Risk Management & Insurance 727-588-6197 727-588-6182 – Fax WWW.pcsB.ORG/NEW-HIRE

2018 Enrollment & Change Form – Required!

Form Required if Enrolling in Coverage Online Application to Enroll in Coverage GUARANTEED ISSUE FOR NEW HIRES Employee coverage up to $100,000 elected on Enrollment & Change Form Employee coverage over $100,000 and spouse coverage require online Medical History Statement

WHEN ARE MY BENEFITS EFFECTIVE? Benefits are effective the first day of the month following 60 days of employment. Example: Hire Date Benefits Effective 8/1 10/1 4/22 7/1 You must turn in your Enrollment and Change form in person or by PONY (interoffice envelope) to Risk Management and Insurance Department within 31 days of your hire date or full time position date.

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

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

Which Health Plan is Right for You?

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

With Doctor on Demand, you pay less than a visit to urgent care: Staff HMO: $25 co-pay NPOS and CDHP: $40 or 20% of $40 after deductible has been met. Visit doctorondemand.com/humana or download the free Doctor on Demand app from the App Store or Google Play.

Healthcare Bluebook can help you find high-quality medical care at the best cost.   Go Green to Get Green You can look up a Fair Price, compare provider prices, and find the best value in your area. Click the “Go Green to Get Green” banner and you’ll earn a $25, $50, or $100 reward (on select procedures) when you choose a Fair Price provider. Download the free Healthcare Bluebook mobile app to start shopping for prices and facilities!

Set goals – create a personalized plan! go365 is a wellness and rewards program for employees enrolled in a Humana health plan that gives its members an opportunity to: Set goals – create a personalized plan! Earn Points™ and shop at the Mall with Bucks! Learn the value of making healthy choices to experience personal results! Employees reaching Silver Status or above by August 31, 2018, will be eligible for a premium credit during 2019! Employee Only              $10 credit per pay period    Employee + Spouse      $15 credit per pay period   Employee + Child/ren   $15 credit per pay period   Employee + Family        $20 credit per pay period Better health, great rewards – it’s all a part of Humana go365!

“No Health” Board Contribution Use your $75 per pay period Board Credit for: Dental Vision Accidental Death & Dismemberment Insurance Short Term/Long Term Disability MetLife HOSPITAL INDEMNITY (HIP) Flexible Spending Account Mark “Refuse” in box #1 Complete and sign page 2 EXAMPLE Board Credit $75.00 Humana Advantage Dental (2P) $13.02 Eye Med Vision (2P) $ 2.83 AD&D $100,000/Fam $ 2.10 Short Term Disability $800/16 day $12.88 Long Term Disability $800 $ 4.05 MetLife HIP (2P) $13.00 Healthcare FSA $25.00 TOTAL USED $72.88

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

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

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

13

Short Term/Long Term Disability Short Term Disability (Base Plan) pays up to 2 years for illness, up to 5 years for injury. Long Term Disability pays after the base plan. Pregnancy benefits: up to 6 weeks post partum for a normal deliver, 8 weeks post partum for a cesarean section. Monthly benefits are paid after the waiting/elimination period.

The Standard Life Insurance BOARD PAID LIFE – Employee Coverage: 1 X your annual salary, rounded to the next $1000. Minimum coverage is $15,000. VOLUNTARY FAMILY TERM LIFE Spouse and Children - $5,000 each Premium covers all eligible dependents VOLUNTARY OPTIONAL TERM LIFE Employee: $10,000 - $500,000** Spouse: $10,000 - $100,000 Online Medical Statement REQUIRED May not exceed employee coverage amount Children: $2,000 - $10,000 Mark election on Enrollment & Change Form **GUARANTEED ISSUE FOR NEW HIRES Employee coverage up to $100,000 elected on Enrollment & Change Form Employee coverage over $100,000 and spouse coverage require online Medical History Statement

Pay for day care costs for your dependent child up to age 13. PCS offers both a Healthcare FSA and a Dependent Care FSA to help you save. HEALTHCARE FSA: You have access to your full annual election amount on the very first day of the plan year! Pay for eligible medical, dental and vision expenses for you and your family members.   Minimum deduction of $10 per pay period, not to exceed $2500 per year Keep your receipts – you may be asked to provide documentation when you use your FSA debit card. DEPENDENT CARE FSA: Pay for day care costs for your dependent child up to age 13.   The IRS annual dependent care limit is $5000 per household/family. Funds become available as they are deducted from your paycheck and deposited into your account. Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31 Keep your receipts! Documentation may be required!

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

Dependent Eligibility For Medical, Dental & Vision coverages: Legally married spouse Dependent children may be covered through end of calendar year in which they reach age 26 Family OTL and Dependent Child(ren) Life Insurance coverages: Legally married spouse Dependent children may be covered up to age 26: A.) if they are dependent upon you for support: OR B.) they are a full-time student For Medical: Dependent children up to age 30, please contact Risk Management at 588-6197 for further details and documentation. DOCUMENTATION IS REQUIRED FOR DEPENDENTS enrolled in health, dental or vision coverage: marriage certificate for a spouse, birth certificates for children. Photocopies are acceptable.

5

Short term assistance with personal issues: Stress Depression Family problems Substance abuse Online training & Webinars: Financial and legal issues Childcare and Eldercare Time Management Debt Management Online courses Certificate of Distinction Educator continuing education 877-240-6863 www.pcsb.org/EAP Covers all eligible employees and family members Up to 8 free counseling sessions (in person or virtual per incident) Strictly confidential

Voluntary Products Convenient payroll deductions Enroll anytime throughout the year after your eligibility begins Group Legal Services may only enroll as a new hire or during annual enrollment 20

Retirement Florida Retirement System (FRS) You will contribute 3% of your gross pay You must decide within eight months of your hire date, which plan to select FRS Pension Plan FRS Investment Plan No election – you will default into the Investment Plan Tax Deferred Annuity Program Defer up to 25% of pay, not to exceed $15,500 per year. (If you turn age 50 or older this year, you can contribute and additional $5,000.) NO contributions /matching funds from PCS 19

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

QUESTIONS ???????????? Please do not ask questions of coworkers, school secretaries, department heads, principals. They may not have the answers that best meet your needs. Instead, contact the RISK MANAGEMENT BENEFITS TEAM for the most accurate answer at 727-588-6197 Or visit our website at www.pcsb.org/risk-benefits