taken with you if you leave or retire. is You may elect Supplemental Life coverage in amounts of 1 "2 or 3 times your annual salary. If you enroll during the Open Enrollment Period, you are guaranteed up to $50,000 of coverage without providing EOI. If you apply for higher amounts of coverage, then you must provide EOI, subject to approval by ReliaStar Life Insurance Company. If you enroll at any other time outside of this enrollment period, you will be subject to EOI and approval by ReliaStar Life Insurance Company for any amount of coverage you elect. New hires are eligible for the guaranteed issue amount of one time their annual salary up to $50,000 if enrolled within 30 days of date of hire. is Coverage is portable. Therefore, if you change jobs or retire, you can keep coverage to age 70 ie Rates are leased on five -year age bands, and the rate will be based on your age as of January 1, 2011 and every January 1st thereafter. The rate will change when you reach the next age band. Nd ,rarcl t o anty 'iil lic ch 1 st_effi U Y � Benefits Enrol rri iit Guide fdr Acklu�_bE _ll yees M Votuntary Benefits (continued) 0 You may elect Dependent Life coverage on your family, if you elect coverage for Supplemental Life. Your spouse will be covered for $10,000 and each child will be covered for $5,000 for $2.00 a month. 0 If you elect Dependent Life when you are first eligible, EOI on your spouse or children is not required. If you elect Dependent Life, you must provide Evidence of Insurability on your dependents, subject to approval by ReliaStar Life Insurance Company. This is a summary ofbenefits only. A complete description of benefits and limitations will be provided in the policy or Certificate of Coverage. AFLAC's Short Term Disability Plan provides coverage in the event that: Is You are disabled due to a covered Off-the-Job Injury or covered Sickness. You determine the level of coverage that meets your financial needs. Im Minimum Coverage = 3 months / Maximum Coverage = 24 months A range of elimination periods are available Monthly Benefits ranging from $500 - $5,000 based on your annual income. AFLAC's Personal Disability Income Protector pays regardless of any other benefits currently in place. Maternity Coverage There is a 10 month waiting period from the coverage effective date before Short Term Disability benefits become active. Employees with existing policies can make policy changes during the AFLAC open enrollment period, Howard County Public School System Benefits Enrollment Guide for Active Employees Voluntary Benefits (continued) (Critical Illness) A.flac's Specified Health Event Protection (Critical Illness) offers both a`hospital intensive care and specified health event combination plan. The combination plan provides benefits to Help cover the unexpected expenses that result from a stay in a hospital intensive care unit, as well as specified health events. Covered events include heart attack, coma, end -stage renal failure, stroke, paralysis, persistent vegetative state, major- human organ transplant, coronary artery bypass surgery, and major third- degree burns. This policy is available to employees 18 -70. Policy benefits include but are not limited to: ri First Occurrence Benefit Reoccurrence Benefit rA Hospital Confinement (includes intensive care) Continuing Care is Transportation and Lodging Ambulance Second Specified Health Event Step -Down Intensive Care Unit Are portable, with no change in coverage or cost after one month's payroll deduction Pay benefits regardless of any other insurance you may have Pay benefits directly to the insured, unless otherwise assigned Fl;vrar�l EoCii7ty Pa'lic cliaol Systrn Bents Enrolment �u�+de far Active Employees Long Term Disability Long -term disability (LTD) insurance helps to replace your income if you are sick or injured and cannot work. It is designed to begin after you have been disabled for predetermined waiting period, known as the elimination period, of 90 days. Important to If you are enrolling in long -term disability (LTD) coverage offered through The Standard via on -line, other than the period that you were initially eligible to enroll, you will be required to mail a completed Medical History Statement to The Standard by November 30, 2010.; Once your application has been processed and reviewed by The Standard, you will receive a notification of approval f denial of LTD coverage. The deduction for LTD coverage will begin the first of the month following notification of approval frorn The Standard. Per pay Period Rates ,i1 = /100 X Annual Salary .Monthly Salary Rate Above Ray Period Cost Your cost may change if your salary changes within the benefits plan year. iiozrd bounty —Public cSchool System Benefits Enrollment Guide for Active Employees Flexible Spending Accounts (FSAs) HFS Benefits P.O. Box 1550 Hunt Valley, MD 21030 -1550 Email: customerservice hfsbenefits.c+om- L+o+cal Phone: 414 -771 -1331 Toll -Free Phone. 888- 460 -8005 Local Fax: 410- 771 -5533 Toll -Free Fax: 1a- 888 - 510 -4218 The expenses must be for children a to the ale of 13 or for other dependents you report for federal income tax purposes who are incapable of self - care. Your dependent care provider must be an organization or an individual (that is not an immediate family member) who provides the care either in your home or outside your home. Educational programs for pre-school age children and summer day camp programs may also qualify for reimbursement, You must obtain a receipt for your dependent care expenses that includes the provider's taxpayer identification number or social security number. Rules for Dependent Care Flexibly Spending Accounts The dependent care expenses must be necessary because you (and spouse if married) work: or attend school on a full -titre basis Some services such as nursing home expenses and overnight expenses do not qualify for Dependent Care FSA reimbursement — consult IRS Publication #503_ for more information or visit the I FS website at wivtv:hfsbenclits.com. Howard t:o lalic cPiaoi pwrt onefts l4rrro(iment Guicie for Active Employees R Spending Flexible (continued) The Health Care FSA is used to reimburse your predictable out -of- pocket medical expenses. If you expect to spend $100 or more this year on medical expenses for yourself` or your spouse and /or dependent children, you should consider participating in a Health Care FSA. Examples of expenses allowed by the IRS include: Copayments or coinsurance amounts that you must pay for doctor's office visits, diagnostic tests or prescriptions. Your share of the cost for orthodontia treatment for yourself, spouse or your children. Medical or dental services not covered by your benefit plans (i.e., laser vision correction) The cost of some over- the - counter medical product as allowed by the IRS (cold and sinus medications, cough products, antacids, medical equipment, etc.) How the Health care FSAs work Estimate what you think you will spend for predictable health care expenses in the upcoming Plan Year (January 1, 2011 — March 15, 2010 Enroll online at www.hcpss.benelogic.corn by entering the amount you expect to spend this year in the Flexible Spending Account section. The annual minimum contribution is $100/20 = $5 /pay and the annual maxiinum contribution is $3500/20 = $175 /pay. Beginning with the first paycheck in January, 2011, you will see a deduction for your Health Care Account. That amount will be credited to your Health Care Account each pay period. Health Care Accounts are pre - funded — than means your have access to the entire election amount for the plan year at any time during the plan year. You can use your pre - funded debit card or submit your receipts and claim requests can be reimbursed for the full amount you spend for qualified services or purchases up to your annual amount at any time during the plan year. Over- the - counter (OTC) medications such as antacids, allergy medicines, pain relievers and cold medicines, currently reimbursable under your plan, will require a prescription from a health care provider to qualify for reimbursement starting with all purchases beginning January 1, 2011. Because OTC medications will be removed from the approved list of reimbursable items, the FSA debit card will not be accessible for these purchases. You will be required to use another farm of payment and submit a claim for reimbursement. Howard County Public School Systern Benefits Enrollment Guide For Active Employees Dependent Care FSA Savings Exam Gross Annual Salary a r, ,f� tix� tdwa Pre -Tax Dependent Care Cost The Health Care FSA is used to reimburse your predictable out -of- pocket medical expenses. If you expect to spend $100 or more this year on medical expenses for yourself` or your spouse and /or dependent children, you should consider participating in a Health Care FSA. Examples of expenses allowed by the IRS include: Copayments or coinsurance amounts that you must pay for doctor's office visits, diagnostic tests or prescriptions. Your share of the cost for orthodontia treatment for yourself, spouse or your children. Medical or dental services not covered by your benefit plans (i.e., laser vision correction) The cost of some over- the - counter medical product as allowed by the IRS (cold and sinus medications, cough products, antacids, medical equipment, etc.) How the Health care FSAs work Estimate what you think you will spend for predictable health care expenses in the upcoming Plan Year (January 1, 2011 — March 15, 2010 Enroll online at www.hcpss.benelogic.corn by entering the amount you expect to spend this year in the Flexible Spending Account section. The annual minimum contribution is $100/20 = $5 /pay and the annual maxiinum contribution is $3500/20 = $175 /pay. Beginning with the first paycheck in January, 2011, you will see a deduction for your Health Care Account. That amount will be credited to your Health Care Account each pay period. Health Care Accounts are pre - funded — than means your have access to the entire election amount for the plan year at any time during the plan year. You can use your pre - funded debit card or submit your receipts and claim requests can be reimbursed for the full amount you spend for qualified services or purchases up to your annual amount at any time during the plan year. Over- the - counter (OTC) medications such as antacids, allergy medicines, pain relievers and cold medicines, currently reimbursable under your plan, will require a prescription from a health care provider to qualify for reimbursement starting with all purchases beginning January 1, 2011. Because OTC medications will be removed from the approved list of reimbursable items, the FSA debit card will not be accessible for these purchases. You will be required to use another farm of payment and submit a claim for reimbursement. Howard County Public School Systern Benefits Enrollment Guide For Active Employees Approval System (IIAS) Medical, Dental and Prescription plan copays will not require receipts. However, please retain all receipts when using your debit card as HFS may need to obtain a copy of your receipt to verify the eligibility of the expense. is If you do not use the debit card, you can file claims with HFS using one of the following methods: HFS Benefits P.O. Box 1550 Hunt Valley, MD 21030 -1550 Local Fax: 410 - 771 -5533 Toll -Free Fax. 1 -888- 510 -4218 By Email: claimslhfsbenefits.com You can elect to have your reimbursements posted to your bank account through a direct deposit option is You can elect to be reimbursed by check mailed to your home address Heatth Care FSA Savings As with the Dependent Care FSA, you will save money because you are paying qualified Health Care expenses with pretax money instead of after tax money. Use W or Lose It Rule Any amount that remains in your account after April 30, 2012 must be forfeited. Keep in mind that you save at least 28% on every dollar you set aside and use to pay for qualified expenses — if you have a small balance at the end of the year, you will still have saved more in taxes than you lose if you didn't have enough expenses to claim all your money. Plus you can use the funds for certain over the counter drugs to avoid forfeiture of the money, Flexible Spending Accounts are governed by the Internal Revenue Service (IRS) regulations. Under current law, amounts set aside in FSAs must be spend for qualified expenses you have during the plan year plus an additional 21 /2;month period after the plan year ends. For the plan year that begins January 1, 2011 you must incur expenses between January 1,;2011 and March 15, 2012. The last day for submitting claims for expenses incurred between January 1, 2011 — March 15, 2012 is April 30, 2012. Alternative healing (acupuncture and chiropractic visits) The debit card system is coded to only accept charges from qualified merchants (i.e. doctor's office, dentist's office, pharmacy, etc.). Please do not use your FSA debit card to pay for your prescription(s) at the same time you purchase non- eligible items like toothpaste, shampoo, vitamins, etc. is Your FSA debit card transaction will be denied if the amount of your transaction is greater than the balance in your FSA account. ss Your FSA debit card offers 24/7 online access to real -time account balances plus other vital information. Go to www,hfsbenefits . coni to review your account status. 1 V'7 Ben i e�t 6 -ide ar NeffA ie 6r pGoyees rta X cr t ro CL C n n 0 In i Spending Flexible ' n i , Please retain all receipts for goods and services that are purchased with your FSA debit card. HFS will request to review receipts for charges which cannot be determined to be an exact copayment match or previously substantiated recurring expense, If you cannot provide a receipt to prove that your purchase is an eligible charge, you will be asked to reimburse your FSA for the amount of the purchase.. When using your FSA debit card, please be sure to notify the merchant to process the transaction as a "credit ". If "debit" is selected in error, the transaction will be declined, as there is no PIN number associated with the card. Is Be sure that you are using your FSA Debit card to pay for current plan year expenses. You will be asked to reimburse the plan if you pay for any expenses that were incurred in the previous plan year. The date that the service was rendered is considered to be the date the expense was incurred. Very Important HFS will email and/or mail you a request for receipt for all transactions that do not match a copay or do not match a previously substantiated expense. If you do not respond to the first request, a second request will be emailed/mailed 30 days after the first notification. If HFS does not receive substantiation of the full expense within 30 days, a third and final notification will be generated. Any transactions that are not substantiated within 90 days from the date of transaction swipe will be deemed ineligible and your card will be temporarily deactivated. Substantiation receipts must be generated from the provider and include the following information; Please note that credit cards receipts do not ineet this requirement. Howard County Public School System Benefits Enrollment Guide for Active Employees Medical HUSS Annual Rate Chart cti Fall -tim l Part-time Em with a Hire Date oti or Before 613012011 School System No Coverage Kaiser Permanente Select HMO Individual $5,082 ` 420 Parent Child ren $9 Y X10 $420 Husband /Wife $11,1$0 u� � �� 4 ,1 $420 Family $16,00 `t tis $420 N CASs Traditional Medical Plan Individual $ 11111,11201 � '3jt t t, il;�i � bjJlF lj,Q $424 Parent /Child ,094 $14,060 /a�111,9a $420 Husband /Wife $19,616 Y?�g'' t , F{k"'�1411 $420 Famil y $2,100 ��a; sr g � $42t1 tYrJ #tJur }r MICAS Alternate Medical Plana?�rtfia x{ &t'ut� L�l.rvlt?df s z WSJ, � �3�L!4*z rip �+Fss4� Individual $8,003 ��;��,�g�t��° � �� }��'�� r „�,��;�.�n $650 Parent /Child $12,372 �!S�,x 1 { $650 Husband /Wife $17,262 $650 Famil $22,6z,,,�xM',r.�t t� < �'�Y'�J�r�7�ttt�k�tq t4 �� , ?,r � 51 i7J btj'�{� tti:+�iiJP t�fi,;,s $650 {.. F�narci Cc�w�nty Pt�I�IIc �hoc�l y�tem Benerrts Enro��mer�t Ouie r Act9ve Emayees HUSS Annual Medicat Costs Rote Chort for Active Fall - r" ,r° Port-time Employees with r Hire Date on or r 71011201. Kaiser Permanente Select HMO Individual P are nt/f { ld (re n) Husband/Wife Family NCAS Traditional Medical Plan Individual Parent /Child Husband Wife Family NCAS Alternate Medical Plan Individual $5,082: $9,910 $11,180 $16,008 $9,094 $14,0611 $19,616 $26,100 $8,008 s..��.kH'{i ,�Sm*f,�? AR P }13�3ft'�i J'2� {�`'•., f.J . " a, J:i..r t" �i z t4 { at, > , {rti $t lir#Y'jr ,,r .,, {Jik s"4.: {i3- .� {3 {t � tsfs�: G } {i {�S t�.stJ EJJ k i , d . } {tt;,rt=i,'n. t >{ ft` rt f; x ` # Jf tF 420 $420 $420 $420 $420 $420 $420 $650 Parent /Child Husband /Wife Family $12,372 $17262 22,}68 5tt sJvit$ r} ,. ,.. {, , r $650 $650 $650 Howard Countt Public School System m% �� m � Benefits Enrollment Guide fair Active AEmployees HCPSS Annual Dental Rates 2011 LEM Fi6-W rd- uWy� rui �i Gu'i or T@WEmp>foFeA ME n co 2011 Emptoyee Benefits Open House For HCPSS Emptoyees rn 3 " This year's Benefits Open House will give Employees 0 AXA Equitable (403(b) vendor) it the opportunity to meet individually with the plan V a luc ' (403(1,) d'" ) rD rD representatives. The meetings will also include plan ven or w materials, and promotional items as well as healthy lifestyle Horace Mann (40� (b) vendor) rinformation. The following plan representatives will be N ING (403(b) vendor) t available at the meetings.. Met Life (403(b) vendor) CareFirst Blue Cross hlueShield FA Nationwide (457(b) vendor) m 0 raiser Permanents Benefits Open House will take UnitedHealthcare Vision Service Plan V following location and tit Hirsch Financial Services (Flexible Spendin Accounts) Oilrq% Aetna. Tuesday, October 12, 203 Cpq Is WAS 12:30 p.m. try 6:00 p.m. cn Delta Dental IN AFLAC (Voluntary Benefit Plans) The Standard (Long Term Disability) ReliaStar (Life Insurance Voluntary Benefit Plans) ilo�v�urd County Piablic School System Benefilts Enrcultment Guide for Active Employees QWA-RD COUNTY.' -'BLIC SCHOOL SYSTE I M NOTICE OF PRIVACY PRACTICES Traditional Medical Plan, Alternate Medical Plan, Aetna Select Open Access HMO, Aetna PPO, CareFirst BlueChoice HMO Open Access, Kaiser Permanente Select HMO, UnitedHealthcare Choice HMO, Current Dental Plan, Alternate Dental Plan, Delta Dental PPO, Vision Care Plan, Vision Service Plan, Health Care Spending Account, and Dependent Care Account. Our Legal Duty This Notice describes our privacy practices, which include how we might use, disclose (share or give out), collect, handle, and protect our members' protected health information. We are required by certain federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your I GZar F rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice took effect April 14, 2003, and is not intended to amend any prior notice of Howard County Public School System Welfare Benefits Plan privacy practices. We reserve the right to change our privacy practices and the terms of this notice at any time, as long as law permits the changes. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all protected health information that we maintain, including protected health information we created or received before we made the changes. If we make a significant change in our privacy practices, we will change this notice and send the new notice to our health plan subscribers within 60 days of the effective date of the change. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice. Uses and Disclosures of Medical Information Primary Uses and Disclosures of Protected Health Information We use and disclose protected health information about you for payment and health care operations. The federal health care Privacy Regulations generally do not "preempt" (or take precedence over) state privacy or other applicable laws that provide individuals greater privacy protection& As a result, to the extent state law applies, the privacy laws of a particular state, or other federal laws, rather than the HIPAA Privacy Regulations, might impose a privacy standard under which we will be required to operate. For example, where such laws have been enacted, we will follow more stringent state privacy laws that relate to uses and disclosures of the protected health information concerning HIV or AIDS, mental health, substance abuse/chemical dependency, genetic testing, and reproductive rights. In addition to these state law requirements, we also may use or disclose protected health information in the following situations: Payment We might use and disclose your protected health information for all activities that are included within M FA 0 C') (D 0 fir (D V) M Notice of Privacy Practices (continued) the definition of "Payment" as written in the Federal Privacy Regulations. For example, we might use and disclose your protected health information to pay claims for services provided to you by doctors, hospitals, pharmacies and others for services delivered to you that are covered by your health plan. We might also use your information to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to obtain premiums, and to issue explanations of benefits to the person who subscribes to the health plan in which you participate. Health Care Operations We might use and disclose your protected health information for all activities that are included within the definition of "health care operations" as defined in the Federal Privacy Regulations, For example, we might use and disclose your protected health information for stop-loss underwriting to determine our premiums for your health plan, to conduct quality assessment and improvement activities, to engage in care coordination or case - management, -;and to manage our business. Business Associates In connection with our payment and health care operations activities, we contract with individuals and entities (called "business associates") to perform various functions on our behalf or to provide certain types of services (such as member service support, utilization management, subrogation, or pharmacy benefit management), To perform these functions or to provide the services, our business associates will receive, create, maintain, use, or disclose protected health information, but only after we require the business associates to agree in writing to contract terms designed to appropriately safeguard your information. Other Covered Entities In addition, we might use or disclose your protected health information to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain of their health care operations. For example, we might disclose your protected health information to a health care provider when needed by the provider to render treatment to you, and we might disclose protected health information to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing or credentialing, Other Possible Uses and Disclosures of Protected Health Information The following is a description of other possible ways in which we might (and are permitted to) use and/or disclose your protected health information. To You or with Your Authorization We must disclose your protected health information to you, as described in the Individual Rights section of this notice. You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose not listed on this notice. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures that we made as permitted by your authorization while it was in effect. Without your written authorization, we might not use or disclose your protected health information for any reason except those described in this notice. Disclosures to the Secretary of the U.S. Department of Health and Human Services We are required to disclose your protected health information to the Secretary of the U.S, Department of Health and Human Services when the Secretary is investigating or determining our compliance with the federal Privacy. Regulations. To Plan Sponsors Where permitted bylaw, we may disclose your protected health information to the plan sponsor of your group health plan to permit the plan sponsor to perform plan administration functions. For example, a plan sponsor may contact us seeking information to evaluate future changes to your benefit plan. We may also disclose summary health information (this type of information is defined in the Federal Privacy Regulations) about the enrollees in your group health plan to the plan sponsor to obtain premium bids for the health insurance coverage offered through your group health plan or to decide whether to modify, amend or terminate your group health plan. Berients Enrollment Guide for Active Employees To family and Friends If you agree (or if you are unavailable to agree), such as in 'a medical emergency situation we might disclose your protected health information to a familymember, friend or other person to the extent necessary to help with your health care or with payment for your health care. Underwriting We might receive your protected health information for underwriting, premium rating or other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits. We will not use or farther disclose this protected health information received under these circumstances for any other purpose, except as required bylaw, unless and until you enter into a contract of health insurance or health benefits with us: Health Oversight Activities We might disclose your protected health information to a health oversight agency for activities authorized by law, such as; audits; investigations, inspections; licensure =or disciplinary actions, or civil, administrative, or criminal proceedings or actions. Oversight agencies seeking this information include government agencies that oversee: (i) the health care system; (ii) government benefit programs; (iii) other government regulatory programs; and (iv) compliance with civil rights laws.: Abuse or Neglect We might disclose your protected health information to appropriate authorities if we reasonably believe that your might be ;a possible victim of abuse, neglect, domestic violence or other crimes. To Prevent a Serious Threat to Health or Safety. Consistent with certain federal and state laws, we might disclose your protected health information if we believe that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Coroners, Medical Examiners, Funeral Directors, and Organ Donation We might disclose protected health information to a coroner or medical examiner for purposes of identifying you after you die, determining your cause of death, or for the coroner or medical examiner to perform other: duties authorized by law. We also might disclose, as authorized by law, information to funeral directors so that they may carry out their duties on your behalf. Farther, we might disclose protected health information to organizations that handle organ, eye, or tissue donation and transplantation, Research We might disclose your protected health information . to researchers when an institutional review board or privacy board has: (1) reviewed the research proposal and established protocols to ensure the privacy of the information; and (2) approved the research. Inmates If you are an inmate of a correctional institution, we might disclose your protected health information to the correctional institution or to a law enforcement official for; (1) the institution to provide health care to you; (2) your health and safety and the health and safety of others; or (3) the safety and security of the correctional institution. Workers' Compensation We might disclose your protected health information to comply with workers' compensation laws and other similar programs that provide benefits for work- related injuries or illnesses. Public Health and Safety We might disclose your protected health information to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others. N ? v r ' c my P�inEic cf'ca ( ys "ter i Z4 X „fr `` R B`erie its E Of irkcef ve Eirr oyes Z 0 F1 rL 0 -n C• n` v� Notice rig Individual Rights Required by Law We might use or disclose your protected health information when we are required to do so by law. For example, we must disclose your protected health information to the U.S. Department of Health and Human Services upon their request for purposes of determining whether we are in compliance with federal privacy laws. Legal Process and Proceedings We might disclose your protected health information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we might disclose your protected health information to law enforcement officials. Lew Enforcement We might disclose to a law enforcement official limited protected health information of a suspect, fugitive, material witness, crime victim, or missing person. We might disclose protected health information where necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has escaped from lawful custody. Military and National Security We might disclose to military authorities the protected health information of Armed Forces personnel under certain circumstances. We might disclose to federal officials protected health information required for lawful intelligence, counterintelligence, and other national security activities. Other Uses and Disclosures of` our Protected ealt h Information Other uses and disclosures of your protected health information that are not described above will be made only with your written authorization. If you provide us with such an authorization, you may revoke the authorization in writing, and this revocation will be effective for future uses and disclosures of protected health information. However, the revocation will not be effective for information that we already have used or disclosed in reliance on your authorization.. Individual i Access You have the right to look at or get copies of the protected health information contained in a designated record set, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot reasonably do so. You must make a request in writing to obtain access to your protected health information. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending a letter to the address at the end of this notice. If you request copies, we might charge you a reasonable fee for each page, and postage if you want the copies mailed to you. If you request an alternative format, we might charge acost- based fee for providing your protected health information in that format. If you prefer, we will prepare a summary or an explanation of your protected health information, but we might charge a fee to do so. We might deny your request to inspect and copy your protected health information in certain limited circumstances. Under certain conditions, our denial will not be reviewable. If this event occurs, we will inform you in our denial that the decision is not reviewable. If you are denied access to your information and the denial is subject to review, you may request that the denial be reviewed. A licensed health care professional; chosen by us will review your request and the denial. The person performing this review will not be the same person who denied your initial request. Disclosure Accounting You have the right to receive a list of instances in which we or our business associates disclosed your protected health information for purposes other than treatment, payment, health care operations and certain other activities, after April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your protected health information, a description of the protected health information we disclosed, the reason for the disclosure, and certain other information. If you request this list more than once in a 12 -month period, we might charge you a reasonable, cost -based fee for responding to these additional requests. Wlo nrd r't I «t (i tt c'hcrr�G y Sri Benefits Enrollment Guide for Active Employees You may request an accounting by submitting your request in writing using the information listed at the end of this notice. Your request maybe for disclosures made up to 6 years before the date of your request, but in no event, for disclosures made before April 14, 2403. reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. Electronic Notice- Even if you agree to receive this notice on our web site, or by electronic mail (email), you are entitled Restriction Requests to receive a paper copy as well. Please contact us using the You have the right to request that we palace additional information listed at the end of this notice to obtain this restrictions on our use or disclosure of your protected notice in written form. If the email transmission has failed, health information. We are not required to agree to these and Howard County Public School System Welfare Benefits additional restrictions, but if we do, we will abide by our Plan is aware of the failure, then we will provide a paper copy agreement (except in an emergency). Any agreement that of the notice to you. we might make to a request for additional restrictions must be in writing and signed by a person authorized to 'Hake such an agreement on our behalf: We will not be Questions and Complaints liable for uses and disclosures made outside of the requested restriction unless our agreement to restrict is in writing. Information on Howard County Public. School We are permitted to end our agreement to the requested System if r e Benefits Plan Privacy Practices restriction by notifying you in writing. If you want more information about our privacy practices You may request a restriction by writing to us using or have questions or concerns, please contact the member the information listed at the end of this notice. In your services number on the back of your card. request tell us: (1) the information of which you want Filing a Complaint to limit our use and disclosure; and (2) howyou want to If you are concerned that we might have violated your limit our use and/or disclosure of the information, privacy rights, or you disagree with a decision we made Confidential Communication about your individual rights, you may use the contact If you believe that a disclosure of all or part of your protected information listed at the end of this notice to complain to health information may endanger' you, you have the right to us: You also may submit a written complaint to the U.S. request that we communicate with you in confidence about Department of Health and Human Services (DHHS) , We your protected health information. This means that you will provide you with the contact information for DHHS may request that we send you information by alternative upon request. means, or to an alternate location. We must accommodate We support your right to protect the privacy of your your request if: it is reasonable, specifies the alternative protected health and financial information. We will not means or alternate location, and specifies how payment retaliate in anyway if you choose to file a complaint with issues (premiums and claims) will be handled.. You may us or with the U.S. Department of Health and Human request a Confidential Communication by writing to us Services. using the information listed at the end of this notice: Contact Information Amendment Howard County Public School System. Welfare Benefits Plan You have the right to request that we amend your protected Benefits Office health information. Your request must be in writing, and it HIPAA Compliance and Privacy Office must explain why the information should be amended. We 14 Route 148 may deny your request if we slid not create the information is Ellicott City, MD 313 you want amended or for certain other reasons. If we deny -6713 Telephoner 414- 313 -151; your request, we will provide you with a written explanation. Fax 414- 313 -1531 You may respond with a statement of disagreement, to be appended to the information you wanted amended. If we accept your request to amend the information, we will make V(MZl orwrat 6JRN Schaal System Benefits " �nrofrnient G 1 a or Actwve Employees Howard County Public Schools Important for Benefits Information The purpose of this Open Enrollment Guirie is to give you basic information about your benefits options and how to enroll for coverage or make changes to existing coverage. This guide is only a sunnnary of your cdzoices aticd rdoes tint full ytdescribe each benefit option: Please refer to yorar Certificates of Coverage provicdead by your health plan carriers for important additional information about the plans. Every effort has been made to make the informati Information Mu Benefits Plan Contact IGWar ur�t P l h al s Benefits Ertro meat Gu�c1e ®r Active Emp cayees Glossary Allowed Benefit Health Maintenance Organization ) The dollar amount allowed for services covered, regardless A health benefits program that usually has the lowest out- of the provider's actual charge. A provider who participates of- pocket costs. HMOs require that the member select a in a network cannot charge the member more than this primary care physician, generally a family practitioner, amount for any covered service. internist or pediatrician, who is part of the plan's network. There are generally small copayments and no claims to Benefit Period file. In an HMO, a referral is required from the primary A period of time for which covered services (or benefits) care physician to see any specialist in its network except are eligible for payment. an OB /GYN. Coinsurance In-Network The percentage or amount patients are required to pay Refers to the use of providers who participate in the health through their insurance plan for reasonable medical plan's provider network. Many benefit plans encourage expenses after a deductible has been satisfied. members to use participating in- network providers to Copayment reduce out -of- pocket expenses. The dollar amount a patient pays when services are received. Lifetime xi -, Deductible The maximum amount the plan will pay in benefits for The dollar amount of covered services based on the each member during their lifetime. Allowed Benefit that mast be paid by an individual or Out-of-Network family per benefit period before the insurance company The use of health care providers who have not contracted (GareFirst) begins to pay its portion of claims. with the health plan to provide services. HMS} members Diagnostic Testy are generally not covered for out -of- network services Medically necessary test(s) and/ or non - surgical except in emergency situations. Members enrolled in Preferred Provider Organizations (PPG) and Point-of- by a physicians dentist to determine Service (PQS) coverages can go out -of- network, but will if if the patient has a certain condition or disease. Such pay higher out -of- pocket. casts.:.... diagnostic tools include radiology, laboratory, pathology services or tests. ` Out-of-pocket Limit or last -of- Pocket Maximurn Durable Medical Equipment The maximum dollar amount a member will pay out- Goods, implements, prosthetics, etc., that are prescribed of- pocket in coinsurance, copays and/or deductibles in for patient care, usually in an outpatient setting. a calendar year for covered indemnity expenses. Once the out-of-pocket limit is met, the plan pays 100 % of the Examples of such equipment include hospital beds, allowed amount for covered services for the rest of the wheelchairs and walkers. benefit period. Generic Drug A drug which is the pharmaceutical equivalent to one or more brand name drugs. The Food and Drug Administration has approved such generic drugs. They meet the same standards of safety, purity, strength and effectiveness as the brand name drug; Pre-Authorization Approval necessary for designated procedures or hospital admissions. When care is received in- network, the primary care physician or Specialist is usually responsible for obtaining pre- authorization. For out- ofAnetworkservices, the member is responsible for obtaining pre - authorization. H rsrci$ Coup ynC'rrbi�c School sterra'=k my A Benefits Enrollment Guide for Active Employees Glossary (continued) Referrat A written recommendation by a physician that a ember may receive care From a specialty physician or facility. i��varci c?�Jr�tyY,Pui�iic rych�oE��i�i�iz� � >�n �ran�,mw �� #� ��n �'B�n��k��y�nro�im�nt Gui'tie }for Active employees Carefifist 1 Blue Choice 10455 Mill Run Circle Owings Mills MD 21117 www.careflrst.com CareFirst BlueChoica Inc, is an independent licensee of the Blue Cross and Blue Shield Association. 0 Registered trademark of the Blue Cross and Blue Shield Association. W Registered trademark of CareFirst of Maryland; Inc, BOK5299 IN (9110)