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FAU –HR/Benefits.  In compliance with the federal Affordable Care Act (ACA) legislation Florida Senate Bill 1802 was passed in May 2013 to amend.

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Presentation on theme: "FAU –HR/Benefits.  In compliance with the federal Affordable Care Act (ACA) legislation Florida Senate Bill 1802 was passed in May 2013 to amend."— Presentation transcript:

1 FAU –HR/Benefits



4  In compliance with the federal Affordable Care Act (ACA) legislation Florida Senate Bill 1802 was passed in May 2013 to amend current state law and extend benefits offered through the State Group Insurance to eligible OPS and Adjunct employees that meet defined measurement criteria effective January 1, 2014. FAU-HR/Benefits

5 People First is the plan administrator for State of Florida State Group Insurance Plan Responsible for the following:  Determining Eligibility  Benefit Enrollments  Qualifying Status Changes  Open Enrollment  COBRA FAU-HR/Benefits


7 People First determines eligibility based on provisions set forth in the federal Affordable Care Act legislation and Florida state law. OPS and Adjunct Employees are eligible for coverage through the State Group Insurance beginning January 1, 2014 if they meet the following criteria:  Hired to work 30 hours or more per week (or)  Worked an average of 30 hours or more per week for a defined measurement period * Hours worked with another state agency that participates in the State Group Insurance Program concurrently with FAU employment are combined with hours worked at FAU to determine eligibility. * Adjunct Faculty hours are calculated at 9 hours for each 3 credit hour course taught. FAU-HR/Benefits

8 People First determines eligibility based on hours worked reported for defined measurement periods determined by the state. Initial Measurement Period (IMP) April 1 – October 2, 2013  Six month measurement period determines eligibility for 2014 plan year  Ineligible OPS employees will continue to be measured during the next measurement period (refer to Open Enrollment Measurement Period) FAU-HR/Benefits Open Enrollment Measurement Period (OEMP) October 3, 20YY through October 2, 20YY  Annual one-year measurement period determines eligibility for next plan year  For example, the current OEMP began 10/3/13 and extends through 10/2/14 and will determine eligibility for 2015 plan year with coverage beginning January 1, 2015 New Hire Measurement Period (NHMP) Begins 1 st of month following hire date for employees hired to work less than 30 hours per week For example, NHMP begins 10/1/13 for employee hired to begin work on 9/7/13  Extends for 12 months and eligibility is determined at the end of the period  If an OPS employee is determined to be eligible at the end of NHMP a qualifying event window will open allowing the employee 60 days to enroll in benefits

9 People First will send eligible OPS employees an enrollment packet containing detailed information Confirming eligibility Information on benefit options Enrollment process Enrollment deadlines  You must keep your mailing address updated by emailing (and include your Z#)  OPS employees with an assigned People First ID# may also logon or contact People First if you wish to have a mailing address different from home address. FAU-HR/Benefits


11 Health Basic Life Dental Vision Hospitalization Cancer Accident Disability Dependent Care Flexible Spending Account Health Savings Account  OPS employees are not eligible for Optional Life and Medical Reimbursement Accounts Enrollment in state benefits must be made through People First FAU-HR/Benefits

12 Types of Health Insurance:  PPO – Florida Blue (Blue Cross Blue Shield)  HMO - AvMed (FL counties only) - Coventry (FL counties only) Plan Options:  Standard  Low deductible – none with HMO option  You generally pay set dollar amount for services you receive (varies by service).  Monthly premiums paid for coverage  Health Investor Health Plan (HIHP)  Higher deductible (in network: $1,250 per person, $2,500 per family)  You meet deductible, then pay part of the cost for services you receive  Lower monthly premiums paid for coverage  Eligible for Health Savings Account with employer contributions FAU-HR/Benefits

13 Monthly Premiums effective Dec. 2013 Plan Type Coverage Level Monthly Premium PPO or HMO – Standard Individual$50.00 PPO or HMO – Standard Family$180.00 Spouse Program (when both spouses are State of FL, benefits eligible employees) Family$15.00 (per spouse) FAU-HR/Benefits For current rates please visit

14 PPO - Standard HMO - Standard Physicians: Choice of network/ non-network Physicians: In Network Only, Open Access Employee Responsibility: *Co-payment, Deductible, Co-insurance Employee Responsibility: Co-payment Pre-existing Exclusion: No Prescription Coverage: 30 or 90-day supply ExpressScripts (Medco) Prescription Coverage: 30 or 90-day supply ExpressScripts (Medco) FAU-HR/Benefits Co-payment: a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. Annual Deductible: this is the yearly amount you are required to pay before anything except preventive care is covered. Coinsurance: a percentage of the medical and pharmacy costs you are required to pay after your annual deductible is met.

15  Health Investor Health Plan offers a choice of PPO or HMO (same providers as Standard option)  Employee assumes greater responsibility with healthcare  Lower Premiums  High Deductibles (including HMO plan)  Participation in Health Savings Account (HSA) with employer contributions to offset out-of-pocket expenses FAU-HR/Benefits

16 Plan TypeCoverage Level Monthly Premium PPO or HMO – HIHPIndividual$15.00 PPO or HMO – HIHPFamily$64.30 Spouse Program ( when both spouses are State of FL, benefits eligible employees) Family$15.00 (per spouse) Monthly Premiums effective Dec. 2013 FAU-HR/Benefits For current rates please visit

17 Health Plan (Network) Coverage LevelAnnual Deductible PPOIndividual/Family$250/$500 HMOIndividual/FamilyNone PPO/HMO – “HIHP” Individual$1,250 PPO/HMO – “HIHP” Family$2,500 FAU-HR/Benefits


19  Employees enrolled in HIHP are able to participate in HSA to pay for out-of-pocket medical expenses on a tax-free basis  Account earns interest, functions as tax-free savings account  Participation is voluntary  FAU will contribute $500/yr for individual and $1,000/yr for family  Employees may contribute up to $2,800/yr for individual and $5,550/yr for family FAU-HR/Benefits

20 How Does It Work? Enrollment is not automatic!  After enrollment, employees must complete bank application (Tallahassee State Bank)  Receive a debit card and checks: - Pay eligible healthcare expenses directly or reimburse yourself for eligible healthcare expenses from accumulated Balance  Funds remaining in account at year-end roll over to future years  Funds in account are portable  Disclaimer: $3/mth maintenance fee (balance under $5,000) FAU-HR/Benefits

21 Plan Type Dependent Care Reimbursement Annual Contribution Limits$60 min $2500-$5000 max (depending on tax filing status) Eligible ExpensesChild or Elder Care UseCare for a child, disabled spouse or qualifying relative who: is dependent on you needs care so that you (and your spouse if you're married) can work Balance AvailableAccumulated Balance FAU-HR/Benefits


23  Coverage level determines premium  Premiums differ by dental plan 1. Employee 2. Employee + Spouse 3. Employee + Child 4. Employee + Family FAU-HR/Benefits

24 Plan Type Exams (Option 1 only) Every 12 months 100% after co-pay Every 12 months $50 allowance Glass LensesEvery 12 months 100% after co-pay Every 12 months $40, $60, $80 allowance depending on type ContactsMedically needed: 100% after co-pay Elective: $100 allowance Medically needed: $200 allowance Elective: $100 allowance FramesEvery 24 months 100% after co-pay $60 retail allowance Every 24 months $60 allowance Co-paysExam: $10 Lenses/Frames: $10 Procedure allowance  Vision Care Plans administered through Humana  Option 1: Exam + Materials or Option 2: Materials Only FAU-HR/Benefits

25  Coverage level determines premium  Premiums differ by vision plan 1. Employee 2. Employee + Spouse 3. Employee + Child 4. Employee + Family FAU-HR/Benefits

26  Hospitalization Alta & State Securities (Philadelphia American)  Cancer/Intensive Care AFLAC & Colonial  Accident/Disability Colonial  Required to meet with company representative, complete medical underwriting  Plans can either work in conjunction with or independently from health insurance  Coverage effective date determined by People First FAU-HR/Benefits

27  Spouse  Children up to age 26  Children with Disabilities:  May be covered after age limit if meet certain criteria  Overage Children up to age 30  Certain criteria and separate premium must be met FAU-HR/Benefits

28  Group Term Life policy  (incl. AD&D)  $25,000 coverage limit  Employee pays 100% of premium ($4.54/month in 2014) Policy for employee only Beneficiary designation through underwriter FAU-HR/Benefits underwritten by Minnesota Life

29 FAU STUDENT HEALTH PLAN  The College of Graduate Studies provides health insurance coverage for all university graduate assistants with appointments:  Coordinated through College of Graduate Studies  Administered by Insurance for Students, Inc.  Underwritten by United Healthcare  Individual coverage is $4,238 {Child coverage an additional $3,600 per child, Spouse additional $5,760; International students at other rates.  Eligibility based on taking 5 credit hours or more in Fall & Spring; and 3 credit hours in Summer.  Coverage period is based on the academic term(s) that the student has a qualifying assistantship (e.g., fall 8/17/2013-1/3/2014, spring 1/4/2014-5/11/2014, annual 8/17/2013- 8/16/2014)  Must actively attend class for the first 31 days after start of coverage. S TATE G ROUP I NSURANCE  OPS employees with a graduate assistantship that meet the eligibility criteria for state benefits will be offered coverage by People First  Coordinated through FAU Human Resources  Administered by People First  Underwritten by various insurance carriers { Florida Blue, AvMed, Coventry}  Employees pay premiums for Individual and Family coverage  Eligibility based on working average of 30 hours per week  Coverage period is the calendar year (e.g., annual 1/1/2014-12/31/2014) FAU-HR/Benefits  Eligibility for the State Group Insurance will not have an impact on eligibility or enrollment in the FAU Student Health Plan. Employees offered the State Group Insurance can elect coverage or choose to decline coverage without any changes to their current Student Health Plan.  Please Note: International Students with F-1 or J-1 Visas and their accompanying dependents are required to have health (medical) insurance coverage for their entire duration of studies at FAU that meets all the State of Florida Board of Governors regulations. The state’s health plans offered by the Div. of State Group Insurance do not meet all of the State of Florida Board of Governors regulations. Additionally, to continue State Group Insurance coverage OPS employees must continue to meet the state’s eligibility criteria on an annual basis.

30 U.S. federal regulations require J-1 Exchange Visitors and J-2 dependents to carry health (medical) insurance during the entire length of their program that meet minimum required health insurance coverage as per Federal Regulations (see below). Medical benefits of at least $50,000 per accident or illness Repatriation of remains (preparation and transportation of remains to home country) in the amount of $7,500 Expenses associated with the medical evacuation (transportation to home country when directed by attending physician) of the exchange visitor in the amount of $10,000 A deductible not to exceed $500 per accident or illness Coverage for pre-existing conditions after a reasonable time period (as per industry standards) Covered benefits must be paid at 75% or more per accident or illness Policy must not unreasonably exclude coverage for perils inherent to the exchange visitor’s program Insurance carrier must have an approval rating that is accepted as per Part 62.14 (c)(1) of Section 22 of the Federal Code of Regulations  The State Group Insurance health insurance plans meet the federal requirements with the exception for repatriation and medical evacuation which are required to be in compliance with federal health insurance requirements FAU-HR/Benefits


32  All OPS employees will receive an initial letter from People First with their new People First user ID  OPS employees will receive an enrollment packet in the mail only if eligible for coverage. Enroll via:  Online  Go to and enter your ID in the first field. Enter your temporary password of Pf (note: the “P” is upper case, the “f” is lower case) plus your six-digit birthday (MMDDYY). For example, if you were born February 3, 1974, your temporary password would be Pf020374  Service Center  Call 1-866-663-4735 UserID and Password required to enroll online FAU-HR/Benefits

33  People First must receive both your portion and FAU’s portion of your premium before sending update to insurance carrier  If People First does not receive premiums prior to the 2nd of the month, you will receive a certified underpayment letter in the mail Delay in premiums = Delay in carrier showing coverage  Insurance cards mailed after effective date FAU-HR/Benefits

34 Employees must enroll within 60 days of eligibility date provided by People First. Otherwise, changes can be made during the following periods: Qualifying Status Change  Marriage, divorce, birth of child, spouse lose of coverage, or spouse termination, etc.  Employees have 60 days from event to contact People First Open Enrollment  Held annually (October – November)  Coverage effective January 1 st of following year FAU-HR/Benefits

35  Please check the HR website /hr for up to date information on FAU’s Implementation of OPS  Questions regarding OPS Healthcare can be sent to Additional information on the state and federal healthcare reform laws can be found on the following websites:  Information on State of Florida benefit options  State of Florida OPS Healthcare Implementation insurance  U.S. Department of Labor – Comprehensive information about the Affordable Care Act FAU-HR/Benefits

36 For additional information or to enroll in benefits visit People First website Contact the People First Service Center at 1-866-663-4735 to have a representative assist you.  Service Center Hours: Monday through Friday 8:00am – 6:00pm EST FAU-HR/Benefits

37 Please complete the acknowledgement form to conclude your online OPS Benefits Orientation Thank you! FAU-HR/Benefits

38 I have viewed the OPS Benefits Orientation.  Name:________________________  Signature:_____________________  Date Viewed: __________________ Please print out this screen only, complete and send interoffice to HR/Benefits AD # 106. Thank you.

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