Benefits Enrollment Guide for Active Employees - 2015

Benefits Enrollment Guide for Active Employees HOWARD COUNTY PUBLIC SCHOOL SYSTEM

Plan Year January 1, 2015— December 31, 2015

Howard County Public School System—Benefits Enrollment Guide for Active Employees • C1

Table of Contents Benefit Plan Choices . . . . . . . . . 1

Prescription Drug Coverage . . 39

Letter from the Benefits Office . . . . . . . . . . . . . 2

CIGNA Dental Care . . . . . . . . 44 Delta Dental PPO Plan . . . . . . 45

Important Things to Remember . . . . . . . . . . . . . . 5

Vision Service Plan (VSP) . . . . 48

Quick Enrollment Reference Guide . . . . . . . . . . . . 6

Life and Accidental Death & Dismemberment Insurance . . 53

General Open Enrollment Information . . . . . . . . . . . . . . . . 7

Supplemental Group Term Life Insurance . . . . . . . . . 54

Special Enrollment Period . . . 10

Whole Life Insurance and Accident Coverage . . . . . . . . . 56

Notices . . . . . . . . . . . . . . . . . . 12 Continuation of Coverage (COBRA) . . . . . . . . . . . . . . . . . 13 Employee Assistance Program (EAP) . . . . . . . . . . . . 16 Employee Wellness Program . 18 Virgin Pulse . . . . . . . . . . . . . . . 20 Weight Watchers Program . . . 21

Aflac Group Critical Illness . . . 57 Short Term Disability . . . . . . . 58 Long Term Disability . . . . . . . . 59 Flexible Spending Accounts (FSAs) . . . . . . . . . . . 60 HCPSS Annual Medical Costs . . . . . . . . . . . . . 65

Aetna Open Choice® PPO . . . 22

HCPSS Dental & Vision Rates . . . . . . . . . . . . . . . 67

Open Access® Aetna Select . . 26

Benefits Open House . . . . . . . 68

BlueChoice HMO Open Access . . . . . . . . . . . . . . 30

Notice of Privacy Practices . . . 69

PPO Option . . . . . . . . . . . . . . . 33

Benefits Plan Contact Information . . . . . . . . . . . . . . . 74

HMO Options . . . . . . . . . . . . . 36

Glossary of Terms . . . . . . . . . . 75

Benefit Plan Choices

Medical Plans

Dental Plans

Aetna Open Choice PPO

CIGNA DHMO

Open Access Aetna Select HMO

Delta Dental PPO

Flexible Spending Accounts

Vision Plans Vision Service Plan (VSP)

Health Care Account Dependent Care Account

BlueChoice HMO Open Access

ReliaStar

MetLife

Whole Life/Long Term Care Rider

Basic Life

Accident

Supplemental Life/AD&D

AFLAC Critical Illness including Cancer

The Standard Short Term Disability Long Term Disability

Open Enrollment Timeline Important Dates

Open Enrollment Activity

October 13—November 7, 2014

If you are not making any changes to your current benefit elections, with the exception of Flexible Spending Accounts (FSA Medical and/or Dependent Care) they will continue for Plan Year 2015. All employees electing FSAs must go online at https://hcpss.hrintouch.com to enroll for the Plan Year 2015. Your current FSA deduction(s) will not carry over.

October 15, 2014

Benefits Open House—10:30am - 5:00pm, Central Office, Board Rooms A & B Plan Representatives and Benefit Office Staff will be present to answer any questions.

October 20, 2014


October 28, 2014


November 7, 2014

Open enrollment ends—all benefit choices must be completed online.

January 1, 2015

Benefit plan elections take effect.

January 2, 2015

Payroll Deductions Begin—Deductions are taken over 20 pay periods.

The purpose of this Benefits 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 of any discrepancy, the provisions of the legal documents will govern.

Howard County Public School System—Benefits Enrollment Guide for Active Employees • 1

Letter from the Benefits Office TO:

HCPSS Employees Eligible for Benefits

FROM: Benefits Office RE: Annual Open Enrollment for Group Benefit Plans—Plan Year 2015 October 13, 2014—November 7, 2014 It’s open enrollment time! The Annual Open Enrollment Period is October 13—November 7, 2014. During this time, we recommend that you review your personal information, the benefits being offered by Howard County Public School System (HCPSS), and the plans you are enrolled in, to determine if you would like to make any changes. The Benefits Enrollment Guide highlights the array of benefits available to employees. HCPSS is pleased to announce that we will continue to offer the same comprehensive benefits programs in Plan Year 2015, including: two health maintenance organization plans (HMOs) with Open Access Select Aetna and CareFirst Blue Cross and Blue Shield of Maryland HMO, one preferred provider organization plan (PPO) with Aetna PPO, a prescription drug program with Express Scripts, a dental PPO plan with Delta Dental PPO, a dental maintenance organization (DMO) plan with CIGNA DHMO, and a vision plan with Vision Service Plan (VSP). In addition, all of the current voluntary benefit offerings will continue for Plan year 2015. BenefitFocus will continue as the online Benefits Administrator for all HCPSS benefit offerings.

If you do not wish to make any changes, your current benefit elections will continue for Plan Year 2015, with the exception of the Medical and/ or Dependent Care Flexible Spending Accounts (FSA). Your current FSA deduction(s) will not carry over to Plan Year 2015. You will have to make a new election for Plan Year 2015. To make changes to your current benefit elections, to update your personal information, and/or to enroll in Medical and/or Dependent Care FSA(s) for Plan Year 2015, please go online to https://hcpss.hrintouch.com.

Important Changes Civil Marriage Protection Act With the passage of the Civil Marriage Protection Act, Same-Sex marriages became legal in the state of Maryland. The Act now provides same-sex couples the same benefits, protections, and obligations as oppositesex couples under Maryland law. Accordingly, effective January 1, 2015, unmarried Same-Sex Domestic Partners are no longer considered eligible Dependents, unless grandfathered.

Express Scripts Home Delivery Program Automatic enrollment in the Express Scripts Home Delivery (Mail Order) Program for certain maintenance medications has been eliminated. Mail order services are still available to members with prescriptions for maintenance medications, however, enrollment in the mail order program is voluntary. If you are currently enrolled in the Home Delivery Program, you have the option to continue in the program or opt out. For additional information regarding the Home Delivery mail order program, please refer to the section on “Prescription Drug Coverage” in this Benefits Enrollment Guide.

Benefit Offering Enhancements We are pleased to inform you of the following enhancements to our Benefit offerings:

CIGNA Dental Care HMO enhancements ■■ Restorative Fillings—Copayments for covered

procedures range from $23–$140 ■■ Periodontics—Copayments for covered

procedures range from $75–$640 ■■ Emergency Care—$65 ($77 after regularly

scheduled hours)

VSP (Vision Service Plan) enhancement/change Hearing Aid Discounts through TruHearing - Members can save up to $2,600 per pair of hearing aids. To take advantage of this offer, VSP members must sign up for this benefit at vsp.truhearing.com. VSP has teamed up with Bausch + Lomb to offer VSP members exclusive rebates on Bausch +Lomb contact lenses. VSP no longer offers rebates through ACUVUE.

2 • Howard County Public School System—Benefits Enrollment Guide for Active Employees

Letter from the Benefits Office

Insurance Cards

Supplemental Life Insurance (MetLife) enhancement During this open enrollment period, you will have the opportunity to enroll in a wide range of Supplemental Life and Dependent Life coverage options, by answering just a few medical questions. Please look for more information on this special benefit opportunity to be mailed to you directly by MetLife.

Premiums/Board Contributions We are pleased to inform you that there will be no increase in your medical, dental, vision, short-term disability, long-term disability, whole life, supplemental life and cancer/critical illness premiums for 2015. A benchmark analysis of other area public school districts shows that premium rates are increasing on average of approximately 4%. Even with no rate increase for 2015, HCPSS is able to continue to offer the same comprehensive benefits programs with no changes to the plan designs. HCPSS is proud to maintain the benefits programs at the current levels and current costs. The Board will continue to pay 87% of the monthly health premium for benefits eligible employees with a hire date on prior to 06/30/2011. All benefits eligible employees with a hire date on or after 07/01/2011, will receive a Board contribution of 85% towards their monthly health premium.

Dependent Eligibility Audit Employees, who add new dependent to their health benefits 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 Bolton Partners, Inc., an independent third party that specializes in dependent verification. You will receive an information packet with instructions on how to submit verification materials.

Insurance cards will be issued only if you are new to a plan or if you changed your coverage level. Pease note that there is no vision insurance card for the Vision Service Plan (VSP).

Learn More About Your Benefit Offerings You can learn more about the HCPSS benefit offerings by visiting our on-line enrollment system https://hcpss.hrintouch.com and/ or www.hcpss.org/employees/benefits.

Grandfathered Status Under the Patient Protection and Affordable Care Act HCPSS health plans are “grandfathered health plans” 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 that law was enacted. Being a grandfathered health plan means that your plans may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be reviewed at the Employee Benefits Security Administration, U.S. Department of Labor at www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.


Letter from the Benefits Office

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

Wednesday, October 15, 2014

10:30am – 5:00pm Central Office, Board Rooms A & B

Monday, October 20, 2014


Tuesday, October 28, 2014


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 and to assist with enrollment. The effective date for all coverage(s) is January 1, 2015. The first deduction will begin January 2, 2015. Please review the Benefits Enrollment Guide carefully, and if you have any questions contact HCPSS Benefits Support Center toll-free at (855) 859-0971, Monday–Friday 8:00am to 8:00pm EST.


Important Things to Remember ■■ Open Enrollment Period is October 13—

example; from 25% to 40%, you will have to complete a Medical History Statement and mail it to The Standard by November 30, 2014.

November 7, 2014. ■■ Review the Benefits Enrollment Guide for

Important information/changes.

■■ The deduction for short term and/or long term

■■ If you are not making any changes to your current

benefit elections, with the exception of Flexible Spending Accounts FSAs (Medical and Dependent care), they will continue for Plan Year 2015. ■■ All employees electing FSAs (Medical and/

or Dependent care) must go online to https://hcpss.hrintouch.com to enroll for Plan Year 2015. Your FSA elections will not carry over for 2015. The maximum FSA medical election for Plan Year 2015 is $2,500. The maximum FSA dependent care election for Plan Year 2015 is $5,000 per household. ■■ All employees must visit the hrintouch website

at https://hcpss.hrintouch.com to review/ update personal information and to elect/ change/cancel benefits. ■■ You MUST select a PCP for the CareFirst

disability coverage will begin the first of the month following notification of approval from The Standard. ■■ If you want to add, change or cancel your

supplemental life coverage you must make these changes during open enrollment online at https://hcpss.hrintouch.com. See the MetLife section of the Enrollment Guide for details on coverage limits and Evidence of Insurability requirements. ■■ To enroll in Whole Life Insurance with Long

Term Care Rider contact The Farmington Co. at (800) 621-0067. ■■ All medical, dental, vision, flexible spending

accounts, disability, and voluntary benefits deductions are based on 20 pays. ■■ Dependent eligibility verifications will be

BlueChoice HMO Open Access ■■ Enter your life Insurance Beneficiary

designations on Benefitfocus. ■■ If you are an existing employee and you wish to

enroll in Short Term Disability 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, 2014. New hires will not be subject to the Medical History Statement if they enroll within the first 30 days of HCPSS employment. If you are decreasing your current waiting period for short-term disability coverage for example; from 14 days to 7 days, you will have to complete a Medical History Statement and mail it to The Standard by November 30, 2014. ■■ If you are an existing employee and you wish to

enroll in Long Term Disability 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, 2014. New hires will not be subject to the Medical History Statement if they enroll within the first 30 days of HCPSS employment. If you are increasing your your benefit for long-term disability coverage for

required for any new dependents added to your benefits during open enrollment. You will receive a package with instructions for providing documentation, from Bolton Partners, Inc. ■■ All benefits elections take effect on January 1, 2015. ■■ 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 on the following dates and times. Wednesday, October 15, 2014 10:30am – 5:00pm Monday, October 20, 2014 10:30am – 5:00pm Tuesday, October 28, 2014 10:30am – 5:00pm arrier representatives will be present to provide C information and to answer any questions. In addition, the Benefits Office staff will be onsite to answer questions or to assist with enrollment. ■■ Payroll deductions begin January 2, 2015.


Quick Enrollment Reference Guide To become covered by the plan, other than during Open Enrollment, you must enroll online within 30 days from your hire date. If you are not making any changes to your current benefit elections, with the exception of Medical and/or Dependent Care Flexible Spending Accounts (FSAs), they will continue for Plan Year 2015. All employees electing FSAs must go online at https://hcpss.hrintouch.com to enroll for the Plan Year 2015. Your current FSA deduction(s) will not carry over to Plan Year 2015.

How to Enroll in Benefits ■■ To enroll/waive/change/decline your benefits, go to

https://hcpss.hrintouch.com. ■■ If you are logging in for the first time, click on Create an Account

in the login box, and follow the prompts. ■■ If you have your user name, your password has been reset to your

last name. (Important: Last names shorter than five 5 characters will be padded with zeros. Example: Last Name “Doe” would be set to “Doe00.”) ■■ If you have forgotten your user name, select Can’t Access Your Account

in the login box and follow the prompts. You will be required to reset your password. ■■ After you have logged in to the site, click on Enroll Now to enroll in

your benefits. ■■ You have completed your enrollment when you reach the green box

with the Congratulations message. ■■ To view a summary of your elections, click on the Employee Detail

Report. This report is available to you online year round simply by logging in and clicking on Enroll Now, or you may print it for your records.


HCPSS Benefits Support Center (BSC) representatives are available to help with online enrollment questions: Monday– Friday 8:00 a.m.–8:00 p.m. Phone Toll Free: (855) 859-0971.

General Open Enrollment Information Eligibility

Dependent Eligibility Verification

All Active Employees regularly scheduled to work 17.5 hours or more per week are eligible for benefits. Food Service Workers regularly scheduled to work at least 15 hours per week are eligible for benefits. 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 may be 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.

Employees who add new dependent(s) to their health benefits 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). For a complete list of dependent verification documents/ definitions of eligible dependent(s), please visit https://hcpss.hrintouch.com.

A Spouse or child in the armed forces of any country is not eligible for coverage. The term “Dependent child” means any of a Participant’s: a. Biological children;

Dependents

b. Legally adopted children or children placed in the Employee’s home pending final adoption;

Eligible Dependents are:

c. Stepchildren who permanently reside in the Employee’s household and are Dependent on the Employee for more than half of his or her support;

a. A Spouse under a legal marriage recognized by the state of Maryland or other state in the U.S.; 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 may be required from time to time;

d. Foster children (provided the foster child is not a 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.

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.


General Open Enrollment Information

Age Limits Dependent children are covered through the end of the birth month until age 26 for all medical, pharmacy, dental and vision plans. Please refer to page 6 for the definition of eligible Dependent.

Open Enrollment Information Online Information about all benefit plans can be found on https://hcpss.hrintouch.com or www.hcpss.org/employees/benefits.

Benefit Credits

HCPSS Benefits Support Center

HCPSS employees electing a Medical Plan will receive benefit credits in the amount of $420 per year. If an employee chooses to waive all Medical plans, they will receive benefit credits in the amount of $750 per year.

The HCPSS Benefits Support Center (BSC) is designed to be your first point of contact for all your benefit needs. The BSC representatives are able to provide assistance in three main areas.

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 5 for the Quick Enrollment Reference Guide.

■■ Benefits questions ■■ Technical/Application Support ■■ Transfer/Redirect Support

Call the HCPSS Benefits Support Center TollFree at 1‑855‑859‑0971, Monday – Friday, 8:00 a.m. – 8:00 p.m. EST

Changes to Benefits Coverage Due to Qualifying Event An Employee may change his election if eligible during the Plan Year when any of the following changes occur due to a qualifying event: ■■ A change in employment status, including

termination or commencement of employment of the Employee, Spouse, or Dependent. ■■ The Employee or Spouse has a significant

change in health coverage attributable to the Spouse’s employment. ■■ A reduction or increase in hours of employment by

the Employee, Spouse, or Dependent, including a switch between part-time and full-time, if eligible, 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.


General Open Enrollment Information

■■ 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. ■■ A change in employment of the Employee, Spouse,

or Dependent. ■■ You or your dependent(s) move to a new residence

outside Maryland that is not included in your current plan’s coverage area. Employee and their dependents must be enrolled under one plan. ■■ 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 Medicaid (other than pediatric vaccines).

Employees must log on to the HRIntouch website: https://hcpss.hrintouch.com to make any changes to existing coverage(s) due to a qualifying event, within 30 days of the qualifying event date.

Family Medical Leave Act (FMLA) An eligible Employee may take FMLA leave, as defined by the Family and Medical Leave Act (FMLA), due to one or more of the following: ■■ The birth of a son or daughter of the Employee and

in order to care for such son or daughter; ■■ The placement of a son or daughter with the

Employee for adoption or foster care; ■■ 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; ■■ A serious health condition that makes the Employee

unable to perform the functions of the position of such Employee;

■■ 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. While on FMLA leave, an employee’s benefits will continue and the premium cost for the elected benefits will remain the same as an active employee. Premiums will be deducted from the employee’s paycheck as long as the employee is receiving a paycheck while on FMLA leave or may be billed by our third party administrator if on an unpaid FMLA status. Employees terminating coverage due to conditions above 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. Employees who re-enroll will not be subject to Pre-Existing Waiting Period provisions.

Leave of Absence (Other than FMLA 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 the Employee return’s.

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 Administrator in a manner similar to that of FMLA Leave.


Special Enrollment Period

The Health Insurance Portability and Accountability Act (HIPAA) established special enrollment rights for certain individuals outside the normal Open Enrollment Period.

If you decline coverage for your self or your dependents during Open Enrollment because of other health insurance coverage, you have the right to enroll yourself and/or dependents within 30 days of your other coverage ending.

Conditions for Special Enrollment An Employee or Dependent is eligible to enroll during a special enrollment period if any of the following applicable conditions is met: ■■ Loss of health coverage under another employer

plan resulting from death, divorce, reduction in hours of employment or termination of other employment ■■ Termination of other employer contributions

for coverage or significant change in employer contributions to other coverage ■■ Exhaustion of COBRA continuation coverage ■■ Adding a spouse due to marriage ■■ Adding a dependent child through birth,

adoption or placement for adoption Employees must go online to https://hcpss.hrintouch.com (for the Employee or the Employee’s Dependent) within 30 days of loss of other coverage or acquiring new dependents.

Effective Date of Enrollment Under Special 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: ■■ 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. ■■ In the case of a Dependent’s birth, adoption

or placement for adoption, coverage will be effective on the date of such birth, adoption or placement for adoption. T he Children’s Health Insurance Program (CHIP) Reauthorization Act created two additional Special Enrollment rights. All group health plans must also permit eligible employees and their dependent(s) to enroll in an employer plan if the employee requests enrollment in or termination from the group health plan within 60 days of either of the following events: ■■ Loss of coverage under Medicaid or a State Child

health plan—you may enroll yourself and/or dependents not later than 60 days after coverage under Medicaid or State Child health plan ended ■■ Gaining eligibility for Medicaid or State Child health

plan allows you to enroll yourself and/or dependents in the group health plan provided you notify the Benefits Office within 60 days after you are notified of eligibility for other coverage. If you are currently enrolled in a group plan sponsored by HCPSS, you have the option of terminating coverage for yourself and/or dependents once eligible for other coverage—please note that terminating enrollment for yourself in our group health plan will also terminate coverage for your dependents.

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 health status. We are electronically transmitting data


Special Enrollment Period

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.

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. 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;

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, 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. E xcept 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.

f. 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.


Notices

Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires group health plans to make certain benefits available to participants who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits for: ■■ All stages of reconstruction of the breast on which the mastectomy

was performed ■■ Surgery and reconstruction of the other breast to produce a

symmetrical appearance ■■ Prostheses ■■ Treatment of physical complications of the mastectomy,

including lymphedema Our plans comply with these requirements. Benefits for these items generally are comparable to those provided under our plans for similar types of medical services and supplies. Of course, the extent to which any of the items is appropriate following mastectomy is a matter to be determined by the patient and her physician. Our plans neither impose penalties (for example, reducing or limiting reimbursements) nor do they provide incentives to induce attending providers to provide care inconsistent with these requirements. For more information about WHCRA coverage, contact your health plan administrator.

Newborns’ and Mothers’ Health Protection Act The Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996 is a federal law that addresses the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. In general, benefits for a hospital stay in connection with childbirth cannot restrict benefits: ■■ to less than 48 hours for a normal vaginal delivery ■■ to less than 96 hours following a delivery by cesarean section

The 48 and 96 hour period starts at the time of delivery. It is important to note that coverage subject to NMHPA guidelines is the mother’s coverage. Newborns must be added to the Employee’s health plan within 30 days of the date of birth.


Continuation of 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.

1. 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: ■■ The covered Employee is terminated (for

reasons other than Gross Misconduct*); ■■ The covered Employee’s number of hours of

employment is reduced. ■■ The covered Employee resigns.

Disability extension A qualified beneficiary may elect to extend coverage an additional 11 months, up to a maximum of 29 months, for himself/herself and 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):

■■ The date on which the qualified beneficiary

loses coverage; or ■■ 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 of the 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.

2. Loss of Dependent Eligibility A covered Dependent may elect to continue coverage under this Plan for up to 36 months, if his or her coverage ends due to any of the following qualifying events: ■■ The covered Employee dies; ■■ The covered Employee is divorced or

legally separated; ■■ The covered Employee becomes eligible for and

elects Medicare benefits; ■■ A Dependent child ceases to be a Dependent (as

defined by the Plan).

■■ The date of the Social Security Administration’s

disability determination; ■■ The date on which the qualifying event occurs;

* 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 such violation has harmed the Employer or other Employees or has been repeated by the Employee despite warning or other explicit instruction from the Employer. Employees may also be terminated for cause, such as fraudulent claims submission.


Continuation of Coverage (COBRA)

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 notify the 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.

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: ■■ 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: ■■ The last day of coverage; or ■■ 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 due date to 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.


Continuation of Coverage (COBRA)

Payment of claims

■■ The date the Continuee fails to make timely

No claim will be payable under this COBRA provision, until the COBRA Administrator receives the applicable monthly premium for the Continuee’s coverage.

■■ For a disabled Continuee who extends coverage

Termination Coverage under the COBRA provision will terminate on the earliest of the following: ■■ The date on which the Employer ceases to

provide a group health plan to Employees; ■■ 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); ■■ The date the Continuee first becomes,

payment of the monthly premium under the Plan; 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; ■■ 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; ■■ For cause, such as fraudulent claims

submission, on the same basis that coverage could be terminated for similarly situated active Employees.

after the date of the election, covered for Medicare benefits;

A Quick Look at Your COBRA Continuation Rights

Maximum COBRA Continuation For you

For your covered spouse

For your covered children

our employment ending for any reason (except gross Y misconduct) or your hours are reduced so you are no longer eligible for medical, dental, vision and the health care spending account.

18 months

18 months

18 months

ou or your covered Spouse or Dependent is disabled (as Y determined by Social Security Administration) at the time of the qualifying event, or becomes disabled during the first 60 days of COBRA continuation.

29 months

29 months

29 months

Your death

—

36 months

36 months

Your divorce or legal separation

—

36 months

36 months

You become entitled to Medicare

—

36 months

36 months

Your covered child no longer qualifies as a Dependent

—

—

36 months

Loss of coverage is due to...

Instead of enrolling in COBRA continuation coverage, there may be other more affordable coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. For more information on the Health Insurance Marketplace plans available in your state go to www.HealthCare.gov or call (800) 318-2596.


Employee Assistance Program (EAP) The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you and your dependents by the Howard County Public School System. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work/life issues in order to live happier, healthier, more balanced lives. These services are completely confidential and can be easily accessed by calling the toll-free Helpline listed below. EAP Services are available 24-hours a day, 7-days a week via toll-free nationwide number, (866) 327-2400. Employees and their household members can receive up to four (4) counseling sessions (which includes assessment, follow up and referral services) per person, per problem, per year. Wellness resources and health tips are also available via the Deer Oaks website, www.deeroaks.com (login and password: HCPSS). Eligibility: All employees and their household members/dependents are eligible to access the EAP. This includes retirees and employees who have recently separated from their employer (within 6 months of separation).

Employee Assistance Program Highlights: ■■ In-person Counseling and Assessment: A network of 50,000

mental health providers throughout the United States are available to provide in-person assessment and up to 4 counseling sessions to members wherever they may reside. ■■ Telephone Counseling and Assessments: Counselors may also

conduct comprehensive assessments by phone and provide in-themoment telephonic support and crisis intervention. ■■ Tele-Language Services: Deer Oaks has the ability to provide

therapy in a language other than English if requested. Services are available for telephonic interpretation in over 190 of the most commonly spoken languages and dialects. ■■ Referrals & Community Resources: Counselors provide referrals to

community resources, member health plans, support groups, legal resources, and child/elder care services. ■■ Advantage Financial Assist: Unlimited telephonic consultation with

a financial counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction and financial planning; supporting educational materials available; credit report review by a financial counselor and tips for improvement; objective, pressure-free advice; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).


EAP Services are available 24-hours a day, 7-days a week via toll-free nationwide number, (866) 327-2400.

Employee Assistance Program (EAP)

■■ Advantage Legal Assist: Free 30-minute

■■ Work/Life Services: Work/Life Consultants are

telephonic consultation with an attorney; free 30-minute in- person consultation; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; interactive online Simple Will preparation; access to state agencies to obtain birth certificates and other records. ID Recovery: Free 30-minute telephonic consultation with an Identity Recovery Professional; customized action plan and consultation; ongoing ID recovery guidance available as needed. Control Your ID: Free identity monitoring program through www.deeroaks.com. This service is free and at no time will you need to pay for the service. Annual renewal is required to re- register and update your information. Interactive Online Simple Will Preparation: Create a legally-binding simple statespecific will at no cost through a step by step online “interview process”. Access this service through www.deeroaks.com. ■■ Monthly Electronic Newsletters: Employees

and supervisors receive monthly e-newsletters covering a variety of topics including health and wellness, work/life balance issues, conflict resolution, leadership, and more. ■■ Online Tools & Resources: Log on to www.

deeroaks.com to access an extensive topical library containing health and wellness articles, downloadable presentations, child and elder care resources, and work/life balance resources. The Deer Oaks website also includes a wealth of information for supervisors with topics covering conflict resolution, leadership, motivation, and more.

available to assist members with a wide range of daily living resources such as pet sitters, event planners, home repair, tutors and moving services. Simply call the Helpline for resource and referral information. Health & Wellbeing: Deer Oaks encourages not only the mental health, but also the physical health and wellbeing of our members. Work/Life Consultants are available to provide referrals to providers, specialists, and resources to meet specific needs such as safety programs, support groups, fitness centers and nutrition programs. College Assist: Preparing for college is a very exciting time for parents and their children. However, it can all too easily become an overwhelming and stressful process. Through www.deeroaks.com, your EAP provides articles and resources that offer helpful tools and tips for handling a variety of issues such as choosing the right college, selecting a major, locating enrichment programs, special needs education, financial aid options and scholarships. ■■ Find-Now Child & Elder Care Program: This

program assists participants caring for children and/or aging parents with the search for licensed, regulated, and inspected child and elder care facilities in their area. Work/Life Consultants assess each member’s needs; provide guidance, resources, and a list of up to three (3) referrals within 12 hours of the call. Searchable databases and other resources are also available on the Deer Oaks website.


Employee Wellness Program Help and support for your journey to better health

Howard County Public Schools System’s Commit To Be Fit Employee Wellness Program will provide you with information, tools, resources and services to help you create and maintain a healthy lifestyle. The Employee Wellness Program is available to you regardless of the medical plan you select at enrollment.

Our Vision is to Begin and End Each Day with Energy and Vitality We invite you to share our vision. With good health all things are possible. When we feel our best, we can do our best and serve as role models for the lives we touch. Our goal is to help you achieve your “personal best” health.

Get to Know the HCPSS Employee Wellness Program The HCPSS Employee Wellness Program can help you make lasting changes in your health—and your life. The program will: ■■ Help you know more about your personal health

profile, including any risk factors. ■■ Empower you to address your health risks through

simple lifestyle changes. ■■ Give you the information and support to better

manage a chronic condition. ■■ Provide one-on-one coaching to help you set and

achieve health-related goals. Our mission is to create an environment that supports and celebrates each individual’s lifelong journey toward optimal physical, social, intellectual, emotional and financial well-being by providing awareness, education, motivation and behavior change programs. To protect against illness and uncover serious health conditions at their earliest stages, you will want to build a preventive care plan. Be sure to schedule your annual checkup, have any necessary immunizations, and of course, set up any necessary cancer screenings such as mammograms, colonoscopies and PSA (prostate-specific antigen) exams, based on your age and health history.


Remember the saying: An ounce of prevention is worth a pound of cure!

Employee Wellness Program Help and support for your journey to better health

Take Action to Know More About Your Health Keeping you motivated to reach your wellness goals with fun and healthy challenges, contests, health tips, team competitions and more! Other parts of the daily engagement platform include: ■■ Tracking—Use your Pedometer to track your steps

daily or visit a HealthZone and track your weight and blood pressure. Visit the website to track your progress and keep an eye on your healthy choices. ■■ Social—Friend your fellow HCPSS employees, chat

with them on the newsfeed, follow their progress, and get healthy together! ■■ Programs—Participate in programs like coaching

or take the Health Risk Assessment to serve as a benchmark as you work toward your wellness goals. ■■ Games & Quizzes—From a sun protection quiz,

a hydration game, to a hug your loved ones day, you can create tons of different ways to play and participate with Virgin Pulse. ■■ Challenges—Which of your friends in the teacher’s

lounge can get the most steps? Burn the most calories? Participate in Personal and School System wide challenges. ■■ Weekly fitness classes that include yoga, Zumba,

and Pilates to keep you active. ■■ As part of our educations series, you will have

access to monthly seminars dealing with health and wellness, financial fitness, and stress reduction. ■■ One on One and Online Coaching with modules in:

Weight Loss Stress Sleep Nutrition Activity Depression Smoking Cessation Rewards—EARN up to $500 in cash per year for participating!

The Commit To Be Fit Employee Wellness Program supports Howard County Public School System and Virgin Pulse’s commitment to good health. It’s a step-by-step journey that helps you make gradual and lasting changes that fit into your life. Best of all, the program works at many different levels, so anyone can benefit from it. The Health Assessment is a secure, confidential online questionnaire that covers topics such as lifestyle, health history, health screenings, and work and daily life. It’s available to you 24/7 and only takes 15-20 minutes to complete. When you’re done, you will know more about your personal health risks and what you can do about them. After you complete the Health Assessment, you will receive a health score, plus personalized health reports and an action plan. Your action plan will include recommendations for online wellness programs that are broken down into easy-to-complete modules that you can complete at your own pace. Information, inspiration and support to help you achieve your health goals No matter what your health goals and challenges, it can help to have someone in your corner to encourage, advise and inform. With the Healthy Lifestyle Coaching program, you will have one-on-one support from a trained wellness coach to make the positive changes you’ve always wanted to make and live your healthiest life.


Virgin Pulse

Get ready to think outside the gym. The Virgin Pulse program makes getting active not just another to-do, but a fun and integral part of your world. And did we mention rewards?! Earn up to $500 a year for getting active and participating in other healthy activities. And it’s free; HCPSS is covering all of the costs for the program.

Here’s what you get ■■ Personal activity tracker… it’s free when you join! ■■ Highly personalized Health & Well-Being

Programs: telephonic health coaching and/or online lifestyle management programs ■■ Access all your programs from your personal

daily engagement site ■■ Access to a HealthZone measurement station to

check your weight, blood pressure, and body fat each month ■■ One on one or online wellness coaching ■■ A fun way to get active with your colleagues ■■ Earn up to $500 per year in cash!

Here’s how it works Pedometer—Track your steps, do the work, and keep motivated, keep moving! You can earn points every day you upload steps and the more you move the more points you will earn. Self-Entry Activity—Love to swim, dance, run? Get points for adding your other activities like running or Swimming into your personal activity journal. Individual Challenges—Let’s Play! Keep your competitive edge by challenging others to see if they can beat you. Win badges and bragging rights. Who’s the Top dog this week? Big Picture Challenges—Earn points by competing against yourself in a steps challenge and win a dream vacation or an iPad. Virgin Pulse gives you the chance to compete in challenges just for HCPSS or with every company that participates in our program.

Online Coaching—Looking for something to help you take the next step in you wellness journey? Telephonic Coaching—Have some fun with a series of one-on-one coaching sessions covering topics that can go beyond activity. Call 866-380-5948 to speak with a coach today! Health Risk Assessment—Not sure where to start? This brief assessment is the best way for you to gauge your health status. Simply fill it out through your secure and private online platform. As always your answers remain completely confidential. Health Zones—Do you know your numbers? Have you just assumed that everything is going well? Visit a Health Station monthly to take validated blood pressure and weight measurements. Rewards for Healthy Behaviors—HCPSS will give you extra points for taking care of yourself and visiting your medical providers for annual physicals, eye exams, dental exams and more. We’ll keep you motivated all year long with challenges, contests, team competitions with your coworkers and more! HCPSS will also give you opportunities to participate in healthy activities for even more HealthMiles. Sign up for Virgin Pulse, a fun and rewarding way to get and stay active. The more you do, the better you feel, and the more rewards you can earn. It’s confidential—Your privacy is very important to us. All your personal health information is strictly confidential. Your employer may be told that you are participating in a health program. However, your personal health and medical information are strictly protected.

If you have any questions about the Virgin Pulse program, please contact Virgin Customer Service at (866) 852-6898. Not a member yet? Log onto http://join.virginpulse.com/hcpss. 20 • Howard County Public School System—Benefits Enrollment Guide for Active Employees

Weight Watchers Program

The HCPSS Commit To Be Fit Employee Wellness Council is excited to continue its partnership with Weight Watchers. This program is designed to bring employees special savings! Weight Watchers offers flexible and convenient weight loss solutions to fit into your life.

Employees May Choose One of the Following Options Weight Watchers Meeting with Monthly Pass FREE Registration, unlimited meetings each month in your local community or at your worksite (with enrollment of 15 members), and FREE eTools, the internet weight-loss companion with interactive tools that you can access anytime to help keep you on track between meetings. Also includes FREE access to Weight Watchers Smart Phone and iPad applications. Month to month commitment. Special Enhanced Pricing for HCPSS Employees: $18.25/month.

Weight Watchers Online Follow the Weight Watchers plan step-by-step online, with interactive tools and resources like a weight tracker, progress charts, restaurant guides and much more. Available in two versions specifically designed for men and women with tailored content that speaks directly to each audience. Also includes FREE access to Weight Watchers Smart Phone and iPad applications. Month to month commitment. Special Enhanced Pricing for HCPSS Employees: $18.95/month. Register at https://wellness.weightwatchers.com/hcpss and use Company ID 13065 and Passcode WW13065. Unique ID is your employee ID beginning with E. Indicate your school NAME in the address field.

Once your school has 15 memberships, an onsite weekly meeting will be scheduled!

If you are a current Weight Watchers member, call (866) 204‑2885 to have your membership changed to the HCPSS rate.


Aetna Open Choice PPO ®

Featuring more freedom and more choice with a nationwide network of health care providers

With Aetna, you get a powerful health care resource. Aetna’s nationwide Open Choice PPO network includesover 1,200,000 health care providers; over 200,000 of whom are Primary Care Providers (PCPs). This makes it easy to find a network doctor or a hospital, whether you are at home, work or traveling.

Your Aetna PPO Plan Gives You More Freedom of Choice When you need care, you have a choice. You can receive care within the network and pay less for your care. Or, you can choose to receive care outside the network and still receive benefits, but at a lower level.

Here’s how the PPO Plan works: IN-NETWORK

OUT-OF-NETWORK

Visit any doctor in the network without a referral

Visit a doctor who is not part of the network

■■ You pay a flat copay for

■■ You need to meet an

your care ■■ Your doctor will file your

medical claims ■■ You do not need to

get a referral to see a specialist ■■ You are not charged the

difference between the doctor’s charge and the amount that is covered by the plan

annual deductible ■■ You pay for the full

amount of the charge at the time you receive care

How to use DocFind Visit www.aetna.com and look for the link on the home page to Find a Doctor. You will provide some basic information to start your search, and choose a Provider Category (such as Medical Providers) and a Provider Type (such as Specialists). To Select a Plan, look under Aetna Standard Plans and select Open Choice® PPO. You can then narrow your search by specialty, name and other criteria, or search for all network providers in your geographic area. DocFind is updated three times a week, so it contains the most current information available. But if you aren’t sure about a provider’s network status, you can either call the provider’s office or call Aetna Member Services at (888) 502-3862.

■■ You need to file a claim

to be reimbursed for covered expenses ■■ You may also have to pay

the difference between the doctor’s charge and the amount covered by the plan

Find the Right Doctor It’s quick and easy with DocFind® DocFind, Aetna’s online provider directory at www.aetna.com, lists the doctors, hospitals, urgent care facilities and other health care providers that belong to Aetna’s network. You can search by name or specialty, or do a geographic search to find all network providers within a given area. You can also get information about each provider’s professional training and credentials, office hours, languages spoken, handicapped access, and more.

Wherever you go, Aetna is there If you’re vacationing in Florida and need care while you’re away, you can find network providers there as well. Do you have a child attending school in another state? Again, Aetna has network doctors available to provide their care. And finding them is easy with DocFind®, the online provider directory available at www.aetna.com. You can even access DocFind with your smart phone!

Leaving the country? If you are out of the country and need medical care, you can get the care you need then submit a claim to Aetna and be reimbursed at the out-of-network level of benefits. For help and assistance, call Aetna Member Services using the number on your Aetna ID card: (888) 502-3862.


Aetna Open Choice® PPO

A wide selection of mental health providers When you or a covered family member needs counseling, therapy or other mental health services, Aetna can offer a large selection of network providers. Use DocFind to see for yourself. Just fill in the geographic information on the General Search page, then under Provider Category, select Behavioral Health. Look under Provider Type and select what you are looking for.

Online Tools & Resources

■■ Cost-of-care tools that give you the estimated

Look up claim information, research costs, go mobile—and more In addition to the nationwide network, Aetna provides a wealth of information, tools, resources and services to help you manage your benefits and stay healthy.

It all starts with Aetna Navigator® Aetna Navigator, your secure member website, is your prime resource for claim and benefits information, consumer tools, self-service convenience and so much more. Once you register with Aetna Navigator at www.aetna.com, you will have a personal home page where you can access online tools and programs that include: ■■ Access to claim information that lets you look up

the status of a claim and view your Explanation of Benefits statements (EOBs) online. You can also use the “send a message” feature to email Aetna Member Services with claim-related questions. ■■ Benefit information that includes a summary of your

medical plan benefits, the names of your family members covered under the plan and a listing of health and wellness programs included with your plan.

Aetna Navigator is easy to use! Once you’re enrolled with Aetna, you can visit www.aetna.com to register with Aetna Navigator. By registering, you set up your own password so that you, and only you, can access your personal health information. If you need help, Aetna’s virtual assistant, “Ann”, is there to guide you. Look for her on the home page. You will also see an invitation to “take a tour” of the site and discover how easy it is to find what you are looking for.

average costs of procedures and tests, treatments for diseases and conditions, and prescription drugs. ■■ Links to reliable, up-to-date health

information through: etna InteliHealth®, the award-winning A health information website with the latest information from Harvard Medical School. ealthwise® Knowledgebase, an online H reference and decision support tool that provides reliable information on a variety of health care topics and issues. etna SmartSourceSM, a tool that scans A all of Aetna’s online resources to pull up health information tailored to your interests and needs.

Your Personal Health Record One secure and confidential place for all your health information From Aetna Navigator, you can also link to your Personal Health Record (PHR). The PHR puts all of your claimsbased information in one handy place so you can see medical procedures and services received, medications prescribed, and preventive and routine care provided—by whom and when. Having trouble remembering when you had an exam or procedure? Want to find out when you started taking that new medication? Need to know which doctor you saw for a certain health problem or condition? It’s all in your PHR. You can also enter your own information, such as overthe-counter drugs and nutritional supplements you use. You may want to print a copy of your PHR and share it with your doctor.



Go mobile with Aetna Visit Aetna Navigator anytime, anywhere. You can log in using any mobile phone with web access. It’s fast, easy and so convenient! Type www.aetna.com in your browser and you will be able to find in-network providers, view or show a virtual member ID card, check on claims, contact Aetna Member Services and much more.

Maternity Program Give your baby a healthy start with Beginning Right® If you or your covered spouse are planning to have or expecting a baby, you should enroll in Aetna’s Beginning Right Maternity Management Program. Beginning Right is part of your Aetna medical plan. When you enroll in the program, you will learn about prenatal care, labor and delivery, newborn care, breastfeeding and more. Plus, you also receive health coaching from registered nurses who can help you with any special health concerns.

Manage Your Health With Aetna’s Disease Management Program Aetna’s Disease Management Program provides one‑on‑one support, information and advice from a team of trained disease management nurses and other health professionals for more than 35 diseases and conditions, including diabetes, asthma, osteoporosis, heart disease and others. When you agree to participate in the program, you get help with medical services and benefits relating to your health condition: ■■ You will talk with a trained nurse about the health

concerns that matter to you. ■■ You receive help and guidance to follow your

doctor’s treatment plan, get important preventive care and manage your risks for other conditions. ■■ Your personal information is kept private and

secure, in full compliance with federal and state law. It is not shared with HCPSS. Aetna nurses will guide you through the maze of information and choices that come along with a health condition and its treatment.

Help and Information is Just a Phone Call Away Aetna Member Services: (888) 502-3862 Aetna Member Services can help with questions about your plan and its benefits, claims and claim payments, ordering a new ID card and a host of other benefits needs. Aetna Member Services representatives are available from 8:00 a.m. to 6:00 p.m. EST, Monday through Friday. You also may access our voice-activated telephone system 24 hours a day, 7 days a week.

24-hour Nurse Line: (800) 556-1555 Available 24 hours a day, 7 days a week, the toll-free Informed Health® Line gives you a quick, simple way to get answers to health-related questions. When you call, you will talk with a trained nurse who can provide information on hundreds of health topics, help you decide where to seek care, tell you how to take care of a health problem until you can get to the doctor, and much more. Howard County Public Schools has partnered with Teladoc® to provide you and your eligible dependents with 24/7/365 access to U.S. board-certified doctors and pediatricians by phone or online video.

Teledoc With Teladoc you can: ■■ Resolve many of your medical issues—Teladoc

can diagnose, recommend treatment and prescribe medication, when appropriate, for many of your medical issues. ■■ Speak with U.S. board-certified doctors—Our

national network includes the highest quality, state-licensed doctors who will call you back within 22 minutes, on average.



■■ Use it anywhere/anytime—On vacation? Is it

3 a.m. and you need care now? No problem. Teladoc doctors are available 24/7/365 via phone and online video consultations. ■■ Save money—At $38 or less per consultation,

Teladoc costs you much less than urgent care or ER visits. Teladoc has quality care for conditions including: Sinus problems

Keep it Simple! You will enjoy the many conveniences of your Aetna Open Choice PPO plan: ■■ You have access to a nationwide network

of doctors, specialists, hospitals and other health care facilities to provide your care at home, at work, or traveling ■■ You pay a flat copay for your care

Bronchitis

■■ You decide to receive care within the

Allergies

network, or out of the network

Poison ivy

■■ You have access to a 24-hour nurse

Cold and flu symptoms

line service

Urinary tract infection Respiratory infection

■■ There are no referrals for in-network care

And More!

■■ There is no need to file claims for

in-network care

Get started with Teladoc today!

■■ A deductible only applies to care received

■■ Step 1: Set up your account

e’ve made it quick and easy. Simply go to W Teladoc.com/Aetna and click Set up account ■■ Step 2: Complete your medical history

Informed doctors equal better care. Log into your account and complete the My Medical History section ■■ Step 3: Request a consultation

Teladoc doctor is just a click or a call away. A Visit Teladoc.com/Aetna or call (855) Teladoc.

out-of-network

■■ Aetna Weight ManagementSM Discount Program—

Save on weight-loss programs and products from some of the world’s leading weight-management firms, such as Nutrisystem®, Jenny Craig ® and eDiets®. You also get big savings on: ■■ Sonic toothbrushes and water-jet flossers

from Waterpik®.

Save Money! You and your enrolled family members can take advantage of these discount programs available through Aetna: ■■ Aetna Fitness

Discount Program—Save on fitness club memberships, home exercise equipment and more. To find a participating fitness center, go to www.globalfit.com. SM

■■ Epic dental products, like gum, toothpaste, and

mouth rinses. ■■ Books and other items from the American

Cancer Society ®, Bookstore and the MayoClinic.com Bookstore. ■■ ZAGAT.com membership (30% off a one-

year membership)

■■ Aetna VisionSM Program—Pay less for eyeglasses,

contact lenses, sunglasses and LASIK surgery. ■■ Aetna Natural Products and ServicesSM Discount

Program—Save on health services, like massage therapy, acupuncture, chiropractic care, nutritional counseling and other natural wellness products. ■■ Aetna Hearing SM Discounts—You can save on the

latest hearing aid styles and technology, and on the retail price of hearing exams. Howard County Public School System—Benefits Enrollment Guide for Active Employees • 25

Open Access Aetna Select ®

An HMO Plan with a nationwide network of health care providers

With Aetna, you get a powerful health care resource. The Open Access® Aetna Select features a nationwide network that includes over 800,000 health care providers; over 115,000 of whom are Primary Care Providers (PCPs). This makes it easy to find a network doctor or a hospital, whether you are at home, work or traveling.

Your Aetna Select Plan Gives You More Freedom

Find the Right Doctor

There’s no requirement to select a PCP, or obtain referrals for specialty care. When you need care, you’re covered— no matter where you live. Our network of medical providers and facilities is nationwide, offering a full range of primary care doctors and specialists wherever you need them. When you visit a network provider, you will pay a flat copay for your care. There’s no claim paperwork— your network provider will handle all claims for you. It’s important to know that, under Open Access Aetna Select, you must see a network provider in order to receive benefits from the plan.

DocFind, Aetna’s online provider directory at www.aetna.com, lists the doctors, hospitals, urgent care facilities and other health care providers that belong to Aetna’s network. You can search by name or specialty, or do a geographic search to find all network providers within a given area. You can also get information about each provider’s professional training and credentials, office hours, languages spoken, handicapped access, and more.

Wherever you go, Aetna is there If you’re vacationing in Florida and need care while you’re away, you can find network providers there as well. Do you have a child attending school in another state? Again, Aetna has network doctors available to provide their care. And finding them is easy with DocFind®, the online provider directory available at www.aetna.com. You can even access DocFind with your smart phone!

It’s quick and easy with DocFind®

How to use DocFind Visit www.aetna.com and look for the link on the home page to Find a Doctor. You will provide some basic information to start your search, and choose a Provider Category (such as Medical Providers) and a Provider Type (such as Specialists). To Select a Plan, look under Aetna Open Access Plans and select Aetna SelectSM (Open Access). You can then narrow your search by specialty, name and other criteria, or search for all network providers in your geographic area. DocFind is updated three times a week, so it contains the most current information available. But if you aren’t sure about a provider’s network status, you can either call the provider’s office or call Aetna Member Services at (888) 502-3862.


Open Access® Aetna Select

A Wide Selection of Mental Health Providers When you or a covered family member needs counseling, therapy or other mental health services, Aetna can offer a large selection of network providers. Use DocFind to see for yourself. Just fill in the geographic information on the General Search page, then under Provider Category, select Behavioral Health. Look under Provider Type and select what you are looking for.

Online Tools & Resources

■■ Cost-of-care tools that give you the estimated

Look up claim information, research costs, go mobile—and more In addition to the nationwide network, Aetna provides a wealth of information, tools, resources and services to help you manage your benefits and stay healthy.

It all starts with Aetna Navigator® Aetna Navigator, your secure member website, is your prime resource for claim and benefits information, consumer tools, self-service convenience and so much more. Once you register with Aetna Navigator at www.aetna.com, you will have a personal home page where you can access online tools and programs that include: ■■ Access to claim information that lets you look up

the status of a claim and view your Explanation of Benefits statements (EOBs) online. You can also use the “send a message” feature to email Aetna Member Services with claim-related questions. ■■ Benefit information that includes a summary of your

medical plan benefits, the names of your family members covered under the plan and a listing of health and wellness programs included with your plan.

Aetna Navigator is easy to use! Once you’re enrolled with Aetna, you can visit www.aetna.com to register with Aetna Navigator. By registering, you set up your own password so that you, and only you, can access your personal health information. If you need help, Aetna’s virtual assistant, “Ann”, is there to guide you. Look for her on the home page. You will also see an invitation to “take a tour” of the site and discover how easy it is to find what you are looking for.

average costs of procedures and tests, treatments for diseases and conditions, and prescription drugs. ■■ Links to reliable, up-to-date health

information through: etna InteliHealth®, the award-winning A health information website with the latest information from Harvard Medical School. ealthwise® Knowledgebase, an online H reference and decision support tool that provides reliable information on a variety of health care topics and issues. etna SmartSourceSM, a tool that scans A all of Aetna’s online resources to pull up health information tailored to your interests and needs.

Your Personal Health Record One secure and confidential place for all your health information From Aetna Navigator, you can also link to your Personal Health Record (PHR). The PHR puts all of your claimsbased information in one handy place so you can see medical procedures and services received, medications prescribed, and preventive and routine care provided—by whom and when. Having trouble remembering when you had an exam or procedure? Want to find out when you started taking that new medication? Need to know which doctor you saw for a certain health problem or condition? It’s all in your PHR. You can also enter your own information, such as overthe-counter drugs and nutritional supplements you use. You may want to print a copy of your PHR and share it with your doctor.



Go mobile with Aetna Visit Aetna Navigator anytime, anywhere. You can log in using any mobile phone with web access. It’s fast, easy and so convenient! Type www.aetna.com in your browser and you will be able to find in-network providers, view or show a virtual member ID card, check on claims, contact Aetna Member Services and much more.

Maternity Program Give Your baby a healthy start with Beginning Right® If you or your covered spouse are planning to have or expecting a baby, you should enroll in Aetna’s Beginning Right Maternity Management Program. Beginning Right is part of your Aetna medical plan. When you enroll in the program, you will learn about prenatal care, labor and delivery, newborn care, breastfeeding and more. Plus, you also receive health coaching from registered nurses who can help you with any special health concerns.

Manage Your Health With Aetna’s Disease Management Program Aetna’s Disease Management Program provides one‑on‑one support, information and advice from a team of trained disease management nurses and other health professionals for more than 35 diseases and conditions, including diabetes, asthma, osteoporosis, heart disease and others. When you agree to participate in the program, you get help with medical services and benefits relating to your health condition: ■■ You will talk with a trained nurse about the health

concerns that matter to you. ■■ You receive help and guidance to follow your

doctor’s treatment plan, get important preventive care and manage your risks for other conditions. ■■ Your personal information is kept private and

secure, in full compliance with federal and state law. It is not shared with HCPSS. Aetna nurses will guide you through the maze of information and choices that come along with a health condition and its treatment.

Help and Information is Just a Phone Call Away Aetna Member Services: (888) 502-3862 Aetna Member Services can help with questions about your plan and its benefits, claims and claim payments, ordering a new ID card and a host of other benefits needs. Aetna Member Services representatives are available from 8:00 a.m. to 6:00 p.m. EST, Monday through Friday. You also may access our voice-activated telephone system 24 hours a day, 7 days a week.

24-hour Nurse Line: (800) 556-1555 Available 24 hours a day, 7 days a week, the toll-free Informed Health® Line gives you a quick, simple way to get answers to health-related questions. When you call, you will talk with a trained nurse who can provide information on hundreds of health topics, help you decide where to seek care, tell you how to take care of a health problem until you can get to the doctor, and much more. Howard County Public Schools has partnered with Teladoc® to provide you and your eligible dependents with 24/7/365 access to U.S. board-certified doctors and pediatricians by phone or online video.

Teledoc With Teladoc you can: ■■ Resolve many of your medical issues—Teladoc

can diagnose, recommend treatment and prescribe medication, when appropriate, for many of your medical issues. ■■ Speak with U.S. board-certified doctors—Our

national network includes the highest quality, state-licensed doctors who will call you back within 22 minutes, on average.



■■ Use it anywhere/anytime—On vacation? Is it

3 a.m. and you need care now? No problem. Teladoc doctors are available 24/7/365 via phone and online video consultations. ■■ Save money—At $38 or less per consultation,

Teladoc costs you much less than urgent care or ER visits. Teladoc has quality care for conditions including: Sinus problems

Keep it Simple! You will enjoy the many conveniences of your Open Access Aetna Select plan: ■■ You have access to a nationwide network

of doctors, specialists, hospitals and other health care facilities to provide your care at home, at work, or traveling ■■ You pay a flat copay for your care

Bronchitis

■■ You have access to a 24-hour nurse

Allergies

line service

Poison ivy Cold and flu symptoms

■■ There are no referrals

Urinary tract infection

■■ There is no need to file claims

Respiratory infection

■■ There is no deductible

And More!

Get started with Teladoc today!

■■ Aetna Weight ManagementSM Discount Program—

■■ Step 1: Set up your account

e’ve made it quick and easy. Simply go to W Teladoc.com/Aetna and click Set up account ■■ Step 2: Complete your medical history

Informed doctors equal better care. Log into your account and complete the My Medical History section

You also get big savings on: ■■ Sonic toothbrushes and water-jet flossers

from Waterpik®.

■■ Step 3: Request a consultation

Teladoc doctor is just a click or a call away. A Visit Teladoc.com/Aetna or call (855) Teladoc.

■■ Epic dental products, like gum, toothpaste, and

mouth rinses. ■■ Books and other items from the American

Save Money! You and your enrolled family members can take advantage of these discount programs available through Aetna: ■■ Aetna Fitness

Save on weight-loss programs and products from some of the world’s leading weight-management firms, such as Nutrisystem®, Jenny Craig ® and eDiets®.

Cancer Society ®, Bookstore and the MayoClinic.com Bookstore. ■■ ZAGAT.com membership (30% off a one-

year membership)

Discount Program—Save on fitness club memberships, home exercise equipment and more. To find a participating fitness center, go to www.globalfit.com. SM

■■ Aetna VisionSM Program—Pay less for eyeglasses,

contact lenses, sunglasses and LASIK surgery. ■■ Aetna Natural Products and ServicesSM Discount

Program—Save on health services, like massage therapy, acupuncture, chiropractic care, nutritional counseling and other natural wellness products. ■■ Aetna Hearing SM Discounts—You can save on the

latest hearing aid styles and technology, and on the retail price of hearing exams. Howard County Public School System—Benefits Enrollment Guide for Active Employees • 29

BlueChoice HMO Open Access An HMO Plan with No Referrals Required

With a BlueChoice HMO Open Access plan, your primary care provider (PCP) provides preventive care and works with you to find specialty care using a large network of CareFirst BlueChoice specialists. However, unique to this plan is its Open Access feature which allows you to visit specialists directly without needing a referral from your PCP.

Benefits of BlueChoice HMO Open Access ■■ Choose from more than 37,000 providers, specialists

and hospitals in Maryland, Washington, D.C. and Northern Virginia. ■■ HMO plans encourage you to establish a relationship

with your PCP for consistent, quality care. ■■ No PCP referral required to see a specialist. ■■ Receive comprehensive coverage for preventive

health care visits at no cost. ■■ Avoid the unwelcome surprise of high medical

costs with predictable copays and deductibles (if applicable). ■■ Save time—you don’t have to file a claim when you

receive care from a CareFirst BlueChoice provider. ■■ Avoid balance billing when you receive care from a

CareFirst BlueChoice provider. ■■ Access the Away From Home Care® program to enjoy

plan benefits if you’re out of the area for at least 90 days.

How Your Plan Works Establishing a relationship with one provider is the best way for you to receive consistent, quality health care. When you enroll in a BlueChoice HMO Open Access plan, you will select a PCP to manage your primary medical care. Make sure you select a PCP for not only yourself but each of your family members as well. Your PCP must participate in the CareFirst BlueChoice provider network and must specialize in either family practice, general practice, pediatrics or internal medicine.


The BlueChoice HMO plan achieved a “Commendable” rating from the National Committee for Quality Assurance (NCQA).


To ensure you receive the highest level of benefits (and pay the lowest out-of-pocket cost), you should first call your PCP when you need care. Your PCP will: ■■ Provide basic medical care. ■■ Prescribe any medications you need. ■■ Maintain your medical history. ■■ Work with you to determine when you should

see a specialist. ■■ Assist you in the selection of a specialist,

if needed. While traditional HMO plans require you to obtain a written referral from your PCP before seeing a specialist, this plan has an Open Access feature, so you have direct access to CareFirst BlueChoice specialists without needing a written referral from your PCP. Make sure you only receive care from a CareFirst BlueChoice provider or you will not be covered, with the exception of emergency services and follow-up care after emergency surgery.

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 allow you 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.

Laboratory Services To receive the maximum laboratory benefit from your BlueChoice HMO Open Access plan, you must use a LabCorp® facility for any laboratory services. Services performed at a facility that is not part of the LabCorp network may not be covered under your plan. Also, any lab work performed in an outpatient hospital setting will require a prior authorization from your PCP. LabCorp has approximately 100 locations throughout Maryland, Washington, D.C. and Northern Virginia. To locate the LabCorp patient service center near you, call (888) LAB-CORP or visit www.labcorp.com.

Maternity and Well-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.

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.



Away 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.

Out-of-Area Coverage Out-of-area coverage is limited to emergency or urgent care only. However, members and their covered dependents planning to be out of the CareFirst BlueChoice, Inc. service area for at least 90 consecutive days may be able to take advantage of a special program, Away From Home Care®.

Currently the following states do not participate in the Away From Home Care Program: Alabama, Alaska, Idaho, Kansas, Mississippi, Montana, Nebraska, North Dakota, Oregon, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wyoming. Please call the member services number on your card to confirm your states participation status. For more information on the Away from Home Care® Program and to enroll, contact Member Services at (866) 520-6099.


PPO Option January 1, 2015–December 31, 2015 Aetna PPO

Benefits

In-Network

Out-of-Network

COST SHARING LIFETIME LIMITS Calendar Year Deductible Individual Family

None None

$100 $300

Calendar Year Out-of-Pocket Maximum Individual Family

$500 includes copays $1500 includes copays

$1,000 includes deductibles and copays $3,000 includes deductibles and copays

Coinsurance

100%

80% after deductible

Lifetime Maximum

Unlimited

Unlimited

Primary Care Office Visit

$15 copay


Gynecology Office Visit

$15 copay for Well Woman visit or $20 copay for all other visits


Specialist Office Visit

$20 copay


Physical Therapy Office Visit

100% (120 visits combined with Occupational Therapy).

80% after deductible 120 visits combined with Occupational Therapy.

Speech Therapy Office Visit

100% no copay 60 visits.

80% after deductible 60 visits.

Occupational Therapy Visit

100% (120 visits combined with Physical Therapy).

80% after deductible 120 visits combined with Physical Therapy.

Chiropractic Office Visit

100% (limited to 30 visit maximum combined in and out of network) Preauthorization not required.

80% after deductible (limited to 30 visit maximum combined in and out of network) Preauthorization not required.

PROFESSIONAL SERVICES

Allergy Shots/Other Covered Injections 100% after copay


Allergy Serum

100% after copay


Allergy Testing

Covered as either a PCP or Specialist office visit


Diagnostic tests

Included with PCP or Specialist copayment


Diagnostic tests performed by lab or other testing facility and billed separately from office visit

100%


Well Child Visit/Immunization

$15 copay


Routine Adult Physical

$15 copay


Routine Gynecological Exam

$15 copay, one exam per calendar year 80% after deductible, one exam per calendar year

Routine Pap Smear

100% when included with routine gynecological exam. One exam per calendar year.

PREVENTIVE CARE

80% after deductible, when included with routine gynecological exam. One exam per calendar year.


PPO Option January 1, 2015–December 31, 2015

Aetna PPO

Benefits

In-Network

Out-of-Network

Routine Mammogram

100% . Baseline between age 35-39. One per calendar year age 40 and over.

80% after deductible. Baseline between age 35-39. One per calendar year age 40 and over.

PSA Testing

One per calendar year for males age 40 and over

80%, no deductible. One per calendar year for males age 40 and over

INPATIENT HOSPITAL CARE (Preauthorization Required) Room and Board

100% Pre-authorization required.

80% after deductible Pre-authorization required.

Physician/Surgical Services

100%


Anesthesia Services

100%


Intensive Care Unit/Critical Care Unit

100%


Maternity/Nursery/Birthing Center

100%


Skilled Nursing/Rehab Facility Care (Preauthorization Required)

100% limited to 120 days per calendar year.

80% after deductible limited to 120 days per calendar year.

Dialysis/Radiation/Chemotherapy

100%


Hospice

100%


Physical/Speech/ Occupational Therapy

100%


Surgical/Anesthesia Services

100%



100%


Outpatient Diagnostic Services

100%


1st prenatal visit

100% after copay


Pre-and Postnatal care and delivery

100%


Routine nursery care

100%


Sterilization/Reverse Sterilization requires preauthorization

100% Reverse Sterilization is not covered

80% after deductible. Reverse Sterilization is not covered

Artificial Insemination (AI)

100%, (subject to applicable copay) preauthorization required. Limited to 6 courses of treatment per lifetime.

80% after deductible, preauthorization required. Limited to 6 courses of treatment per lifetime.

In Vitro Fertilization (IVF)*– maximum of 3 IVF attempts/lifetime (Preauthorization Required)

100%, (subject to applicable copay) preauthorization required.

80% after deductible, preauthorization required.

Emergency Room

100% after $50 ER copay (waived if admitted)


Urgent Care Center

100% after $25 copay.

80% after deductible.

OUTPATIENT HOSPITAL CARE

MATERNITY/INFERTILITY SERVICES

MEDICAL EMERGENCIES (USE OF ER)


PPO Option January 1, 2015–December 31, 2015

Aetna PPO

Benefits

In-Network

Out-of-Network

MEDICAL EQUIPMENT/SUPPLIES Durable Medical Equipment

100%


Prosthetic Devices (Pre-authorization required)

100%


Orthopedic Devices

100%


Foot Orthotics (Subject to medical necessity)

100%


MENTAL HEALTH AND SUBSTANCE ABUSE (Preauthorization required for inpatient only) Mental Health: Inpatient Outpatient

100% $20 copay

80% after deductible 80% after deductible

Substance Abuse: Inpatient Outpatient

100% $20 copay

80% after deductible 80% after deductible

Ambulance

Ground 100% Air 100%

Ground: 100% no deductible. non-emergency use–80% after deductible Air: 100% no deductible

Kidney, Cornea Bone Marrow Transplants

Covered in full. The National Medical Excellence (NME) unit will arrange transplant services by a facility that is part of the Institutes of Excellence (IOE) transplant network.


Heart, Heart-Lung, Lung, Pancreas, Liver Transplants



Cardiac Rehabilitation

100% if performed in an outpatient hospital setting;100% after copay in office setting or freestanding cardiac rehabilitation center


Hearing Aids

Hearing aids: 100% to a maximum of $1,400 per ear during any 36 month period for a child up to age 19. Hearing exam: 100% after specialist copay. One exam every 12 months.

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

Acupuncture therapy includes services provided by a licensed acupuncturist covered at 100% no copay subject to R&C


Vision (Routine eye exam)

Routine eye exam covered at 100% after $20 copay. One exam every 12 months.

Not covered.

OTHER SERVICES


HMO Options January 1, 2015–December 31, 2015 Benefits


CareFirst Open Access HMO

Network Coverage

Nationwide Network

Regional Network (MD, DC and Northern VA)

COST SHARING LIFETIME LIMITS Calendar Year Deductible Individual Family

None None

None None

Calendar Year Out-of-Pocket Maximum Individual Family

$2,000 (includes copays) $6,000 (includes copays)

$2,000 $6,000

Coinsurance

100%

100%

Lifetime Maximum

None

None

Primary Care Office Visit

$10 copay

$10 copay

Gynecology Office Visit

$10 copay for Well Woman visit or $15 copay for all other visits

$10 for Well Woman visit or $15 copay for all other visits

Specialist Office Visit

$15 copay

$15 copay

Physical Therapy Office Visit

100% after copay (120 visits combined 100% after copay (30 visits per with Occupational Therapy). condition per calendar year)

Speech Therapy Office Visit

100% after copay (60 visits).

Occupational Therapy Visit

100% after copay (120 visits combined 100% after copay (30 visits per with Physical Therapy). condition per calendar year)

Chiropractic Office Visit

100% after copay (limited to 30 visit maximum combined in and out of network) Preauthorization not required.

PROFESSIONAL SERVICES

100% after copay (30 visits per condition per calendar year)

100% after copay (limited to 20 visits per benefit period)

Allergy Shots/Other Covered Injections 100% after copay

100% after copay

Allergy Serum

100% after copay

100% after copay

Allergy Testing



Diagnostic tests

Included with PCP or Specialist copayment

100% after copay

Diagnostic tests performed by lab or other testing facility and billed separately from office visit

100%

100%

Well Child Visit/Immunization

$10 copay

$10 copay

Routine Adult Physical

$10 copay

$10 copay

Routine Gynecological Exam

$10 copay, one exam per calendar year.

$10 copay, one exam per calendar year.

Routine Pap Smear



PREVENTIVE CARE


HMO Options January 1, 2015–December 31, 2015

Benefits



Network Coverage

Nationwide Network


PREVENTIVE CARE (CONTINUED) Routine Mammogram

100% . Baseline between age 35-39. One per calendar year age 40 and over.

100% unlimited visits

PSA Testing

Covered based on place of service. One per calendar year for males age 40 and over

Covered based on place of service. One per calendar year for males 40 and over

INPATIENT CARE (Pre authorization required) Room and Board

100% Pre-authorization required.

100% Pre-Authorization Required

Physician/Surgical Services

100%

100%

Anesthesia Services

100%

100%

Intensive Care Unit/Critical Care Unit

100%

100%

Maternity/Nursery/Birthing Center

100%

100%

Skilled Nursing/Rehab Facility Care

100% limited to 120 days per calendar year.

100% unlimited days


100%

100%

Hospice (Preauthorization Required)

100%

100%

Physical/Speech/ Occupational Therapy

100%

100%

Surgical/Anesthesia Services

100%

100%


100%

100%

Outpatient Diagnostic Services

100%

100%

1st prenatal visit

100% after copay

100% after copay

Pre-and Postnatal care and delivery

100%

100%

Routine nursery care

100%

100%

Sterilization/Reverse Sterilization requires preauthorization



Artificial Insemination (AI)

50% of Allowed Benefit (preauthorization; limited to 6 courses of treatment per lifetime)

50% of Allowed Benefit limited to 6 courses of treatment per lifetime

In Vitro Fertilization (IVF)*– maximum of 3 IVF attempts/lifetime (Preauthorization Required)

50% of Allowed Benefit

50% of Allowed Benefit

Emergency Room


100% after $50 copay (waived if admitted)

Urgent Care Center

100% after $15 copay.

100% after $15 copay

OUTPATIENT HOSPITAL SERVICES

MATERNITY/INFERTILITY SERVICES

MEDICAL EMERGENCIES (USE OF ER)


HMO Options January 1, 2015–December 31, 2015

Benefits



Network Coverage

Nationwide Network


MEDICAL EQUIPMENT/SUPPLIES Durable Medical Equipment

100%

100%

Prosthetic Devices (Pre-authorization required)

100%

100%

Orthopedic Devices

100%

100%

Foot Orthotics (Subject to medical necessity)

100%

100%

MENTAL HEALTH AND SUBSTANCE ABUSE (Preauthorization required for inpatient only) Mental Health: Inpatient Outpatient

100% $15 copay

100% $15 copay

Substance Abuse: Inpatient Outpatient

100% $15 copay

100% $15 copay

Ambulance

Ground 100% non-emergency not covered Air 100% non-emergency not covered

Ground: 100% non-emergency not covered Air: Covered 100% non-emergency not covered

Kidney, Cornea Bone Marrow Transplants


100%

Heart, Heart-Lung, Lung, Pancreas, Liver Transplants

Covered in full. The National Medical Excellence (NME) unit will arrange transplant services by a facility that is part of the Institutes of Excellence (IOE) transplant network. Performed at approved IOE facility. If non-IOE facility no coverage.

100%

Cardiac Rehabilitation

100% if performed in an outpatient hospital setting;100% after copay in office setting or freestanding cardiac rehabilitation center

100% after $15 copay

Hearing Aids

Hearing aids: 100% to a maximum of $1,400 per ear during any 36 month period for a child up to age 19. Hearing exam: 100% after specialist copay. One exam every 12 months.

100% to a maximum of $1,400 per ear during any 36 month period for a child up to the age of 18.

Acupuncture


100% of Allowed Benefit no copay

Vision (Routine eye exam)

Routine eye exam covered at 100% after $15 copay. One exam every 12 months.

Routine eye exam covered at 100% after a $10 copay. One exam per calendar year

OTHER SERVICES


Prescription Drug Coverage Express Scripts

Express Scripts is the pharmacy Benefits Manager (PBM) for the Prescription Drug Coverage. Your Express Scripts plan includes: ■■ 24-hour, 365-day-a-year Patient Care Express

Contact Center at (877) 866-5859 ■■ A national network of over 50,000 pharmacies ■■ Voluntary Home Delivery (mail order) program for

your medications from Express Scripts Pharmacy ■■ Show your ID card to your pharmacist each time

you get a prescription filled

Copayments for Your Prescription Program HMO Prescriptions from a Pharmacy in-Network*

Prescriptions from the Express Scripts Pharmacy (Mail Order–Voluntary)

Up to a 30-day supply

Up to a 90-day supply**

Generic Medication: $5


Preferred Brand-Name Medication: $10


Non-Preferred Brand-Name Medication: $25


Copayments for Your Prescription Program PPO Prescriptions from a Pharmacy in-Network*

Prescriptions from the Express Scripts Pharmacy (Mail Order–Voluntary)

Up to a 30-day supply

Up to a 90-day supply**







* To receive the in-network level of benefits, you must use a pharmacy in the Express Scripts network ** A 90 day supply may also be purchased at a retail pharmacy for eligible medications.

How to Locate a Participating Pharmacy To locate pharmacies near you that are in the Express Scripts network, visit our website at www.express-scripts.com. Important: Effective January 1, 2015, Express Scripts will make changes to the Preferred Formulary list and certain drugs will no longer be covered under our plan. Express Scripts will contact members with details about the Formulary Change and will provide information about covered alternatives.

Home Delivery (Mail Order) Program Express Script’s mail order program is voluntary. You can either receive maintenance medications via retail pharmacy or through the mail order program for the same co-pay amounts.



What is home delivery? Your prescription benefit offers delivery of maintenance medications—those you need on a long-term basis—right to your door, with free standard shipping.

How easy is it to get started? Very easy. Visit Express-Scripts.com, sign in and choose which of your current maintenance medications you’d like to receive through home delivery. Or you can call us at the toll-free number on your ID card. We’ll take care of the rest.

Do I need to contact my doctor to get a new prescription? Most people prefer to have Express Scripts contact their doctor to get a new 90-day prescription for home delivery. Just get started as described above, and Express Scripts will follow up with your doctor if necessary.

How long will it take to get my medication? When you fill a prescription through home delivery for the first time, you should receive your medication within 8 days after Express Scripts receives your order. Refills are usually ready sooner—within 3 to 5 days.

Worry Free Fill Program If you choose to use the Home Delivery Mail Order pharmacy you can participate in the Worry Free Fill program. As part of the services of the Worry-free Fills program, Express Scripts will contact a doctor when you are out of refills for your medication. Once we receive your new prescription, you will continue to receive the prescribed number of refills automatically. With Worry-free Fills, you will receive your medication when your refill is due. There is nothing you need to do. We will automatically ship your eligible medications when you are within 10 days of running out. For more information you can call ESI at 877-603-1032, Monday–Friday, 7:30 a.m. to 5 p.m., Central or visit www.Express-Scripts.com.

How to Use Accredo® Accredo®, the Express Scripts Specialty Pharmacy, is a full service specialty pharmacy that provides personalized care to individuals with chronic, complex health conditions. Accredo® offers several comprehensive patient care management programs specific to major medical conditions such as cancer, hemophilia, hepatitis, multiple sclerosis, psoriasis, pulmonary arterial hypertension, respiratory syncytial virus, rheumatoid arthritis and more. Through the patient care management programs, you can receive a complete range of services and specialty medication—many of which are costly and often unavailable at retail pharmacies—through disease-specific management programs.

Accredo® provides: ■■ Patient Counseling—Convenient access to highly

trained specialty experts, including pharmacists, nurses and patient care coordinators who provide the support you need to manage your condition. ■■ Patient Education—Clinicians and disease-specific

educational materials available 24/7. ■■ Convenient Delivery—Coordinated delivery to

your home, your doctor’s office or any other approved location. ■■ Refill Reminders—Ongoing refill reminders from a

patient care coordinator. ■■ Language Assistance—Translation services are

available for non-English speaking patients. To learn more, please call 800-803-2523.

How to Use Prior Authorization Some prescription drugs require a Prior Authorization review in certain situations before being covered. To initiate a Prior Authorization request, have your healthcare professional contact Express Scripts Prior Authorization at 800-753-2851.



How to Use Step Therapy

they recommend appropriate prescription drugs for the Step Therapy Program.

Step Therapy is a program designed for people who regularly take prescription drugs to treat ongoing medical conditions, such as arthritis, asthma or high blood pressure. Step Therapy is all about health and value— about getting the most effective medication for your money. That means getting a tried-and-true medication that’s proven safe and effective for your condition at the lowest possible cost.

What is Step Therapy? In Step Therapy, prescription medications are grouped into categories: ■■ Step 1 medications are generic drugs that have been

rigorously tested and approved by the FDA. These medications should be prescribed first because generics can provide the same health benefit as more-expensive medications but a lower cost. ■■ Step 2 medications are brand-name drugs such

as those you see advertised on TV. They’re recommended for you only if a Step 1 medication doesn’t work for you. Step 2 medications almost always cost more.

What if my doctor prescribes a Step 2 medication? If your doctor prescribes a Step 2 medication, ask if a generic (Step 1) medication may be right for you. Please share your formulary—the list of prescription drugs covered by your plan—with your doctor. The pharmacy will not automatically change your prescription; your doctor must write a new prescription for you to change from a Step 2 medication to a Step 1 medication. If a Step 1 medication is not a good choice for you, then your doctor can request prior authorization to determine if a Step 2 medication will be covered by your plan.

Who decides which prescription drugs are included? Step Therapy is developed under the guidance and direction of independent licensed doctors, pharmacists and other medical experts. Together with Express Scripts—the company chosen to manage your prescription-drug benefit—they review the most current research on thousands of prescription drugs tested and approved by the FDA for safety and effectiveness. Then

For more information on Step Therapy, visit www.Express-Scripts.com or call (877) 866-5859

Medication Adherence Program About the program The Express Scripts Medication Adherence rates lead the industry. We focus on adherence solutions that target specific chronic-medication areas where non-adherence tends to be high: antipsychotic, asthma, depression, diabetes, high cholesterol, hypertension and osteoporosis. We effectively improve adherence by successfully encouraging the use of lower-cost therapies (generics and low-cost brands) and Home Delivery from the Express Scripts Pharmacy. The Express Scripts Medication Adherence solutions encourage collaboration between members and their physicians. We promote adherence through mailings to both members and physicians. Our goal is to empower members and to enlist their active participation in achieving better health outcomes by taking their medication as prescribed. We provide additional support tools for members and physicians to address the reasons for poor adherence and effect positive change.

Personal Medication Coach (PMC) About the program The Express Scripts Personal Medication Coach is designed to enhance members’ overall health and reduce wasteful healthcare spending. Express Scripts pharmacists focus on prescription and over-thecounter medication use as well as adherence, formulary alignment, and member education, to empower members to take an active role in managing their medication.

Program benefits The Personal Medication Coach program helps members get the most from their prescription-drug benefit by providing one-on-one time with a well-trained pharmacist for a personal medication assessment. Pharmacist interventions are aimed at improving the health and



quality of life for members, while decreasing overall healthcare costs for both members and plan sponsors. Express Scripts has partnered with the Medication Management Center (MMC) at the University of Arizona to provide support for this program. Their staff includes Board Certified Pharmacotherapy Specialists, drug information certified pharmacists, as well as multilingual capabilities. The PMC services are specifically designed to maximize treatment by incorporating national consensus guidelines from: ■■ National Heart, Lung and Blood Institute ■■ The National Kidney Foundation® Kidney Disease

Outcomes Quality Initiative ■■ American Diabetes Association® ■■ American College of Cardiology ■■ The American Heart Association®

How the program works Personal Medication Coach targets members with multiple chronic conditions. Pharmacists will reach out to targeted members to discuss medication regimens and identify potential therapy issues. If needed, the pharmacists will collaborate with prescribers, to discuss potential areas of concern and possible solutions.

Additional benefits include:

Fraud, Waste, and Abuse Monitoring The Pharmacy Benefit Manager—Express Scripts— monitors for potential fraud, waste, and abuse to help control prescription-drug and medical costs and maximize patient health and safety. This monitoring program identifies situations of unusual or excessive utilization patterns that can contribute to wasteful spending or other possible fraud and abuse risks. Examples of situations that are monitored and investigated by Express Scripts include, but are not limited to: ■■ Overutilization of controlled substances from

multiple prescribers and/or pharmacies ■■ Dangerous drug combinations ■■ Prescription forgeries or identity theft ■■ Overlapping therapies ■■ Inconsistent days supply of medications or

exceeding maximum daily dosage ■■ Physician overprescribing

To report potential prescription fraud or abuse: ■■ If you suspect potential fraud or abuse of your

Express Scripts prescription benefit, please call the Fraud tip hotline at (866) 216-7096 or [email protected]

■■ Expertise: The Medication Management Center’s

PMC program has been developed and improved over years of experience, focusing solely on chronic disease management. There is no conflict of interest between the reimbursement tied to drugs dispensed and recommendations for changes in therapy. ■■ 24/7 Pharmacist Accessibility: Members have

access to a pharmacist 24 hours a day/seven days a week for assistance on issues ranging from simple tablet identification to more complex issues. ■■ Proactive Approach: Prescription claims are

reviewed weekly for opportunities to improve safety, reduce cost or maximize treatment. Each identified intervention results in patient outreach.

Customer Service General prescription questions/coverage checks/eligibility ■■ For questions relating to your prescriptions, please

call the 24 hour, 365-day-a-year Express Scripts Patient Care Contact Center at (877) 866-5859 Our team Patient Care specialist can answer your questions relating to which medications require Step Therapy and/or Prior Authorization

For assistance with home delivery: ■■ Call Express Scripts Patient Care Contact Center at

(877) 866-5859 ■■ For more information log on to:

www.express-scripts.com



For assistance with Accredo®, the Express Scripts Specialty Pharmacy: ■■ Call (800) 803-2523

For Prior Authorization member support: ■■ Call Express Scripts Patient Care Contact Center at



For Step Therapy member support: ■■ Call Express Scripts Patient Care Contact Center at



Prior Authorization/Step Therapy prescriber or pharmacy support: ■■ Some prescriptions require Prior Authorization

before being covered ■■ To initiate a Prior Authorization request, have your

healthcare professional contact Express Scripts Prior Authorization department at (800) 753-2851; this number will not assist members; member support as above

To report potential prescription fraud or abuse: ■■ If you suspect potential fraud or abuse of your

Express Scripts prescription benefit, please call the Fraud tip hotline at (866) 216-7096 or [email protected]

Express Scripts provides 24-hour online access to information regarding your prescription benefit. ■■ Learn how you could save money ■■ Order prescription refills and check order status* ■■ Renew expired prescriptions* ■■ Check the price of a drug ■■ View or print a list of drugs included in your

formulary (drug list) ■■ Locate participating retail pharmacies near you ■■ View up to 24 months of your prescription history ■■ Better understand your benefit coverage

Accessing your prescription benefit online is quick and easy; just go to www.express-scripts.com and complete our brief registration process to get started.


CIGNA Dental Care

CIGNA Dental Care is a dental health maintenance organization (DHMO). You must select and seek services from your DHMO facility. No benefits are available if non-participating dentists are used. For the most current information regarding participating dentists in your area, you may obtain a personalized provider directory by calling CIGNA’s automated dental office locator at (800) 367-1037.

You may also visit CIGNA’s Web site at www.CIGNA.com/ dental. Both resources are available 24 hours a day. You may change your primary dentist selection by calling Customer Service at (800) CIGNA24 ((800) 244-6224). In most cases, the change will take effect on the first day of the following month.

Plan Highlights ■■ There is no deductible. ■■ There are no annual dollar maximums. ■■ There are no claim forms for you to file.

Know What’s Important to You Programs and services that help you make the most of your CIGNA dental plan.

CIGNA dental benefits at-a-glance CIGNA Dental DHMO Covered Services

In-Network only

Deductible

$0

Maximum Benefit per Calendar Year

Unlimited

Covered Services

Plan Pays:

Preventive Care Exams, Cleanings and Xrays

100%*

Restorative Fillings

Copayments for covered procedures range from $23–$140*

Crowns and Bridges


Endodontic–Root Canals


Periodontics


Prosthetics


Orthodontics

Copayments vary from case to case. Maximum benefit of 24 months. *

Emergency Care

$65 ($77 after regularly scheduled hours)

The tools you need for better oral and overall health Nothing is more important than your health. That’s why there’s www.myCIGNA.com—your online home for assessment tools, plan management, dental health information and much more. Once you’ve enrolled in a CIGNA dental plan, you can use www.myCIGNA.com to: ■■ Choose dentists and create, download, and print a

* To view patient charge schedule, go to https://hcpss.hrintouch.com. Click on Dental, select CIGNA Dental DHMO.

personal directory. ■■ Verify plan details ■■ Print a dental ID card. ■■ Get the forms you need. ■■ Access dental health information through WebMD®

Dental Health Resource Center.


Delta Dental PPO Plan

Delta Dental offers you what no other dental plan can— The Delta Dental Difference®. Here’s what makes us a leading provider of dental benefits: ■■ Exceptional Cost Savings—Our networks protect

enrollees from balance billing and prevent dentists from charging more by “unbundling” services that should be billed as one service. Your costs are usually lowest when you visit a Delta Dental dentist. ■■ Guaranteed Coinsurance/Copayment—Delta Dental

dentists agree to accept our determination of fees. They won’t balance bill over Delta Dental’s approved amount. ■■ Professional Treatment Standards—Delta Dental

reviews utilization patterns and office practices to ensure that Delta Dental dentists meet professional standards for safety and quality of care.

In PPO Network Sample Claims Savings

Delta Dental PPO Dentists

Out of PPO Network Delta Dental Premier Dentists

Non-Delta Dental Dentists

Dentist bills

$180.00

$180.00

$180.00

Dentist accepts as payment in full

$90.00

$130.00

$180.00

(Delta Dental’s agreed-upon fee)

(Delta Dental’s agreed-upon fee)

(No fee agreement with Delta Dental)

Delta Dental’s payment 50%

$45.00

$45.00

$45.00

Patient share*

$45.00

$85.00

$135.00

Patient savings

$90.00

$50.00

$0.00

The Delta Dental PPO 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 a Premier or non-Delta Dental dentist. Consider the information below:

In-PPO Network

Out-of-PPO Network

Delta Dental PPO Dentists

Delta Dental Premier® Dentists & Non-Delta Dental Dentists

You will usually pay the lowest amount for services when you visit a Delta Dental PPO dentist.

You are responsible for the difference between the amount Delta Dental pays and the amount your non-Delta Dental dentist bills. You will usually have the highest out-of-pocket costs when you visit a non-Delta Dental dentist.

PPO dentists agree to accept a reduced fee for PPO patients.

Premier dentists may not balance bill above Delta Dental’s approved amount, so your out-of-pocket costs may be lower than with non-Delta Dental dentists’ charges.

You are charged only the patient’s share* at the time of treatment. Delta Dental pays its portion directly to the dentist.

Non-Delta Dental dentists may require you to pay the entire amount of the bill in advance and wait for reimbursement. Premier dentists charge you only the patient’s share* at the time of treatment.

Premier dentists will complete claim forms and submit them for you at no charge.

You may have to complete and submit your own claim forms, or pay your non-Delta Dental dentist a service fee to submit them for you.* Premier dentists will complete claim forms and submit them for you at no charge.

* Patient’s share is the coinsurance/copayment, any remaining deductible, any amount over the annual maximum and any services your plan does not cover. ** If you visit a non-network dentist, Delta Dental will send the benefit payment directly to you. You are responsible for paying the non-network dentist’s total fee, which may include amounts in excess of your share of your plan’s contract allowance.



Program Overview The following information is not intended or designed to replace or serve as an Evidence of Coverage or Summary Plan benefit structure, limitations or exclusions, consult your company’s benefits representative for the provisions specified in your Group Dental Contract. Who’s Eligible

Primary enrollee, Spouse or Domestic Partner and eligible Dependent children to the end of the month that Dependent turns 26.

Deductibles

$25 per person / $75 per family (per calendar year)

Deductible Waived For Diagnostic, Preventive, Basic Restorative and Orthodontics?

Yes

Annual Maximum

The maximum benefit paid per calendar year is $2,000 for premier and PPO/$1,500 for nonparticipating dentists per person

Contact Information Delta Dental of Pennsylvania Customer Service deltadentalins.com 800-932-0783 (Business Hours: 8:00 a.m. – 8:00 p.m. EST)

Claims Address P.O. Box 2105, Mechanicsburg, PA 17055

Benefits and Covered Services*

In-PPO Network**

Out-ofPPO Network**

Diagnostic and Preventive Benefits—Oral examinations, routine cleanings, x-rays, fluoride treatment, space maintainers, sealants

100%

100%

Basic Benefits—Fillings, posterior composites

90%

90%

Major Benefits—Inlays, onlays and cast restorations

50%

50%

Endodontics—Root canals

80%

80%

Periodontics—Gum treatment

80%

80%

Oral Surgery—Incisions, excisions, surgical removal of tooth including simple extractions

80%

80%

Prosthodontics—Bridges, dentures, implants

50%

50%

Crowns

60%

60%

Orthodontic Benefit—children only to the end of the calendar year they reach age 19

50%

50%

Orthodontic Maximum

$1,200 Lifetime

$1,200 Lifetime

Other—Denture Repair

Service covered at 80%

Service covered at 80%

* Limitations or waiting periods may apply for some benefits; some services may be excluded. Please refer to your Evidence of Coverage or Summary Plan Description for waiting periods and a list of benefit limitations and exclusions. **Fees are based on PPO fees for PPO dentists and PPO fees for out-of-PPO dentists. Reimbursement is paid on Delta Dental contract allowances and not necessarily each dentist’s actual fees.



Delta Dental’s Mobile Online Services It’s easy to view and interact with us on your smartphone. Reduce phone calls and save time—the information you need is at your fingertips!

Find a dentist: ■■ Returns dentists closest to you, using your phone’s

location services. ■■ Choose between Delta Dental PPO and Delta

Dental Premier.

Log in to: ■■ Check benefits, eligibility, deductibles and

maximums. Search for benefits by keyword or procedure code. ■■ Check claims status and claims history. ■■ View your ID card—pull it up at your dentist’s office. ■■ Go paperless. Choose Receive Statements Online

under My Account.

Don’t forget to bookmark or add a home page shortcut to our mobile website, so you can easily come back in just one tap.


Vision Service Plan (VSP)

Vision Service Plan doctors take the time to get to know you and your eyes. Through a WellVision Exam®, 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 love. Before selecting your eyewear, ask your doctor what is fully covered by your VSP plan. The following chart summarizes the main benefits of your plan.

Your Vision Plan Coverage from a VSP Doctor Benefits

Copay

Frequencies

WellVision Exam focuses on your eye health and overall wellness

No copay

Every calendar year

Prescription Glasses Lenses: ■■ Single vision, bifocal, trifocal, lenticular Frame ■■ $130 allowance for frame of your choice ■■ 20% off amount over your allowance

$20 copay

Every calendar year

Contact Lens Care* ■■ Medically necessary ■■ Contact lens exam (fitting and evaluation) ■■ $130 allowance for contacts: copay does not apply

$20 copay up to $60

Every calendar year

®

Extra Savings and Discounts Prescription Glasses

■■ Average 35-40% savings on lens options like progressives and scratch-resistant

and anti-reflective coatings ■■ 30% off additional glasses and sunglasses, including lens options within the same

day or 20% off any VSP doctor within 12 months of your last exam Contacts

■■ 15% off cost of contact lens exam (fitting and evaluation)

Laser Vision Correction

**

■■ Average 15% off the regular price or 5% off the promotional price from

contracted facilities. ■■ After your surgery, use your frame allowance (if eligible) for sunglasses from any

VSP doctor. * Patients choosing contacts use their eligibility for a frame and lenses. Materials are provided at the customary fees. Your VSP doctor must get prior approval from VSP for medically necessary contact lenses. **Laser vision correction (PRK and LASIK surgery) is available through contracted laser centers. Must see a VSP doctor. For a referral. Call 888-354-4434 for information.



Getting Started is a Breeze. ■■ Find the right VSP doctor for you. You’ll find

plenty to choose from at www.vsp.com or by calling (800) 877‑7195. ■■ Already have a doctor? Make an appointment and

tell them you’re a VSP member. ■■ Check out your coverage and savings. Visit

www.vsp.com to see your benefits anytime and check out how much you saved with VSP after your appointment. That’s it! We’ll handle the rest—no ID card or claim forms to complete.

Open Access You get the best value from your benefit when you see a VSP doctor. If you see a non-VSP provider, you’ll typically pay more out of pocket. You’ll pay the provider in full and must submit a claim to VSP for partial reimbursement less copays. Before seeing a non-VSP provider, call us first at (800) 877‑7195.

Service

Covered up to

You’re Free to Choose. You’ll find a big selection of VSP doctors and a get better value by staying in-network. If your doctor isn’t in our network, you can choose to see a non-VSP provider. You’ll pay the provider in full and have six months to submit a claim to VSP for partial reimbursement. Before seeing a non-VSP provider, contact us at (800) 877‑7195.

For Non-VSP Doctor Appointments Only: Sign on to www.vsp.com, select the VSP Member Reimbursement Form and follow the instructions. If you don’t have Internet access, send the following to VSP: ■■ Itemized receipt listing services received ■■ Name, address and phone number of the non-

VSP provider ■■ Insured member’s name, unique ID number, address

and phone number ■■ Patient’s name, date of birth, address, phone

number and relationship to insured member ■■ Reference Howard County Public Schools

Exam

$52

Single Vision Lenses

Submit your claims to VSP within six months. Keep copies of the claims and send the originals to:

$55

Bifocal Lenses

$75

VSP P.O. Box 997105 Sacramento, CA 95899-7105

Trifocal Lenses

$100

Lenticular Lenses

$125

Frame

$70

Medically Necessary Contacts

$210

Elective Contacts

$105

Questions? Please call VSP at (800) 877‑7195 or visit www.vsp.com.



How the VSP Works To Use a Vision Service Plan Provider…

More Choice and Convenience with VSP® Vision Care

Step 2:

You’ll have more eyecare providers to choose from with VSP. Finding the right eyecare provider for you is important to your eye health and overall wellness. That’s why you can choose to see a VSP doctor, retail chain affiliate (including Costco and VisionWorks), or any other provider.

hen making an appointment, identify yourself as a VSP W member. The participating doctor will also need the last 4 digits of your social security number, last name, and DOB so that your eligibility may be verified with VSP.

Below is a high-level summary of your coverage with VSP doctors and Costco or VisionWorks. You can visit www.vsp.com for a complete descriptions of your benefits.

Step 1: all VSP at (800) 877-7195 or visit VSP’s website at C www.vsp.com to locate a participating optometrist or ophthalmologist.

Important Note: The vision plan is offered through VSP. No identification card is necessary. Do not offer your medical health insurance identification card to a VSP provider. Step 3: t your appointment, the participating doctor will provide A an eye examination and determine if eyewear is necessary. Simply pay your copayment(s) listed on page 52.

To Use a Non-Participating Provider… Step 1: Select any licensed vision care provider of your choice. Step 2: Pay for the services when they are rendered. Step 3: ubmit a claim to VSP for reimbursement within 6 months. S The reimbursement schedule does not guarantee full payment when services are provided by a non-participating provider. Your claim must include your name, address, social security number, group name (i.e. the name and relationship of the patient, the itemized bill and receipt). Please keep a copy of the information for your records and send the originals to the following address: SP V P.O. Box 997105 Sacramento, CA 95899-7105

Have You Seen the New vsp.com? On vsp.com, you’ll land on the Member site. Visit the new site at vsp.com to get started and get the tools and information you need.

Extra $20 frame bonus You will automatically get an extra $20 to spend towards your frame allowance when you choose a featured frame brand like Bebe, ck Calvin Klein, Flexon, Lacoste, Nike, Nine West, and more. Visit vsp.com to find a doctor who carries these brands.

Now, greater coverage for diabetics An eye exam by a VSP doctor can detect signs and symptoms of diabetes. The VSP Diabetic Eyecare Plus Program is being added as an enhancement to our existing plan. The Diabetic Eyecare Plus Program provides coverage for additional eyecare services targeted specifically for members with type 1 or type 2 diabetes. Under this program, eligible members can receive both routine and follow-up medical eyecare from their VSP Preferred Provider. They never need a referral, and pay only a $20 copay for services.

New hearing aid discounts for VSP members TruHearing is offering all VSP members and their covered dependents free access ($108 value) to the TruHearing MemberPlus® Program* to enjoy savings on hearing aides and batteries. Through TruHearing, VSP members can save up to $2,600 per pair of hearing aides. Best of all, if a member already has a hearing aid benefit, they can combine it with this program to maximize the benefit and reduce their out-of-pocket expense.



To take advantage of this offer, VSP members must enroll at vsp.truhearing.com. Members (members must identify themselves as being VSP) can add their covered dependents and other family members to enjoy the same great savings. Learn more about this VSP member offer at vsp.truhearing.com.

Eyeconic offers VSP members: ■■ ability to apply VSP benefit for purchases, ■■ savings on more than 100 popular brands of

contact lenses, ■■ discounts on the hottest sunglasses, ■■ a virtual try-on tool to see how different frames look

*Through December 31, 2015 **Savings vary based on hearing aid model purchased

on their face, ■■ coordination with a VSP doctor to ensure quality

New & improved contact lens benefit We’ve made some exciting changes to our contact lens benefit so it’s easier to understand and maximizes your benefits. We now separate the contact lens exam (fitting and evaluation) from the materials coverage. Members choosing contact lenses will receive a covered-in-full contact lens exam after a copay that is guaranteed not to exceed $60. Members will also continue to receive a 15% discount on all contact lens exam services. And because we’ve separated the exam benefit, members can use their full contact lens allowance toward contact lens materials.

Extra savings with exclusive contact lens rebates for VSP members We have teamed up with contact lens manufacturers to offer VSP members exclusive rebates on Bausch + Lomb contact lenses. VSP members who purchase an eligible supply of Bausch + Lomb® brand contact lenses from a VSP doctor may qualify for rebates up to $110. This rebate is exclusive to VSP members and their dependents and is the highest rebate amount available anywhere on Bausch + Lomb contacts. Getting the rebate is simple! Just visit the Rebates & Special Offers section on vsp.com to learn more.

of care, ■■ a search tool to help them find a doctor near them, ■■ and peace of mind—we’ll happily refund or

exchange any purchase. To see the latest, check out eyeconic.com today.

Finding a doctor or viewing benefits is a snap with smart phones Now VSP members visiting vsp.com with their mobile phones have access to an optimized view of select features within the member portal. Members can see their vision benefits and find a VSP eye doctor and directions right from your mobile phone.

Keep up with the latest eye health and wellness trends with EnVision. Each month, the VSP member newsletter, EnVision, delivers eye health and wellness information to keep your members healthy. You and your members will enjoy the inside scoop on eye health, eyewear fashion and trends, and engaging ways to connect with VSP. Every issue features articles and videos on: ■■ Eye health news and information ■■ Designer eyewear fashions ■■ Trends in fitness and nutrition

An innovative way to shop for eyewear

■■ A chance to win exciting prizes

Greater numbers of people are shopping online for eyewear. To meet the demands of the changing marketplace we developed Eyeconic, an exciting online optical store that offers our members easy access to quality eyewear brands.

■■ Exclusive rebates and special promotions

From your computer or mobile device, VSP members can quickly browse through hundreds of the latest eyewear styles. Plus, they can buy quality contact lenses and designer sunglasses!

■■ Reader questions answered by our VSP

doctor experts EnVision highlights information that promotes a healthy lifestyle. Members can register to receive EnVision newsletter on vsp.com.



Transitions lenses satisfaction guaranteed—or we’ll replace them! VSP Vision Care and Transitions Optical® are committed to healthy sight. That’s why VSP has teamed up to provide an exclusive offer to VSP members. The VSP satisfaction guarantee allows members to try Transitions lenses for up to six months. If you are not 100% satisfied you can contact VSP for a refund of any associated out-of-pocket expenses, less any copays, and VSP will replace your Transitions lenses with clear prescription lenses at no additional charge.

Using your VSP Benefit is Easy Whether you choose to see a VSP doctor, retail chain affiliate, or any other provider using your vision coverage is simple and convenient. ■■ Find an eyecare provider who’s right for you. To

■■ At your appointment, tell them you have VSP.

There’s no ID card necessary. That’s it. VSP will handle the rest—there are no claim forms to complete when you see a VSP doctor or retail chain affiliate. If you choose to see a provider other than a VSP doctor or retail chain affiliate, you may need to submit a claim form to VSP for reimbursement. Some providers, such as WalMart, submit your claim to VSP for you. Visit www.vsp.com for more details. VSP has made getting your benefit information and finding a doctor easier and more convenient through your smartphone. Simply register and log on to www.vsp.com and you’ll be able to access information on the go—when you need it.

See well and stay well with VSP.

find a VSP doctor or an affiliate provider, visit www.vsp.com or call 800-877-7195. ■■ Review your benefit information. Visit

www.vsp.com to review your plan coverage along with the details about how your coverage differs with retail chain affiliates and other providers.

Benefit

Coverage with VSP Doctors

Coverage with Retail Chain Affiliate Providers (Costco or Visionworks)

Eye Exam

No copay

No copay

Prescription Glasses

$20 copay

$20 copay

Frame

$130 allowance; 20% discount on amount over your allowance

■■ $70 allowance at Costco ■■ $130 allowance at other Affiliate

locations such as Visionworks; 20% discount on amount over allowance Lenses

■■ Single Vision, lined bifocal, and line

trifocal lenses ■■ Polycarbonate lenses for

dependent children

■■ Single Vision, lined bifocal, and line

trifocal lenses ■■ Polycarbonate lenses for

dependent children

Lens Options

Average 35%–40% off lens options

Check with Costco or Visionworks for member pricing on lens options

Contacts (instead of glasses)

■■ Up to $60 contact lens exam (fitting

■■ Up to $60 contact lens exam (fitting

and evaluation) Extra Savings and Discounts

and evaluation)

■■ $130 allowance for contacts

■■ $130 allowance for contacts

Available through VSP doctors only

20% off of complete pairs of additional glasses at participating retail providers other than Costco.


Life and Accidental Death & Dismemberment Insurance Basic Term Life

Conversion

HCPSS offers eligible employees life insurance and accidental death and dismemberment (AD&D) insurance at no cost to the employees through MetLife. The amount of basic term life insurance is equal to your current annual salary (minimum $10,000 and a maximum of $250,000), rounded to the nearest $1,000.

You can generally convert your Group Term Life insurance benefits to an Individual Whole Life insurance policy if your coverage terminates in whole or in part due to your retirement, termination of employment, or, a change in your employee class. Conversion is available on all Group Life insurance coverages. Please note that conversion is not available on AD&D coverage.

Accidental Death & Dismemberment Coverage This valuable coverage provides benefits beyond your disability or life insurance for losses due to covered accidents. MetLife’s AD&D insurance pays you benefits if you suffer a covered accident, such as an accident that results in paralysis or the loss of a limb, speech, hearing or sight. If you suffer a covered fatal accident, benefits will be paid to your beneficiary. Your AD&D amount is equal to your basic term Life insurance amount.

If you experience an event that makes you eligible to convert your coverage, you will receive information from MetLife about this option.

Funeral Planning Guide It highlights details of pertinent information including: how to plan for funeral costs, the death claim process, personal funeral preferences and more. An electronic version of the guide is available on HR Intouch.

WillsCenter.com Employees and retirees with basic life have access to WillsCenter.com, which is an online will support service that provides reference materials.


Supplemental Group Term Life Insurance Supplemental Group Term Life Insurance with Portability Supplemental group term life insurance through MetLife provides employees with affordable financial protection for short term needs. Coverage may be taken with you if you terminate or retire from Howard County Public School System. ■■ You may elect Supplemental Life coverage in

amounts of 1 to 5 times your annual salary to a maximum of $500,000. ■■ You must provide Evidence of Insurability for

all coverage requests above $50,000 or 1 times Basic Yearly Earning, whichever is less subject to approval by MetLife. ■■ New Hires are eligible for the guaranteed issue

amount of one times salary up to $50,000 if enrolled within 30 days of date of hire. ■■ Coverage is portable. Therefore, if you no longer

work for Howard County Public School System or retire, you can keep coverage to age 100. Your portable coverage will be reduced by 50% at the age of 70. ■■ Rates are based on five-year age bands, and the

rate will be based on your age as of January 1, 2014 and every January 1st thereafter. The rate will change when you reach the next age band.

Supplemental Term Life Insurance Coverage Options For you

1 to 5 times your basic annual earnings, to a minimum of $10,000 and a maximum of $500,000

For your spouse

$10,000

For your dependent children*

■■ From 14 days but less than 6

months of age: $500 ■■ From 6 months but less than 26

years of age: $5,000 *Child(ren)’s Eligibility: Dependent children ages from 14 days to the end of the calendar month the dependent turns 26.

■■ You may elect Dependent Life coverage on your

family, if you elect Supplemental Life coverage for yourself. Your spouse will be covered for $10,000 and each child will be covered for $5,000. Coverage is also portable for dependent life. Therefore, with portability your spouse can keep coverage to age 70 and child can keep coverage to age 26. At age 26, the child may apply to continue their portable coverage by completing a NewPort Election Form. They will also have the option of applying for preferred rates. ■■ If you elect Dependent Life when you are

first eligible, Evidence of Insurability on your spouse and children is not required. If you elect Dependent Life after you are first eligible then you must provide Evidence of Insurability on your dependents, subject to approval by MetLife.

The following services are included with your supplemental life insurance coverage Will preparation service Like life insurance, a carefully prepared Will (Simple, Complex or Living) along with a Power of Attorney are important. With a will, you can define your most important decisions such as who will care for your children or inherit your property. ■■ Living will:

Ensures your wishes are carried out, and protects your loved ones from making these very difficult and personal medical decisions by themselves. Also called an “advanced directive,” it is a document authorized by statutes in all states. A person appoints someone as his/her proxy or representative to make decisions on maintaining extraordinary life-support if the person should become incapacitated so that he or she is unable to communicate his or her wishes.


Supplemental Group Term Life Insurance

Portability

■■ Powers of attorney:

Allows you to plan ahead by designating someone you know and trust to act on your behalf in the event of unexpected occurrences or if you become incapacitated. It is a written document that grants an individual the power to act on the grantor’s behalf. By enrolling for Supplemental Term Life coverage, you will have access to Hyatt Legal Plans’ network of 12,000 participating attorneys When you enroll in this plan, you may take advantage of face-to-face access to a participating plan attorney to prepare or update a will, living will or powers of attorney.* When you use a participating plan attorney there will be no charge for the services*. To obtain the legal plan’s toll-free number and your company’s group access number please contact your employer or your plan administrator for this information. *You also have the flexibility of using an attorney who is not participating in the Hyatt Legal Plans’ network and being reimbursed for covered services according to a set fee schedule. In that case you will be responsible for any attorney’s fees that exceed the reimbursed amount.

MetLife Estate Resolution MetLife Estate Resolution Services—is a valuable service offered under the plan. When your estate representative uses a participating Hyatt Legal plan attorney there will be no charge for the services. A Hyatt Legal Plan attorney will consult face-to-face with your beneficiaries or by telephone regarding the probate process for your estate. The attorney will also handle the probate of your estate for your executor or administrator. This can help alleviate the financial and administrative burden upon your loved ones in their time of need.

Should you leave the Howard County Public School System for any reason, and your Supplemental and Dependent Term Life insurance under this plan terminates, you will have an opportunity to continue group term coverage (“portability”) under a different policy, subject to plan design and state availability. Rates will be based on the experience of the ported group and MetLife will bill you directly. Rates may be higher than your current rates. Generally, there is no minimum time for you to be covered by the plan before you can take advantage of the portability feature. Please see your plan certificate for specific details. Please note that if you experience an event that makes you eligible to convert your coverage, you will receive information from MetLife about this option.

Customer Service To contact MetLife for claim questions and claims processes, you can call the Customer Service line from 8:00 a.m.—8:00 p.m. EST Monday—Thursday and 8:00 a.m.—5:00 p.m. EST on Friday. ■■ Customer Service for Claims: 800-638-6420

To contact MetLife for any questions related to Statement of Health, Conversion, Portability, or Will Preparation and Estate Resolution Services, you can reach a representative at the following customer service lines: ■■ Statement of Health: (800) 638-6420 ■■ Conversion: (877) 275-6387 ■■ Portability: (888) 252-3607

Conversion

■■ Will Preparation Service: (800) 821-6400

You can generally convert your Group Term Life insurance benefits to an Individual Whole Life insurance policy if your coverage terminates in whole or in part due to your retirement, termination of employment, or, a change in your employee class. Conversion is available on all Group Life insurance coverages. Please note that conversion is not available on AD&D coverage.

■■ MetLife Estate Resolution Service (ERS):

(800) 821-6400

If you experience an event that makes you eligible to convert your coverage, you will receive information from MetLife about this option.


Whole Life Insurance and Accident Coverage Premier whole life insurance with optional long term care rider with restoration and extension of benefits through reliastar life insurance company.

This is a policy that is very well suited for long term insurance needs and final expenses. Your spouse and children/grandchildren may also be covered. There is an optional Long Term Care rider available. ■■ Employees may apply for the amount of

coverage that $20 per week will purchase for their age up to $100,000 with only two health questions asked. An employee may apply for more coverage, but additional underwriting will be required. ■■ Spouses may apply for the amount of coverage

that $5 per week will purchase for their age with a minimum coverage of $5,000 with only two health questions asked. A spouse may apply for more coverage but additional underwriting will be required. ■■ Children/grandchildren may apply for an

individual policy in amounts of $12,500, $15,000, $20,000 or $25,000 with only two health questions asked. ■■ Your spouse and children/grandchildren may

apply for coverage even if you are not applying for coverage yourself. ■■ Premiums are guaranteed to be fixed for the life

of the policy. ■■ The policy builds guaranteed cash value. ■■ Coverage is Portable. Therefore, if you retire or

leave employment, the policies may be taken with you. To apply for Premier Whole Life Insurance with optional Long Term Care Rider with Restoration and Extension of Benefits through Reliastar Life Insurance Co. at (800) 621-0067. Premier Whole Life Insurance is issued and underwritten by ReliaStar Life Insurance Company, Policy Form Number RL- WL2-POL-07, form number may vary by state.

Accident insurance, a limited benefit policy For plan year 2015, Accident coverage will continue to be offered through ReliaStar Insurance Company. You cannot anticipate what one accident could mean to your financial stability. Accident insurance benefits are paid directly to you. You can use the money however you wish. The benefits are paid in addition to other medical coverage. Accident Insurance can help cover the unexpected costs related to accident expenses. This policy pays a specified benefit amount for: ■■ Initial care such as ambulance, emergency room

and initial doctor visit. ■■ Follow-up care such as outpatient doctor’s

treatment and medical appliances. ■■ Injuries, including burns, dislocations

and fractures ■■ Catastrophic accident ■■ Accidental death ■■ You are eligible to apply if you are 18 years old

or older, you are a permanent benefits eligible employee who meets the requirements and you are actively at work on the enrollment date. ■■ You may also apply for coverage on your spouse

and dependent children. ■■ Coverage is available to you without answering

health questions. ■■ Coverage is portable. Therefore, if you retire or

leave, policies can be taken with you. This is a summary of benefits only. A complete description of the benefits and limitations will be provided in the policy or Certificate of Coverage. Accident Insurance is issued and underwritten by ReliaStar Life Insurance Company, Policy Form Number RL-ACC2005POL, form number may vary by state.


Aflac Group Critical Illness Including Cancer

Aflac’s Group Critical Illness product provides a lump-sum benefit upon the diagnosis of not only one covered illness, but for each diagnosed covered illness, including Cancer.

Group Critical Illness insurance provides a lump-sum benefit payment to cover out-of-pocket medical expenses and the costs associated with life-changes following a covered critical illness. Cancer, Heart Attack, Stroke, or Renal Failure (end stage) are all life-changing events. This product is available to employees 18-69 years of age. Plan benefits include but are not limited to: ■■ Lump-sum paid directly to the insured (unless

otherwise assigned) following the diagnosis of each covered critical illness. ■■ Guaranteed Issue—available for employee at

$15,000 and $7,500 spouse coverage.

Coverage Availability ■■ Individual ■■ Spouse ■■ Dependent child, under age 26, at no additional cost

at 25% of the employee benefit amount.

Plan Features ■■ $50 annual health screening benefits paid

to employee. ■■ The plan is portable, with certain stipulations. ■■ Level premium rates based upon the applicant’s

■■ Benefit amounts available for $5,000 up to $50,000

for employees and $25,000 for spouse. ■■ Each dependent child is covered at 25% of the

age as of the time of application. Rates cannot be individually increased on a particular insured due to a change in age, health or individual claim.

primary insured amount at no additional charge. ■■ Additional Benefit Rider includes Coma, Paralysis,

Burns, Loss of Sight, Loss of Hearing and Loss of Speech.

For additional details, go to www.aflac.com/howard.’ Coverage is underwritten by Continental American Insurance Company.

For program details, rates, questions and claims, contact Suzanne Herrmann at (301) 985-2020 or [email protected].


Short Term Disability

Short-term disability (STD) 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 a predetermined waiting period, known as the elimination period. You have a choice of elimination periods with this plan: 7 days, 14 days or 30 days.

Important Note:

Maximum Benefit Period

If you are enrolling in short term disability coverage, other than for the period you were initially eligible to enroll, or if you are decreasing your elimination period you will be required to complete a medical history statement and mail it to The Standard by November 30, 2014. Once your application has been processed and renewed, you will receive notification of approval/denial of short term disability coverage. The deduction for short term disability will begin the first of the month following notification of approval from The Standard.

The benefit period will last until you are no longer disabled, or 3 months, whichever is shorter. If you have also purchased long-term disability coverage from Standard they will automatically transition your claim and review whether benefits will continue.

Eligibility All active full-time employees who work 30 hours per week on a regularly scheduled basis for HCPSS.

Benefit Percentage and Maximum Benefit The benefit percentage is 60% of your regular weekly pay. The maximum weekly benefit is $2,500. The chart below will help you determine the cost of STD insurance. The cost will automatically calculate when you select this coverage online.

Eligibility waiting period First day of the month following your date of hire. Coverage elected during the 2014 open enrollment begins on January 1st, 2015.

Elimination period (EP) The elimination period will run for 7, 14 or 30 days depending on the option you choose. During this time you will not receive any short-term disability benefits, but you may receive sick leave.

____________________ Annual Salary

Per Payroll Rates Based on 20 Annual Deductions