Instead of using this manual index, you can search the Benefits Administrator Manual online, using Adobe Reader.

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1 Benefits Administrator Manual Did you know? Instead of using this manual index, you can search the Benefits Administrator Manual online, using Adobe Reader. Adobe Reader is a free software program you can use to open and view the Benefits Administrator Manual and any other pdf document. It has a built-in search feature which makes it easy to look through documents to find a key word or phrase. Also, by clicking on the Bookmarks tab in Adobe Reader, you open an interactive Table of Contents for the manual. You can expand (+) and collapse (-) the list of contents. Clicking on an entry will jump you to that section in the manual. Quick Access Tips Open the BA Manual and minimize it on your Task bar on the bottom of your computer monitor so you can access it with one click. You can even save a copy of the manual to your desktop for offline access. INDEX May 2015 PEBA Insurance Benefits -1

2 A Academic Retirees. See Retirement Academic Transfers. See Transfers Accidental Death and Dismemberment. See Life Insurance Accident Questionnaire J-5 Accounting. See also Premiums; See also Reports Accounting Definitions K-4 Accounting Rules K-4 Accounting System Checklist L-87 Active Accounting System K-5 Adjustments K-22 Administrative Fee E-9, K-13, K-18 Billing and Billing Statements. See Billing Canceled Warrant K-11 Credits K-5 Forms L-75 Mid-month Changes K-4 MoneyPlus Payrolls and Accounting. See MoneyPlus Pay Frequency K-18 Payroll Center K-4 Refunds and Adjustments K-11 MoneyPlus K-22 SLTD Salary Updates K-25 Special Accounting Rules for CG Agencies. See Comptroller General (CG) Special Accounting Rules for Local Subdivisions. See Local Subdivisions Submitting Premium Payments K-15 TEFRA/DEFRA Letter K-11 Acronyms L-3 Administrative Error (Request for Review) J-13 Adoption H-10, H-18, K-10. See also Child Adoption Assistance Program H-18, H-19 Placement for Adoption H-10 Temporary Adoption K-10 Appeals J-9, J-10. See also Request for Approval Eligibility Appeals J-14 Basic Life. See Life Insurance Basic Long Term Disability (BLTD). See Long Term Disability Beneficiaries C-14 Beneficiaries Information on NOE C-14 Beneficiary Changes C-38 Benefits. See Programs/Benefits Benefits Identification Number (BIN) A-10, C-12, G-5 Billing. See also Accounting Active Billing File K-8 Active Group Billing Statement K-5 B Benefits Administrator Manual Advance Deposit Billing Statement K-7 Billing Statement K-5, K-14 Account Summary Pages K-6, K-14 Billing Summary Pages K-6, K-14 Coverage Processing Pages K-6, K-14 Group Address Page K-5, K-14 Remittance Advice Page K-7, K-14 Retiree/COBRA/Survivor Billing Statement K-14 Birth H-10 Birthday Rule H-9 Certificate of Coverage E-8 Change in Status C-28, D-7, H-4, H-9. See also Child; See also Eligibility; See also MoneyPlus During Transfer D-4 Gain of Other Group Coverage C-29, H-12 Loss of Other Coverage C-31, H-9 Loss of TRICARE Coverage C-32 Marriage C-29 Spouse Gains Coverage as an Employee H-5 Spouse Gains Coverage as a Retiree H-5 Spouse Gains Other Coverage H-5 Checklists Accounting System L-87 Claims L-86 Disability L-86 MoneyPlus Health Savings Account (HSA) C-20 NOE L-79, L-80 Retiree Checklists L-81, L-84 Termination L-81 Child H-9, H-18. See also Adoption Age 19 H-10, H-15 Age 26 H-14, H-18 Birth H-9, H-10 Birthday Rule H-9 Child of Foreign National Employee H-12 Court Order H-11 Custody C-36, H-11 Death L-83 Eligibility C-18, H-18 Audit H-9 Gain of Employment With Coverage H-12 Gains Other Coverage H-12 Guardianship C-36, H-11 Incapacitated Child H-13 Military Service H-14 Newborn H-10 Special Needs Child H-18. See also Adoption Termination L-83 Which SSN/BIN to Use for Claims G-5 Claims C-11. See also Appeals C -2 PEBA Insurance Benefits May 2015

3 Benefits Administrator Manual Checklist J-4 Dental Insurance J-6 Filing Claims J-4 Health Insurance Mental Health and Substance Abuse J-6 SHP Medicare Prescription Drug Program J-4 SHP Prescription Drug Program J-4 State Health Plan Claims J-4 BlueCard Worldwide International Claim Form J-4 Life Insurance J-7 Accidental Death and Dismemberment J-9 Assignment J-8 Claim Denied J-9 Dependent Life J-9 Long Term Disability I-4, J-9 Claim Denied J-10 MoneyPlus J-11 Dependent Care Spending Account C-18, J-11, J-13 Health Savings Account C-21, J-13 Medical Spending Account C-19, J-11 myfbmc Card SM J-12 State Vision Plan J-6 Which SSN/BIN to Use for Claims G-5 COBRA E-3 Administrative Fee E-9 COBRA Administrator E-3 COBRA Election Period E-8 COBRA Notification/Notices H Day COBRA Notification Requirement for Dependents E-5 COBRA Qualifying Event Notice E-6 COBRA Termination Notice E-8 Initial COBRA Notice E-4 Mailing Requirements For All COBRA Notices E-4 Required COBRA Notices E-4 COBRA Quick Reference E-11 Eligibility E-5, E-8 Forms L-74 COBRA Ineligibility Form E-5 MoneyPlus E-10 Premiums E-9 Qualified Beneficiary E-6 Qualifying Events 18-Month E-6 Extending COBRA Coverage to 29 Months E-7 Extending COBRA Coverage to 36 Months E-7 Survivors G-6 Termination D-10 Transfers D-3 Comptroller General (CG) Accounting CG Definitions K-11 Deduction Codes K-11 Payroll Reconciliation Report K-11 Reconciliation K-11 Adoption Assistance H-19 Premiums K-16, K-17 Contact Information L-88 PEBA Insurance Benefits A-9 Continuation. See Life Insurance Conversion. See Life Insurance Coordination of Benefits J-4 County Codes L-4 Court Order H-8, H-11 Coverage. See also Change in Status; See also Eligibility; See also Termination Coverage Changes C-33, C-34, C-37 Creditable Coverage C-15 Custody. See Child Death L-82. See also Survivors Death Benefits Within 31 Days After Retirement F-6 Death of Covered Dependent H-8, H-12, L-83 Death of Subscriber K-4, L-82 Suicide J-8 Dental Insurance C-12, C-14, C-27, F-6. See also Programs/Benefits Dental Plus A-16, J-6 Dependent Care Spending Account (DCSA). See MoneyPlus Dependent Eligibility. See also Eligibility Foreign Documents H-4, H-9, H-17 Dependent Eligibility Audit H-16 Dependent Life-Child. See Life Insurance Dependent Life-Spouse. See Life Insurance Dependent Spouse. See Spouse Disability I-3, L-81. See also Retirement; See also Long Term Disability Applying for Disability Benefits I-3 Assisting a Disabled Employee I-3 Disability Determination E-7 Disability Retirement I-3 Partial Disability I-4 Returning to Work I-6 Return to Work Program I-6 Divorce H-7, H-11 Documentation Quick Reference L-49 Dual Employment C-7, D-9, H-5 Eligibility. See also COBRA; See also Survivors; See also Change in Status Both Spouses Employed By Participating Employers H-5 Dependent Child H-18 Dependent Eligibility Audit H-16 Spouse H-4, H-17 When Spouse and Children Eligibility Ends H-17 Employee C-5 D E May 2015 PEBA Insurance Benefits -3

4 20-Hour Threshold C-8 Reduction in Hours L-81 Employee Benefits Services (EBS) A-9. See also Using the Online Enrollment System BA Console B-24 Acknowledgement Tab B-25 Approval Tab B-26 Suspended Tab B-24 Types of Status B-28 SLTD Salary Updates B-33 To Sign Up B-5 Employees. See also Retirement; See also Terminations; See also Transfers Academic Employees/Teachers D-3, D-10, F-4 Contract Hours C-33 Permanent, Part-time Teachers C-23, C-25, C-26, C-33 Both Spouses Employed by Participating Employers H-5 Disabled Employees. See Disability Dual Employment C-7, D-9 Employee Eligibility C-5 New Employee/New Hire C-7, C-40. See also Enrollment Assisting a New Hire With Enrollment C-11 Refusal of Coverage C-10 End-Stage Renal Disease F-5, J-5 Enrollment C-10. See also Using the Online Enrollment System Dental Insurance C-27 Health Insurance C-12, C-22, C-25, C-27 Late Entrant C-27 Life Insurance C-14, C-28 Long Term Disability C-14, C-28 Medicare C-12 MoneyPlus C-16 New Hire C-11, C-26 New Retiree F-8 Open Enrollment C-39, C-40, E-10 Refusal of Coverage C-10 Retiree Returns to Work F-9 Special Eligibility Situations C-28. See also Change in Status Experience Rating K-13 Explanation of Benefits (EOB) J-4 Family and Medical Leave Act (FMLA) C-44 Fees Administrative Fee E-9, K-13, K-18 Forms L-73. See also Notice of Election (NOE) Accounting. See Accounting Active Termination Form D-12 Affordable Care Act L-73 Change in Status Form C-33 COBRA Forms. See COBRA Dental Insurance Forms L-73 Employee Benefits Services (EBS) L-74 F Health Insurance Forms L-73 HIPAA L-75 Life Insurance/AD&D L-73 Statement of Health Form C-35 Long Term Disability L-74 MoneyPlus Forms. See MoneyPlus On the Web A-8, L-73 Other Forms L-75 Request for Review J-13 Transfer Form D-6, D-7 Vision Care L-73 Benefits Administrator Manual G Gain of Other Coverage C-29, H-5, H-12 Generic Copay Waiver A-15 Guardianship C-36, H-11 Health Insurance. See Programs/Benefits Health Savings Account (HSA). See MoneyPlus History, State Insurance Benefits Programs Administration L-24 Dental Insurance L-14 Health Insurance L-5 Life Insurance/AD&D L-16, L-22 Long Term Care L-21 Long Term Disability L-22 MoneyPlus L-19 Supplemental Long Term Disability L-23 Vision Care L-24 Incapacitated Child H-13 H I L Late Entrant C-27 Leave Without Pay (LWOP). See also Leave of Absence Family and Medical Leave Act (FMLA) C-44 Forms L-74 General Leave Policies C-41 Long Term Disability K-22 Military Leave C-44, L-83 MoneyPlus C-43 Submitting Premiums While on LWOP K-16 Workers Compensation C-46 Life Insurance A-16. See also Claims; See also Enrollment; See also Termination; See also Retirement; See also Survivors Accidental Death and Dismemberment J-9 Assignment J-8 Basic Life A-16 Beneficiary Changes C-38 Changing Coverage C-34, C-36 Continuation F-7-4 PEBA Insurance Benefits May 2015

5 Benefits Administrator Manual Conversion D-11, F-7 Dependent Life A-16, F-7, J-9 Dependent Non-Confinement Provision H-15 Eligibility H-8, H-15 Late Entrant C-28 Optional Life A-16, G-6, I-4 Accelerated Benefits Option J-9 Accidental Death and Dismemberment A-16 Continuation/Conversion I-4 Living Benefit Option J-9 Premium Waiver I-4 Statement of Health C-35 Statement of Health Status Report C-35 Retiree Billing Policy F-6 Line of Duty Death. See Death Local Subdivisions Accounting K-13. See also Accounting Administrative Fee E-9 Experience Rating K-13 Premium Waiver G-5 Long Term Disability A-17, I-4. See also Enrollment; See also Termination; See also Retirement; See also Disability Adjustments I-5 Assignment I-5 Basic Long Term Disability (BLTD) A-17, I-4 Coverage Changes C-37 Eligibility I-4 FICA and Medicare I-6 Offsets I-5 Overpayments I-5 Payments I-5 Supplemental Long Term Disability (SLTD) I-4 Late Entrant C-28 SLTD Salary Updates B-33, K-25 Waiver of Premiums I-5 Loss of Other Coverage H-9, H-12 M Marriage C-29, H-5 Medicaid C-31 Medical Emergencies C-26 Medical Spending Account Claims J-12 Medical Spending Account (MSA). See MoneyPlus Medicare C-30, F-10 Claims J-5 COBRA E-8 Disability I-3 Eligibility F-5 Medicare Part D C-30, F-5 Medicare Supplemental Plan F-5 SHP Medicare Prescription Drug Program F-5 Mid-month Changes K-4, K-15 Military C-44, H-14, L-83 MoneyPlus A-17 MoneyPlus C-16. See also Enrollment; See also Change in Status; See also Termination; See also Transfers; See also Retirement Administrative Fees K-18 Change in Status C-32 Health Savings Account C-33 Claims/Reimbursement. See Claims COBRA E-10 Coverage Changes C-37 Flexible Spending Accounts C-37 Health Savings Account (HSA) C-37 Pretax Group Insurance Premium Feature C-34 Dependent Care Spending Account (DCSA) C-18, D-12 Whose Expenses Are Eligible C-18 Discrepancy Reports K-21 Effective Date C-17 Expenses Dependent Care Spending Account (DCSA) C-18 Medical Spending Account (MSA) C-19, C-20 Orthodontia C-19 Forms L-74 MoneyPlus Enrollment Form C-20 Health Savings Account (HSA) C-20, C-21, C-39, D-12 Closing Wells Fargo Account C-38 Opening Wells Fargo Account Online C-21 Medical Spending Account (MSA) C-18, C-19, D-12, E-10 Grace Period C-19 Run-out Period C-18, C-20 Whose Expenses Are Eligible C-20 myfbmc Card SM J-12, K-24 Automatic Substitution C-19 Reclassification K-24 Payrolls and Accounting K-18, K-19 Imputed Income K-23, K-24 MoneyPlus Payroll File K-18 Nondiscrimination Testing K-23 Reclassification K-25 Refunds and Adjustments K-21, K-22 MyBenefits A-8, B-20. See also Using the Online Enrollment System BA Console B-22 Beneficiaries B-22 Dependents B-22 How to Register on MyBenefits B-20 Making Open Enrollment Changes B-22 myfbmc Card SM. See MoneyPlus N Newborn. See Child Notice of Election (NOE) L-73 Active NOE Quick Reference L-29 Beneficiaries Information on NOE L-73 Certification and Authorization C-15 Completing the NOE C-26 Dependent Information C-15 Open Enrollment C-40 May 2015 PEBA Insurance Benefits -5

6 Retiree NOE F-8 Sample Active NOE C-13 Transfers D-7 O Online Enrollment and Changes. See MyBenefits; See Employee Benefits Services (EBS); See Using the Online Enrollment System Optional Employers. See Local Subdivisions Other Group Coverage C-29 Overpayments. See Long Term Disability Overview of State Insurance Benefits and Programs A-11 Part-time Teachers. See Employees Payroll Center K-4 Payroll/Processing SCEIS Payroll Process K-12 Pay-the-difference policy A-12 PEBA L-27 Administration A-18 Legal A-18 Operational Areas Finance A-20 PEBA Business Transformation Contracts/Procurement A-18 Health Care Initiatives A-19 Research and Statistics A-18, A-19 Health and Wellness Programs A-18 PEBA Insurance Benefits Communications and Training A-21 PEBA Insurance Benefits. BA Call Center A-10 Benefits at Work A-22 Contact Information A-9 EBS. See Employee Benefits Services (EBS) Insurance Benefits Training A-22 PowerPoint A-22 Webcasts A-23 Webinars A-22 Website A-7 Plan of Benefits Document A-11, C-5 Portability (Continuation). See Life Insurance Preauthorization C-11 Premiums COBRA Premiums E-9 Collecting Premiums for Mid-month Changes K-4 Non-Payment of Premiums L-82 Premium Waiver I-4 Submitting Premium Payments K-15 Active Employees K-16 Retiree, Survivor and COBRA Subscribers K-16 Prescription Drug Program P Benefits Administrator Manual State Health Plan Pay-the-difference policy A-12 SHP Medicare Prescription Drug Program A-13 Pretax Group Insurance Premium Feature C-17 Health and Wellness Programs A-15. See also Worksite Screening Programs/Benefits A-11 Dental Insurance A-15 Dental Plus A-16 State Dental Plan A-15 Health Insurance A-11 GEA TRICARE Supplement Plan A-15 State Health Plan A-11 Mammograms A-14 Maternity Management A-14 Medicare Prescription Drug Program A-13 Mental Health and Substance Abuse A-12 Migraine Program A-14 Pap Test Benefit A-14 Preauthorization A-13 Prescription Drug Program A-12 Shingles Vaccine Benefit A-14 Weight Management A-14 Well Child Care Benefit A-15 Life Insurance A-16 Basic Life A-16 Dependent Life-Child(ren) A-16 Dependent Life-Spouse A-16 Optional Life A-16 MoneyPlus A-17 Health and Wellness Programs A-15 State Vision Plan A-17 Vision Care Discount Program A-18 Proof of Insurance A-10 Publications Insurance Advantage A-21 Insurance Benefits Guide (IBG) A-11, A-21 PEBA Direct A-21 PEBA Update A-21 The BA Advantage A-21 When You Become Eligible for Medicare Handbook A-21 Q Qualified Beneficiary E-6 Qualifying Events. See Changes in Status; See COBRA Quick Reference Charts Active NOE Quick Reference L-29 Active Termination Form Quick Reference L-51 COBRA Quick Reference E-11 Effective Date Quick Reference L-47 MoneyPlus Enrollment Form Quick Reference L-34 Premium Checks Quick Reference K-17 Special Eligibility Situations Quick Reference L-35 R -6 PEBA Insurance Benefits May 2015

7 Benefits Administrator Manual Refunds and Adjustments Unclaimed Refund Checks K-12 Refusal of Coverage C-10 Reports K-8. See also Accounting Active Subscriber Roster K-8 Age Group Change Report K-9 Automated Subscriber Coverage Changes Report K-15 Dependent Age 1 and Over With no SSN K-10 Dependents Terminated due to Eligibility Audit K-9 Dependent Turning 26 K-10 MoneyPlus Payback Report K-24 Payroll Discrepancy Reports K-21 Payroll Reconciliation Report K-11 Subscriber/Dependent Roster K-9 Subscriber Premium Data File K-11 Subscriber Roster K-14 Subscribers in SLTD Waiver Status K-9 Subscribers With Incorrect Coverage Level K-10 Terminated Subscriber Listing K-10 Retirement F-4, L-81. See also Enrollment; See also Termination Academic Retiree F-4 Assisting an Eligible Retiree F-4 Changing Coverage in Retirement F-9 Disability Retirement F-5 Health Insurance F-4 Life Insurance F-6 Long Term Disability F-8 Medicare F-10 Medicare Supplemental Plan F-5 Retiree Packet F-4 Retiree Returns to Work F-9 Vision Insurance F-6 When the Retiree Becomes Eligible for Medicare F-5 Retroactivity K-4 Termination D-10 Review Benefits Available C-8 Reviewing and Editing the Summary of Enrollment MyBenefits B-15 Review Network C-11 S Sabbatical. See Leave Without Pay (LWOP) Separation H-7 SLTD Salary Updates K-25 Social Security Number (SSN) A-10, G-5. See also Benefits Identification Number (BIN) SOC (Summary of Change). See Using the Online Enrollment System SOE (Summary of Enrollment). See Using the Online Enrollment System Special Eligibility Situations. See Enrollment; See Changes in Status Spouse H-4, H-17 Both Spouses Employed by Participating Employers H-5 Common Law Spouse H-5, H-6 Court Order H-8 Death H-8, H-12, L-83 Divorce H-7, H-11 Eligibility Audit H-4 Former Spouse H-7, H-11 Marriage C-29, H-5 Reconciliation H-7 Separation H-7 Spouse Gains Coverage as an Employee H-5 Spouse Gains Coverage as a Retiree H-5 Spouse Gains Other Coverage H-5 Spouse of Foreign National Employee H-6 Termination L-83 Supplemental Long Term Disability (SLTD). See Long Term Disability Survivors G-3. See also Claims; See also Life Insurance; See also Termination Assisting a Survivor G-3 Eligibility COBRA G-6 If Survivor Was Covered at the Time of Death G-3 If Survivor Was Not Covered at the Time of Death G-3 When Survivor Coverage Ends G-6 General Rules About Survivor Coverage G-3 Health/Dental/Vision Coverage G-4 If the Deceased Was an Active Subscriber G-4 Optional Life Benefits G-6 Premium Waiver G-5 Supplemental Long Term Disability (SLTD) G-4 T Teacher and Employee Retention Incentive Program (TERI) C-7, F-10 Teachers. See Employees Termination D-9. See also COBRA; See also Retirement Active Termination Form. See Forms Death L-82. See also Death Life Insurance D-11 Long Term Disability D-11 MoneyPlus D-9, D-11 Dependent Care Spending Account (DCSA) D-12 Health Savings Account (HSA) D-12 Medical Spending Account (MSA) E-10 Non-Payment of Premiums L-82 Reinstating Coverage D-13 Retroactive Terminations D-10 Termination of Covered Dependent L-83 Termination of Employment D-10 Academic Employees D-10 Assisting a Terminating Employee E-3 Dismissal L-81 Reduction in Force (RIF) L-81 May 2015 PEBA Insurance Benefits -7

8 Benefits Administrator Manual Reduction in Hours L-81 Resignation L-81 Using the Online Enrollment System B-19 Tobacco Certification C-15 Tobacco-use Surcharge Waiver C-15 Transfers C-7, C-40, D-3. See also COBRA Academic Transfers D-4, D-5 Part-time Teachers D-4 Assisting a Transferring Employee D-3 Dual Employment D-9 Lateral Transfer D-8 MoneyPlus D-3, D-5, D-8 New Group Created D-8 Permanent, Part-time Teacher Transfers D-4 Transfer Form D-6 Transferring IN D-5 Transferring OUT D-3 U Using the Online Enrollment System B-4. See also MyBenefits Changes B-15 Beneficiaries Tab B-17 Coverage Tab B-16 Dependents Tab B-16 Enrollee Data Tab B-16 Review Tab B-17 Summary of Change (SOC) B-17 EBS Home Page B-6 EBS Home Page Buttons B-7 Employee Benefits Services (EBS) To Sign Up B-5 Enrollment B-8 Beneficiaries Tab B-12 Coverage Tab B-10 Dependents Tab B-9 Enrollee Data Tab B-8 Review Tab B-13 Summary of Enrollment (SOE) B-14, B-15 Manage Subscribers B-8 Manual Transactions B-19 Online Enrollment System Terms B-3 Termination B-19 W Waiver of Premium. See also Premiums Killed in the Line of Duty G-5 What s New A-3 Workers Compensation C-46 Worksite Screening C-9-8 PEBA Insurance Benefits May 2015