Baltimore County Public Schools. Benefits Enrollment & Reference Guide. Open Enrollment Period October 7 November 10, 2014

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1 Baltimore Couty Public Schools Beefits Erollmet & Referece Guide Ope Erollmet Period October 7 November 10, 2014 Effective Jauary 1, 2015 December 31, 2015

2 Table of Cotets Letter from the Superitedet...1 What s New for This Pla Year Beefits ad Eligibility HIPAA...12 Rates ad Deductios Your Medical Optios Highlights Medical Optios At-a-Glace Chart Refereces from Beefit Chart Employee Assistace Program (EAP) Your Detal Optios Highlights Detal Beefits At-a-Glace Chart Visio Isurace Flexible Spedig Accout (FSA) Highlights Life Isurace Volutary Whole Life Isurace Volutary Critical Illess Isurace Persoal Accidet Isurace Savigs ad Retiremet Beefits Log Term Disability Isurace Aual Ope Erollmet Curret Employees How to Eroll - New Hires Frequetly Asked Questios Qualified Life Evets...71 COBRA Health Care Reform Impact Health Isurace Marketplace Coverage Affordable Care Act FAQs Depedet Eligibility Verificatio Form Flexible Spedig Accouts Electio Prescriptio Order Form Erollmet Form...91 Prudetial Group Life Erollmet/Chage Card Prudetial Group Isurace Applicatio Importat Resources The purpose of this Beefits Erollmet ad Referece Guide is to provide iformatio about your beefit optios ad how to eroll for coverage or make chages to existig coverage. This Guide is oly a summary of your choices ad does ot fully describe each beefit optio. Please refer to your Employee Beefit Guide or Certificate of Coverage for iformatio about the plas. Every effort has bee made to esure that the iformatio i this Guide is accurate; however, the provisios of the actual cotracts for each pla will gover i the evet of ay discrepacy. Copies of the Employee Beefit Guides, pla cotracts, ad other pla materials are available upo request from the Office of Beefits, Leaves ad Retiremet at our Web site, or from the isurace carriers.

3 1 October 2014 Re: Ope Erollmet Dear fellow employees, Our aual Ope Erollmet period for 2015 begis o October 7, 2014, ad eds o November 10, 2014 at 10:00 pm. For 2015, the premium costs for those erolled i the Ciga Ope Access Plus-i/out of etwork Pla (OAP) will see a higher percetage icrease i accordace with the Master Agreemets egotiated i If you are participatig i the Ciga OAP pla ad your providers are i etwork, I would ecourage you to cosider erollig i the Ciga Ope Access Plus i etwork pla (OAPIN) for 2015 sice sigificat savigs are possible with the OAPIN pla. We will cotiue to strive to offer a attractive package of beefits to meet your eeds ad to support the visio of Blueprit 2.0. Letter From the Superitedet For 2015, several provisios of the Affordable Care Act will go ito effect. The primary effect of the 2015 requiremets will ivolve temporary ad cotract employees of BCPS who are curretly ot eligible for beefits. BCPS employees curretly ot eligible for beefits may be able to eroll i the beefits offered through the State of Marylad Health Care Exchage. The Office of Beefits, Leaves ad Retiremet will provide iformatio to employees as it becomes available. The Beefits Erollmet Guide provides details o your 2015 pla optios. Takig time to review these materials carefully will help you make iformed choices about your beefits. Just a Few Remiders Employee Self Serve (ESS) will be available this year for viewig your curret beefit choices ad employees will be able to eroll o lie for medical, detal, visio ad Log Term Disability (LTD). Please ote if you do ot wish to make chages to ay of your beefits, o actio from you is required. The oly exceptio is erollmet i Flexible Spedig Accouts (FSA). A erollmet form for this beefit eeds to be completed each caledar year. Erollmet chages may also be completed usig the paper erollmet form. There are o chages to the medical plas. Ciga ad Kaiser are beig offered for Plas iclude the Ciga Ope Access Plus i etwork (OAPIN) ad a Preferred Provider Orgaizatio (PPO) type pla - Ope Access Plus i/out of etwork (OAP) ad the Kaiser Permaete HMO. Please review the details ad costs of these plas. No actio is required if you wish to maitai your medical coverage. There are o chages to our detal plas. CareFirst PPO ad CareFirst Traditioal plas ad the Ciga Detal DHMO are still i effect for No actio is required if you wish to maitai your detal coverage. CareFirst Davis Visio remais our visio provider. No actio is required if you wish to maitai your visio coverage. You must make a NEW electio to participate i the Flexible Spedig Accouts (FSA). Please ote IRS rules have chaged cocerig these accouts ad you eed to review the iformatio cotaied i the beefit guide. If you have ay questios, please refer to the cotact listigs i the back of this Erollmet Guide, call the Office of Employee Beefits, Leaves ad Retiremet at (410) , or at We hope you cotiue to be pleased with these programs as we edeavor to maitai a competitive beefits package for you ad your family. Sicerely, S. Dallas Dace, Ph.D. Superitedet Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

4 2 What s New for This Pla Year What s New For This Pla Year 2015 At-a-Glace All Ope Erollmet iformatio is available from the BCPS web site at by clickig o the Ope Erollmet lik. Here is a Look at What s New for 2015 EMPLOYEE SELF SERVE (ESS) WILL BE AVAILABLE FOR VIEWING YOUR CURRENT BENEFIT CHOICES AND EMPLOYEES WILL BE ABLE TO ENROLL ONLINE FOR MEDICAL, DENTAL, VISION AND LONG TERM DISABILITY (LTD). Ciga Ope Access Plus I-Network (OAPIN) is available for This pla icludes a Ope Access Pla that requires a i etwork use of doctors. This is similar to a HMO but the use of a Primary Care Physicia is ot required ad referrals are ot required. Ciga maitais a world wide etwork. Ciga Ope Access Plus (OAP) is available for This pla allows for i etwork or out of etwork use of doctors. This pla is similar to a PPO pla. A Primary Care Physicia is ot required ad referrals are ot required. Depedets may be covered util the ed of the moth they tur age 26 for all beefit programs. CareFirst PPO ad Traditioal Detal plas remai i effect for Ciga Detal DHMO pla remais i effect for CareFirst Davis Visio pla remais i effect for Flexible Spedig Accouts (FSA) have a ew maximum deductio for Healthcare i The maximum amout that ca be deducted from your paycheck for 2015 has bee reduced to $2550 for approved medical expeses. The Depedet Care Flexible Spedig Accout maximum remais $5000 for Whole Life Isurace with Log Term Care ad Critical Illess Isurace are available for all employees. Please see pages 55 & 56 for more details. Premium costs have chaged for FSA Pla admiistrator has chaged to TASC Here s What s Not Chagig For all active full-time employees BCPS pays 65% of the lowest cost detal pla. Employees erolled i Ciga or Kaiser Health Plas who wish to maitai their curret beefit choices do ot eed to complete a beefit erollmet form. Your selectios will be established for If you are participatig i the Flexible Spedig Accout (FSA), you must fill out a FSA electio form for Prescriptio plas remai with Express Scripts. Please ote that Walgrees Pharmacy is ot part of the ESI etwork with BCPS. A ope erollmet statemet will be set to you i December 2014 cofirmig your electios for Jauary 1, Review this documet carefully ad compare the iformatio to your copy of the erollmet form. If there is a error, please cotact the Office of Employee Beefits, Leaves ad Retiremet immediately at , so that chages ca be made i a timely maer. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

5 3 What s New For This Pla Year 2015 New Volutary Beefits ING Employee Beefits, Reliastar Life Isurace Compay Whole Life Isurace with log term care rider. Trasamerica Life Isurace Compay Critical Illess Isurace. Over the years BCPS employees have expressed a iterest i log-term care beefits as well as portable life isurace coverage. Additioally, there was a eed to provide a more broad cacer isurace type beefit. After a complete review of a array of volutary products available i today s marketplace, BCPS idetified these two programs as the volutary beefit offerigs that will be made available this year for BCPS employees. If you have questios about these programs, please visit our Website at Backgroud o Flexible Spedig Accouts A Flexible Spedig Accout (FSA) allows you to pay for certai medical ad/or depedet care expeses with pre tax dollars. Because you will ot pay ay Federal, State*, Local*, FICA or Medicare taxes o this icome, you ca save about $30 for every $100 you elect to defer. FSA maximum deductio for 2015 has bee reduced to $2,550. There are two types of FSAs. The Medical Care FSA helps you pay for medically ecessary expeses ot covered or oly partially covered by your health, detal ad/or visio isurace. The Depedet Care FSA helps you pay for certai depedet care expeses, such as day care for a child or elderly adult. Maximum deductio for Depedet Care FSA remais at $5,000. If you sped your ow moey o: Copays Deductibles Coisurace Prescriptio drugs Over-the-couter badages Detal care ad orthodotic expeses Visio care, eyeglasses ad cotact leses Day care (for childre or elderly adult) Before ad/or after school care Summer day camp You ca save 30% o these ad other costs by erollig i a Flexible Spedig Accout. How Flexible Spedig Accouts Will Save You Moey Most of us have expeses for medical services ad supplies that are ot fully covered by isurace or reimbursed by ay other sources. Also, some of us have childcare or eldercare expeses that we icur so that we ca work. If you aticipate expeses i either of these categories, erollig i a FSA ca save you moey. Whe you participate i a FSA, you elect to have a specific amout of dollars deducted from your gross earigs (before tax) each pay period. Participatig i both accouts will result i two separate payroll deductios. By cotributig pre-tax dollars, you lower your taxable icome ad icrease your spedable icome! I fact, by participatig you are actually usig dollars you would have paid i taxes to help pay for your medical ad/or depedet care costs. Below are some examples of how much YOU ca save o your everyday expeses. What s New for This Pla Year Sample Health Care Expeses Your Cost Without a FSA Your Cost With a FSA Your Estimated Out-of-Pocket Savigs* Doctor Copay $20.00 $14.00 $6.00 Specialist Copay $30.00 $21.00 $9.00 PPN Geeric Retail Rx Copay $10.00 $7.00 $3.00 HMO Brad Retail Rx Copay $25.00 $17.50 $7.50 Over-the-Couter Badages $10.00 $7.00 $3.00 Mothly Diabetic Supplies $ $70.00 $30.00 Mothly Orthodotic Paymet $ $87.50 $37.50 Eyeglasses $ $ $90.00 Laser Eye Surgery $2, $1, $ * Assumes a 15% tax bracket Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

6 4 What s New for This Pla Year What s New For This Pla Year 2015 Sample Depedet Care Expeses Your Cost Without a FSA Your Cost With a FSA Your Estimated Out-of-Pocket Savigs* Daycare for child uder age 13 $5, $3, $1, Before/After School Care $4, $2, $1, Summer Camp $2, $1, $ Disabled/Elder Adult Daycare $5, $3, $1, *Assumig 15% Federal Tax Bracket Plaig Your Electio Here are just a few strategies you ca use to be sure that you are makig every pey cout i your FSA: Pla ahead whe erollig. Base your cotributio o your aticipated expeses for the pla year which are ot covered by other isurace or beefit plas. Look back to last year. Oe way to estimate those expeses is to look back at the health care ad depedet care expese you paid out of your ow pocket durig the past year. This ca be the startig poit for your aual cotributio, adjusted of course for ay past or future extraordiary expeses. Use the attached worksheet. For a olie worksheet, visit Look outside your health pla. May health care plas offer some, but ot full, coverage for certai expeses such as laser eye surgery, orthodotia, some over-the-couter medical supplies. Evaluate your home pharmacy. Throw away all expired over-the-couter (OTC) medicatios ad the ext time you visit your health care provider, ask for a prescriptio for the OTC medicies that you use o a regular basis icludig aspiri, allergy medicatio, atacids, etc. Badaids, cotact les solutio ad other OTC items that are ot medicatios caot be reimbursed without a prescriptio. Be Coservative. Ay uused fuds caot carry forward to the ext pla year ad are forfeited. Participatio i a FSA is ot automatic. You must re-eroll aually durig ope erollmet. Moies remaiig i the accout 90 days after the ed of the pla year caot be retured. The last day for filig claims is March 15th. Erollig i The Pla Make your electio durig ope erollmet (or whe you first become eligible). Determie your electio amout(s) by usig the FSA worksheet. Elect up to the pla maximums. Remember you do ot have to participate i the health pla to be eligible for the FSA. Aual electio(s) will be deducted equally pre tax over the course of your pla year. FSA Debit Card Participatig i a FSA with a Debit Card has may advatages! Look at what the card ca do for you. Elimiates the eed of fillig out claims forms ad waitig for a reimbursemet check. Most trasactios will ot require supportig documetatio. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

7 5 What s New For This Pla Year 2015 It s Easy To Participate i a FSA 1. use the worksheet(s) to determie the amout of moey you will sped for medical ad/or depedet care for you ad your depedets i the upcomig pla year. 2. Oce you determie the amout, complete the erollmet process with your employer. Depedet Care FSA Use this worksheet to estimate your eligible child ad depedet care expeses. Eligible depedets iclude your depedet childre through age 12, your spouse or other depedet who is physically or metally disabled ad speds at least 8 hours a day i your home. The aual pretax cotributio limit is the lesser of $5,000, the employee s eared icome for the year or the spouse s eared icome. Sample Depedet Care FSA Expeses Depedet Care Ceter Fees (qualifyig child or adult day care) Nursery/Preschool Fees (excludig Kidergarte) Before ad/or After School Care $ Private Sitter (i your ow or someoe else s home) Summer Day Camp $ Caregiver s Wages ad Employer Taxes Total Use this amout as a guidelie for your upcomig electio Estimated Aual Amout $ $ $ $ $ Medical FSA Use this worksheet to estimate eligible medical expeses that you, your spouse ad your qualified depedets may icur durig the pla year. The worksheet below cotais some of the most commo expeses. For a more comprehesive list of eligible expeses, please see the FSA Expese Guide. Sample Medical FSA Expeses Medical Isurace Deductibles $ Office Visit Copays $ Prescriptio Drugs/Copays $ Emergecy Room or Urget Care Copays $ Physical Therapy/Chiropractic Care $ Well Baby Care $ GYN Exams $ Physicals $ Immuizatios $ Hearig Exams $ Hearig Aids/Batteries $ Prescriptio (OTC) Medicatios $ Special Educatio Tuitio $ Detal Isurace Deductibles $ Exams $ Filligs $ Root Caals $ Crows $ Bridges $ Detal Implats $ Detures $ Orthodotic Paymets/Braces $ Estimated Aual Amout What s New for This Pla Year Visio Exams $ Eyeglasses $ Cotact Leses/Supplies $ Prescriptio Suglasses $ Laser Eye Surgery $ Total Use this amout as a guidelie $ for your upcomig electio Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

8 6 What s New for This Pla Year What s New For This Pla Year 2015 Medical Flexible Spedig Accout Expeses Guide Oly health care expeses ot reimbursed by isurace or ay other source ca be claimed. A Ace treatmet (o-cosmetic) Acupucture (excludig remedies ad treatmets prescribed by acupucturist) Air purifier Alcoholism treatmet Alterative healer Ambulace Artificial limbs/teeth B Birthig classes (portio related to birthig) Blood pressure moitor Blood sugar test kit Body sca Braille books ad magazies Breast pump Breast recostructio surgery followig a mastectomy C Chemotherapy Chiropractor Christia Sciece practitioer services Copaymets Coisurace Computer storage of medical records Cotact leses ad solutios Couselig Crutches D Deductibles Detal services (o-cosmetic) Detures/artificial teeth Diagostic fees ad services Drug addictio/overdose treatmet Drug ad medical supplies** E Ear plugs (for medical coditio) Equipmet for the hadicapped Eye drops** Eye examiatio Eye surgery (i.e. cataracts, LASIK, etc.) Eyeglasses (prescribed) F Fluoridatio device Flu shots G Gamblig addictio treatmet Geetic testig (to determie medical defects) Glucose moitor H Hearig devices ad batteries Hearig tests Holistic ad atural healer services Home care ursig services Hormoe therapy treatmet for meopause Hospital expeses (o-cosmetic) I Immuizatios Isuli L Laboratory fees Lactatio cosultat services Lamaze classes (portio related to birthig) Laguage traiig (for disabled idividual) Laser eye surgery Learig disability expeses (fees to school or specially traied tutor) M Massage therapy Medical coferece (admissio ad trasportatio) Medical expeses i excess of usual, customary ad reasoable (UCR) Medical record charges N Nasal sprays** Norplat (isertio or removal of device) Nutritioist expeses O Obstetrical expeses Occlusal guard (to prevet teeth gridig) Occupatioal therapy Oral surgery Orthodotic expeses Orthopedic devices Over-the-couter** medicatios (ot to iclude utritioal supplemets, cosmetic care items or items primarily used for geeral health) Oxyge P Pap smears Physical exams (ot employmet related) Physical therapy (for specific medical coditio) Prescriptio medicies (o-cosmetic) Prescriptio suglasses Preatal vitamis (prescriptio) Prosthesis Psychiatric/Psychological care R Radial keratotomy Routie physicals S Safety glasses (prescriptio oly) Schools ad educatio (special) Screeig test for medical diagosis Seeig-eye dog (purchase, traiig & care) Sleep deprivatio treatmets Smokig cessatio program Suglasses (prescriptio) Supplies to treat a medical coditio Surgical fee (o-cosmetic) T Taxes o medical services ad products Therapy, for medical care oly Trasplat expeses (surgical, hospital, laboratory ad trasportatio expeses for orga door) Trasportatio ad travel expeses for perso receivig medical care U Umbilical cord (collectio, freezig ad storage for immiet use to treat a specific medical coditio) V Varicose vei treatmet (o-cosmetic) Vaccies Visio correctio procedures Vitamis (prescriptio) W Weight loss drugs/programs (associated with a certai disease) X X-rays Physicia s ote must idicate the specific medical coditio, the medical item/treatmet recommeded to treat the medical coditio, the expected duratio of the coditio ad that the medical item is ot for cosmetic purposes. Depedet Care Flexible Spedig Accout Expeses Guide Oly depedet care expeses provided for a eligible IRS tax depedet ca be claimed. Adult daycare facility After-school programs Before-school programs Caregiver s wages ad employer taxes Depedet care i someoe else s home I-home depedet care Licesed childcare facility Motessori school (prior to kidergarte age) Nursery school Pre-school Private school (prior to kidergarte age) Summer day camp Toddler programs Trasportatio provided by depedet care provider to/from depedet care locatio ** Importat: Effective Jauary 1, 2011, all purchases for over-the-couter (OTC) drugs ad medicatios will require a prescriptio for reimbursemet. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

9 7 What s New For This Pla Year 2015 Kow what s importat to you Programs ad services that help you make the most of your Ciga health pla ad support your well-beig. Myciga.com your secure portal for beefit iformatio ad resources Nothig is more importat tha uderstadig your beefits ad your good health. That s why there s www. myciga.com your olie home for assessmet tools, provider search egie, explaatio of beefits paid, medical updates ad much more. So get ready to click with a site that clicks with you. How to register: Step 1 Eter i the web address lie o your browser. Step 2 Click o the Register Now butto. Step 3 Eter persoal details. Your Member ID umber is prited o your ID card. Upo eterig persoal iformatio a Cofirmatio Page should the appear. Click Accept if all iformatio is accurate. Step 4 Complete your Demographic ad Security Iformatio data. Click Cotiue. Step 5 Cofirm your idetity. Step 6 Review ad submit. 24 Health Iformatio Lie 24-hour guidace o medical treatmet Dial the toll-free umber o your Ciga ID card ad you ll be coected directly to a urse who is ready to help aswer your health questios. Nurses ca offer detailed aswers to your health questios, ad help you decide where ad whe to seek medical attetio. You ca also liste to hudreds of our latest podcasts i Eglish ad Spaish to help you stay iformed. Healthy Rewards complimetary discouts If you have Ciga coverage, the choice to use Healthy Rewards is etirely yours. The program is separate from your coverage, so the services do t apply to your pla s copays or coisurace. No doctor s referral is required ad o claim forms, either. Set the appoitmets yourself, show your ID card whe you pay for services ad ejoy the savigs. Health Assessmet persoalized report about your health The health assessmet ca give you a idea of the curret state of your health. Based o your resposes, you ll also lear if you are at ay risk for certai coditios like diabetes or high blood pressure. It will also help you uderstad what you ca do to maitai ad improve your health. To start. Go to ad select Take my health assessmet ad follow the registratio istructios util you reach my health & welless ceter. Select Take my health assessmet ow ad follow the steps through the questioaire. Whe takig the health assessmet, kow the followig: your blood pressure, total cholesterol, HDL cholesterol, height, weight, ad waist circumferece. If you do t kow these, you ca aswer, I m ot sure, but aswerig all questios produces the best results. We ll help you get what you eed for your chroic health coditio If you have a chroic health coditio, we kow there are times whe you eed extra help. That s why we re here. Take advatage of our free health coachig ad the, whe you re ready to go it aloe, say the word. We ll guide you to self service resources ad be there whe you eed us. It s up to you. A health advocate, urse, health educator or behavioral health specialist may be callig you to get thigs started, or you ca call us at ay time. We ca help you: Maage a chroic health coditio. Create a persoal care pla. Uderstad medicatios or your doctor s orders. Idetify health risks that affect your coditio. Make educated decisios o your treatmet optios. Kow what to expect if you eed to sped time i the hospital. Improve your lifestyle by copig with stress, quittig tobacco use, maitaiig good eatig habits, ad maagig or losig weight. What s New for This Pla Year Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

10 8 What s New for This Pla Year What s New For This Pla Year 2015 Beefits Available to All Ciga Participats YOU VE GOT A GOAL. AND YOU VE GOT WHAT IT TAKES TO REACH IT. Whether your goal is to lose weight, quit tobacco or lower your stress levels, you have the power to make it happe. Ciga Lifestyle Maagemet Programs ca help ad all at o cost to you. Each program is easy to use ad available where ad whe you eed it. Ad, you ca use each program olie or over the phoe or both. Weight Maagemet Reach your goal of maitaiig a healthy weight all without the fad diets. Create a persoal healthy-livig pla that will help you build your cofidece, be more active ad eat healthier. Ad, you ll get the support you eed to stick with it. Tobacco Get the help you eed to fially quit tobacco. Create a persoal quit pla with a realistic quit date. Ad, get the support you eed to kick the habit for good. You ll eve get free over-the-couter icotie replacemet therapy (patch or gum). My Health Assistat - Your way to achieve BIG health chages My Health Assistat olie coachig is a fu, iteractive program to help you achieve big health ad welless goals i just a few small steps. Here s how it works for you. Visit myciga.com, click o Maage My Health ad select My Health Assistat Olie Coachig You select the activities you like ad the goals you wat to achieve My Health Assistat creates a persoal coachig program just for you You check i regularly to track your success My Health Assistat lets you add or chage activities ad goals at ay timesmall steps are a great way to make big chage possible. Especially whe it comes to your health. Get started ow. You ll be happy that you did ad o your way to better health. Powered by WebMD Stress Maagemet Lower your stress levels ad raise your happiess levels. Lear what causes you stress i your life ad develop a persoal stress maagemet pla. Ad, get the support you eed to help you cope with stressful situatios both o ad off the job. Over the phoe Oe-o-oe welless coachig Coveiet eveig ad weeked hours Program workbook ad toolkit Olie Secure, coveiet support Self-paced program Educatioal materials, iteractive tools ad resources Take the first step. Call or visit myciga.com Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

11 9 Beefits ad Eligibility 2015 Basic Beefits With the exceptio of the defied beefit pesio plas, the costs for the basic beefits for all regular part-time ad full-time employees are paid i full by Baltimore Couty Public Schools. Basic beefits iclude: Paid Holidays* Paid Vacatio & Compesable No-Duty Work Days* Paid Sick Leave* Paid ad Upaid Leaves of Absece* Tuitio Reimbursemet* Employee Assistace Program Employee Welless Program $15,000 of Basic Term Life Isurace Employee Visio Coverage* First Fiacial Federal Credit Uio membership available Defied Beefit Pesio Pla *Refer to your supervisor or the Office of Huma Resources for more iformatio regardig your eligibility for these beefits. Membership i the Marylad State Teacher s Pesio System is madatory ad requires a cotributio based o your aual compesatio. Membership i the Baltimore Couty Employees Retiremet System (ERS) is volutary ad the employee cotributio percetage is based o a flat percetage of compesatio. Optioal Beefits I geeral, full ad part-time employees may choose to eroll i ay combiatio of the beefits listed below. BCPS cotributes a large portio toward the purchase of health ad welfare beefits. This allows you the flexibility to choose the beefit plas that best meet your eeds. The Flexible Beefits Program for BCPS is a cafeteria pla as defied by Sectio 125 of the Iteral Reveue Code. A cafeteria pla allows you to pay for certai employee beefits with pre-tax deductios from your paycheck. You pay for most beefits o a before-tax basis, which lowers the taxes take out of each paycheck. Your before-tax beefits iclude: Medical Detal Visio (Must be.5 FTE to be eligible) Cacer & Itesive Care Isurace (ot offered to ew hires after 7/1/2007) Optioal Term Life Isurace up to 10x salary. First $35,000 is before tax. Flexible Spedig Accouts 403(b) / 457(b) Plas Your after-tax beefits iclude: Persoal Accidet Isurace Log Term Disability Isurace (Must be.5 FTE to be eligible) Optioal Term Life Isurace up to 10x salary. Amout over $35,000 is after tax. Maximum is $1 millio. Whole Life Isurace with Log Term Care Critical Illess Isurace Beefits ad Eligibility Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

12 10 Beefits ad Eligibility Beefits ad Eligibility (cotiued) Eligibility Employees You are eligible to participate i the BCPS Flexible Beefits Program if you are a: Regular full-time employee Part-time employee workig.5 FTE or more Depedets Eligible family members iclude your: Legal spouse Domestic parter Domestic Parter, which is defied as: l Same or opposite geder l Both 18 years or older ad l Not related by blood l Who share fiacial obligatios l Reside together cotiuously for at least 12 moths l Have agreed to be joitly resposible for each other s welfare l Not legally married to ayoe else or i a registered domestic partership with ayoe else You ca cover your domestic parter if your partership is registered with BCPS. You ca fid more iformatio about domestic parter registratio o the beefits Web site at: Depedet childre Childre iclude the employee s: l Natural childre l Stepchildre l Legally adopted childre l A child for whom you have legal guardiaship, icludig gradchildre l Childre of your Registered Domestic Parter who deped o you for fiacial support Depedet childre are covered through the ed of the moth that they tur 26 years of age. Depedet childre who are married are eligible. Depedets are eligible for beefits if the employee is required to provide beefits through a divorce decree, court order, or Qualified Medical Child Support Order (QMCSO). Depedets who reach age 26 will be eligible for COBRA beefits. Importat Domestic Parter Tax Note: The Iteral Reveue Service regulatios require differet tax treatmet for group isurace costs associated with same-sex domestic parter coverage i cases where the parter does ot qualify as a tax depedet uder the IRS Code. (I determiig the tax effect of same-sex domestic parter coverage, Baltimore Couty Public Schools require a completed Declaratio of Tax Status Form.) The Federal ad State tax cosequeces of beefits coverage are differet for a same-sex domestic partership tha for a husbad ad wife. Uder Federal law, Baltimore Couty Public School s cotributio toward the cost of health care coverage for a domestic parter ad his or her depedet(s) is cosidered taxable icome to the employee. The employee should cosult with a tax advisor for a full uderstadig of the tax cosequeces. My Spouse or Domestic Parter is also a employee of BCPS. Ca we cover each other for beefits? If you ad your spouse (or domestic parter) are both employees of BCPS, you may each eroll as a idividual or oe of you ca elect two-perso or family health care coverage. If you elect coverage separately, you caot claim each other as a depedet. Your eligible depedet child(re) may oly be covered by oe of you. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

13 11 Beefits ad Eligibility Whe Your Depedet Loses Eligibility for Coverage Ay ieligible depedets should be removed from your coverage as soo as they become ieligible. You must otify the Office of Beefits, Leaves ad Retiremet at or withi 30 days of ay qualifyig evet (e.g. marriage, birth of a child, divorce, etc.) affectig your eligibility or the eligibility of your depedets. You should cotact the Beefits Office, i advace, so that the depedet ca be removed from coverage at the appropriate time. There are o refuds of mothly deductios or quarterly paymets take durig the period of ieligibility. Whe coverage eds for a depedet, he or she may choose to cotiue coverage uder COBRA for a maximum of 36 moths, as log as you have otified the Office of Beefits, Leaves ad Retiremet withi 60 days of the loss of eligibility. Beefits ad Eligibility BCPS shall have the right of determiig eligibility of a spouse ad depedets cosistet with the provisios of the Pla. A few examples of ieligible depedets are: Ayoe who is ot your legal spouse (e.g. ex-spouse) Depedets o loger covered by a court order Childre of live-i parters, if the domestic parter is ot covered Stepchildre followig divorce from atural paret Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

14 12 HIPAA Health Isurace Portability Accoutability Act (HIPAA) The Health Isurace Portability ad Accoutability Act (HIPAA) places limitatios o a group health pla s ability to impose pre-existig coditio exclusios, provides special erollmet rights for certai idividuals, ad prohibits discrimiatio i group health plas based o health status. BCPS electroically trasmits data to the vedors for eligibility purposes. The vedors ad BCPS are i compliace with the HIPAA requiremets. No persoally idetifiable iformatio may be released to a third party. For more detailed iformatio, please go to our Web site, Special Erollmet Rights If you declie erollmet for yourself or your depedets (icludig your spouse) because of other health isurace coverage, you may i the future be able to eroll yourself or your depedets i this pla. A erollmet request must be made withi 30 days of your other coverage edig. I additio, if you have a ew depedet (as a result of marriage, birth, adoptio, or placemet for adoptio), you may be able to eroll yourself ad your depedets provided that you request erollmet withi 30 days of the qualifyig evet. For more iformatio about your rights, icludig COBRA, the Health Isurace Portability ad Accoutability Act (HIPAA), ad other laws affectig group health plas, cotact the earest Regioal or District Office of the U.S. Departmet of Labor s Employee Beefits Security Admiistratio (EBSA) i your area or visit the EBSA Web site at New Special Erollmet Rights This otice is beig provided so that you uderstad your right to apply for group health isurace coverage outside of Baltimore Couty Public School s ope erollmet period. You should read this otice regardless of whether or ot you are curretly covered uder the Baltimore Couty Public School s Group Health Pla. The Health Isurace Portability ad Accoutability Act requires that employees be allowed to eroll themselves ad/ or their depedet(s) i a employer s Group Health Pla uder certai circumstaces, provided that the employee Baltimore Couty Public Schools otified the employer withi 30 days of the occurrece of ay followig evets: Loss of health coverage uder aother employer pla (icludig exhaustio of COBRA coverage); or Acquirig a spouse through marriage; or Acquirig a depedet child through birth, adoptio, placemet for adoptio or foster care placemet. Effective April 1, 2009, the Childre s Health Isurace Program Reauthorizatio Act of 2009 creates two ew special erollmet rights for employees ad their depedets. I additio to the special erollmet rights set forth above, all group health plas must also permit eligible employees ad their depedet(s) to eroll i a employer pla if the employee requests erollmet uder the group health pla withi 60 days of the occurrece of followig evets: Loss of coverage uder Medicaid or a state child health pla: If you or your depedet(s) lose coverage uder Medicaid or a state child health pla, you may request to eroll yourself ad/or depedet(s) i our group health pla ot later tha 60 days after the date coverage eds uder Medicaid or the state child health pla. Gaiig eligibility for coverage uder Medicaid or a state child health pla: If you ad/or your depedet(s) become eligible for fiacial assistace from Medicaid or a state child health pla, you may request to eroll yourself ad/or your child(re) uder our group health pla, provided that your request is made o later tha 60 days after the date that Medicaid or the state child health pla determies that you ad/or your depedet(s) are eligible for such fiacial assistace. If you ad/or your depedet(s) are curretly erolled i our group health pla, you have the optio of termiatig your ad/or your child(re) s erollmet i our group health pla ad eroll i Medicaid or a state child health pla. Please ote that oce you termiate your erollmet i our group health pla, your childre s erollmet will be also termiated. Failure to otify us of your loss or gai of eligibility for coverage uder Medicaid or a state childre s health pla withi 60 days, will prevet you from erollig i our plas ad/or makig ay chages to your coverage electios util our ext ope erollmet period. To request special erollmet, or if you have questios regardig special erollmet rights, please cotact the Office of Beefits, Leaves ad Retiremet at Beefits Erollmet & Referece Guide

15 13 Medical, Detal, ad Visio Deductios for Full-Time Employees Hired O or Before December 31, 2012 Effective 1/1/ /31/2015 MEDICAL INSURANCE ** Your bi-weekly Deductio * CIGNA OAPIN (I Network) Idividual $45.48 Paret/Child Two Adults Family CIGNA OAP (I/Out Network) Idividual $67.14 Paret/Child Two Adults Family Kaiser Permaete HMO Idividual $48.58 Paret/Child(re) Two Adults Family Rates/Deductios: Full-Time DENTAL INSURANCE ** CareFirst Regioal Detal PPO Idividual $5.08 Paret/Child or Two Adults Family CareFirst Regioal Detal Traditioal Idividual $7.01 Paret/Child or Two Adults Family CIGNA Detal DHMO Idividual $14.08 Paret/Child(re) or Two Adults Family VISION INSURANCE CareFirst Davis Visio Idividual (Free if FTE is.5 or greater) $- Family (icludes Paret/Child ad Two Adults) 3.94 *All employee beefits deductios are based upo 20 pay periods **Domestic Parter beefits may be subject to imputed icome Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

16 14 Rates/Deductios: Part-Time Medical, Detal, ad Visio Deductios for Part-Time Employees Hired O or Before December 31, 2012 Effective 1/1/ /31/2015 Part-Time Employee Bi-Weekly Deductio* MEDICAL INSURANCE ** Your Full-Time Equivalecy (FTE) CIGNA OAPIN (I Network) Idividual $75.92 $ $ $ $ Paret/Child Two Adults Family CIGNA OAP (I/Out Network) Idividual $99.92 $ $ $ $ Paret/Child Two Adults Family Kaiser Permaete HMO Idividual $81.09 $ $ $ $ Paret/Child(re) Two Adults Family DENTAL INSURANCE ** CareFirst Regioal Detal PPO Idividual $6.03 $6.97 $7.92 $8.86 $9.81 Paret/Child or Two Adults Family CareFirst Regioal Detal Traditioal Idividual $7.96 $8.90 $9.85 $10.79 $11.74 Paret/Child or Two Adults Family CIGNA Detal DHMO Idividual $15.02 $15.97 $16.91 $17.86 $18.80 Paret/Child(re) or Two Adults Family VISION INSURANCE CareFirst Davis Visio Idividual (Free if FTE is.5 or greater) $- $- $- $- $- Family (icludes Paret/Child ad Two Adults) Cost of Coverage for Part-Time Employees The cost of medical ad detal coverage varies accordig to your full-time equivalecy (FTE). All employees are assiged a FTE based o the hours worked as a percetage of the umber of hours a full-time employee i that same positio would work. For example, a employee who works 20 hours durig a week i a positio which defies full-time employmet as workig 40 hours each week would have a FTE of.5. * All employee beefits deductios are based upo 20 pay periods ** Domestic Parter beefits may be subject to imputed icome Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

17 15 Medical, Detal, ad Visio Deductios for Full-Time Employees Hired O or After Jauary 1, 2013 Effective 1/1/ /31/2015 MEDICAL INSURANCE ** Your bi-weekly Deductio * CIGNA OAPIN (I Network) Idividual $52.48 Paret/Child Two Adults Family CIGNA OAP (I/Out Network) Idividual $78.99 Paret/Child Two Adults Family Kaiser Permaete HMO Idividual $56.06 Paret/Child(re) Two Adults Family Rates/Deductios: Full-Time DENTAL INSURANCE ** CareFirst Regioal Detal PPO Idividual $5.08 Paret/Child or Two Adults Family CareFirst Regioal Detal Traditioal Idividual $7.01 Paret/Child or Two Adults Family CIGNA Detal DHMO Idividual $14.08 Paret/Child(re) or Two Adults Family VISION INSURANCE CareFirst Davis Visio Idividual (Free if FTE is.5 or greater) $- Family (icludes Paret/Child ad Two Adults) 3.94 *All employee beefits deductios are based upo 20 pay periods **Domestic Parter beefits may be subject to imputed icome Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

18 16 Rates/Deductios: Part-Time Medical, Detal, ad Visio Deductios for Part-Time Employees Hired O or After Jauary 1, 2013 Effective 1/1/ /31/2015 Part-Time Employee Bi-Weekly Deductio* MEDICAL INSURANCE ** Your Full-Time Equivalecy (FTE) CIGNA OAPIN (I Network) Idividual $82.22 $ $ $ $ Paret/Child Two Adults Family CIGNA OAP (I/Out Network) Idividual $ $ $ $ $ Paret/Child Two Adults Family Kaiser Permaete HMO Idividual $87.83 $ $ $ $ Paret/Child(re) Two Adults Family DENTAL INSURANCE ** CareFirst Regioal Detal PPO Idividual $6.03 $6.97 $7.92 $8.86 $9.81 Paret/Child or Two Adults Family CareFirst Regioal Detal Traditioal Idividual $7.96 $8.90 $9.85 $10.79 $11.74 Paret/Child or Two Adults Family CIGNA Detal DHMO Idividual $15.02 $15.97 $16.91 $17.86 $18.80 Paret/Child(re) or Two Adults Family VISION INSURANCE CareFirst Davis Visio Idividual (Free if FTE is.5 or greater) $- $- $- $- $- Family (icludes Paret/Child ad Two Adults) Cost of Coverage for Part-Time Employees The cost of medical ad detal coverage varies accordig to your full-time equivalecy (FTE). All employees are assiged a FTE based o the hours worked as a percetage of the umber of hours a full-time employee i that same positio would work. For example, a employee who works 20 hours durig a week i a positio which defies full-time employmet as workig 40 hours each week would have a FTE of.5. * All employee beefits deductios are based upo 20 pay periods ** Domestic Parter beefits may be subject to imputed icome Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

19 17 Your Medical Optios Highlights BCPS offers eligible employees the choice of the followig medical pla optios: Ciga Ope Access Plus OAP Ciga Ope Access Plus I-Network OAPIN Kaiser Permaete HMO Noe of these plas cotai a pre-existig coditio limitatio. This meas that each pla will ot exclude beefits for illesses you had whe you joied BCPS. About Our Medical Pla Optios The medical plas offered through BCPS flexible beefits program have differet ways of deliverig health care. BCPS gives you the choice of oe Health Maiteace Orgaizatio (HMO) pla, oe Ope Access I-Network pla (OAPIN), ad oe Ope Access i- or out- ofetwork pla (OAP). The differeces betwee the HMO pla ad the Ope Access plas are the levels of coverage ad the selectio of providers. A HMO ad Ope Access Plus I-Network pla (OAPIN) offers oe level of coverage ad you must use the etwork of participatig providers. The Ope Access Plus (OAP) allows for both i- ad out-of etwork providers. The flexibility to seek care outside the etwork traslates ito a higher price tag from your paycheck. You decide which pla works best for you. What is a Primary Care Physicia (PCP)? The Kaiser Permaete HMO optio require the selectio of a Primary Care Physicia (PCP) to obtai the highest level of coverage. A PCP is typically a geeral practitioer, a family practitioer, a iterist, or a pediatricia. You ad each covered member of your family must choose a PCP from the pla s provider directory. The most curret provider directory iformatio is available from each pla s Web site, from Member Services, or you may call the Office of Beefits, Leaves ad Retiremet to obtai a paper copy of the directory. The Ope Access Plus I Network (OAPIN) ad the Ope Access Plus (OAP) plas do ot require a PCP but it is recommeded that a PCP be used to coordiate care. Your PCP provides your medical care or refers you to a specialist, as ecessary. Your PCP will get to kow your medical history ad your idividual health care eeds. Primary Care Physicias make sure that you are ot receivig uecessary medical treatmet ad that the medicatios that you are takig are safe ad effective. There are geerally o claim forms to complete or submit. Call the Member Services umber o your medical pla idetificatio card for iformatio o chagig your PCP. Your Medical Optios Highlights O the followig pages you will fid a compariso of the beefits provided uder each medical optio. Importat Note: This erollmet guide is either a cotract or a summary descriptio of your health pla choices. If you have specific questios about a particular pla before erollig i it, call the Office of Beefits, Leaves ad Retiremet to obtai erollmet brochures ad a copy of the applicable Beefit Guide or Certificate of Coverage. After you eroll, you will receive a copy of the Beefit Guide or Certificate of Coverage for the health pla that you have selected. Please retai this iformatio for your records. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

20 18 Your Medical Optios Highlights Your Medical Optios Highlights (cotiued) Ciga Ope Access Plus Ciga s Ope Access Plus pla gives you importat choices. Each time you eed care, you ca choose the doctors ad other health professioals ad facilities that work best for you. Eroll i the Ope Access Plus pla ad you ll get: Optios for accessig quality health care. Primary Care Physicia (PCP). You decide if you wat to choose a PCP as your persoal doctor to help coordiate care ad act as a persoal health advocate. It s recommeded but ot required. I-etwork. Choose to see doctors or other health professioals who participate i the Ciga etwork to keep your costs lower ad elimiate paperwork. No-referral specialist care. If you eed to see a specialist, you do ot eed a referral to see a doctor who participates i the Ciga etwork just make the appoitmet ad go! Precertificatio may be ecessary for hospitalizatios ad some types of outpatiet care, but there is o paperwork for you. Out-of-etwork. You also have the freedom to visit doctors or use facilities that are ot part of the Ciga etwork, but your costs will be higher ad you may eed to file a claim. Emergecy ad urget care. Whe you eed care, you re covered, 24 hours a day, worldwide. 24/7 service. Wheever you eed us, customer service represetatives are available to take your calls. You ca also speak with a health care professioal over the phoe, ay time, day or ight. Access to myciga.com. Use a persoalized website to: Lear more about your pla ad the coverage adwprograms available to you. View claim history ad accout trasactios; prit claim forms whe you eed them. Fid iformatio ad estimate costs for medical procedures ad treatmets. Lear how hospitals rak by umber of procedures performed, patiets average legth of stay ad cost. Questios ad Aswers Do I have to choose a Primary Care Physicia (PCP)? No. However, a PCP gives you ad your covered family members a valuable resource ad ca be a persoal health advocate. What if my doctor is t o your list? That meas your PCP does ot participate i the Ciga etwork. To receive your maximum coverage, you should select a doctor from the Ciga list of participatig doctors ad other health care professioals. You ca cotiue seeig your curret doctor, eve if he or she is ot i Ciga s etwork. However, i that case, you will pay higher out-of-pocket costs, ad your care will be covered at the out-of-etwork coverage level. Do I eed a referral to see a specialist? Though you may wat your persoal doctor s advice ad assistace i arragig care with a specialist i the etwork, you do ot eed a referral to see a participatig specialist. If you choose a out-of-etwork specialist, your care will be covered at the out-of-etwork coverage level. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

21 19 Your Medical Optios Highlights (cotiued) What is the differece betwee i-etwork coverage ad out-of-etwork coverage? Each time you seek medical care, you ca choose your doctor either a doctor who participates i the Ciga etwork or someoe who does ot participate. Whe you visit a participatig doctor, you receive i-etwork coverage ad will have lower out-of-pocket costs. That s because our participatig health care professioals have agreed to charge lower fees, ad your pla covers a larger share of the charges. If you choose to visit a doctor outside of the etwork, your out-of-pocket costs will be higher. What if I eed to be admitted to the hospital? I a emergecy, your care is covered. Requests for o-emergecy hospital stays other tha materity stays must be approved i advace or pre-certified. This eables Ciga HealthCare to determie if the services are covered. Pre-certificatio is ot required for materity stays of 48 hours for vagial deliveries or 96 hours for cesarea sectios. Depedig o your pla, you may be eligible for additioal coverage. Ay hospital stay beyod the iitial 48 or 96 hours must be approved. Who is resposible for obtaiig pre-certificatio? Your doctor will help you decide which procedures require hospital care ad which ca be hadled o a outpatiet basis. If your doctor participates i the Ciga etwork, he or she will arrage for pre-certificatio. If you use a out-of-etwork doctor, you are resposible for makig the arragemets. Your pla materials will idetify which procedures require pre-certificatio. What is Case Maagemet? Case maagemet is a program that assists customers with the hardships of a illess. A urse Case Maager will help to coordiate the most appropriate care ad works with you, your family ad your physicias for the best results. What if I go to a out-of-etwork physicia who seds me to a etwork hospital? Will I pay i-etwork or outof-etwork charges for my hospitalizatio? Ciga HealthCare will cover authorized medical services provided by a Ope Access Plus participatig hospital at your i-etwork beefits level whether you were set there by a i- or out-of-etwork doctor. How do I fid out if my doctor is i the Ciga etwork before I eroll? Our dedicated Erollmet Iformatio Lie is available 24/7 to help you lear about the beefits ad advatages of Ciga. Call today ad a kowledgeable Erollmet Specialist will provide you with assistace i idetifyig participatig physicias ad related service providers. Call us at Or go to the olie provider directory foud o Click o Fid a Doctor Select a Directory Choose betwee Doctor, Detist, or Hospital, Pharmacy, Facility Eter a Locatio (City ad State OR Zip Code) Click Select a Pla Click Ope Access Plus, OA Plus, ChoiceFud OA Plus Click Choose Click A-Z (for specialized doctors or search by ame (optioal) Click Search Prit ad optios are available to save your results. After the pla effective date use which recogizes the pla you are i, ad what health care professioals are i your pla or simply call Customer Support for assistace. What is Trasitio of Care? Trasitio of care coverage allows you to cotiue to receive services for specified medical ad behavioral coditios for a defied period of time with health care professioals who do ot participate i the Ciga etwork util the safe trasfer of care to a participatig doctor or facility ca be arraged. You must apply for Trasitio of Care at erollmet, or chage i Ciga medical pla, but o later tha 30 days after the effective date of your coverage. For behavioral health related services please cotact Ciga Behavioral Health by callig the Customer Services phoe umber o the back of your ID card. Your Medical Optios Highlights Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

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