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

Transcription

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 [email protected]. 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

22 20 Your Medical Optios Highlights Your Medical Optios Highlights (cotiued) Ciga Ope Access Plus I-Network Ciga s Ope Access Plus I-Network 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 I-Network 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. For your health care to be covered by the pla, you must choose a health care professioal who is part of the Ciga etwork. 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! Pre-certificatio may be ecessary for hospitalizatios ad some types of outpatiet care, but there is o paperwork for you. Out-of-etwork. If you choose to see a doctor who is ot i the etwork, your care will ot be covered except i emergecies. 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 coverage from your health pla, you must select a doctor from the Ciga list of participatig doctors ad other health care professioals. If you decide to cotiue seeig your curret doctor, your care will ot be covered by your pla. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

23 21 Your Medical Optios Highlights (cotiued) 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, you do ot eed a referral to see a participatig specialist. If you choose a out-of-etwork specialist, your care will ot be covered by your pla. How does my pla cover my care? Whe you visit a doctor who participates i the Ciga etwork, 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 care will ot be covered by your pla. What if I eed to be admitted to the hospital? I a emergecy, your care is covered. Requests for oemergecy 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 caesarea 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 ad your care will ot be covered. Your pla materials will idetify which procedures require precertificatio. 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 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 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

24 22 Your Medical Optios Highlights Your Medical Optios Highlights (cotiued) Prescriptio Drug Coverage for Ciga Members Prescriptio drug coverage is provided through Express Scripts (ESI). A separate idetificatio card will be mailed directly to your home for use at participatig pharmacies throughout the coutry. To obtai the ame of a pharmacy that is coveietly located i your area, visit their Web site at or call Member Services. How are Prescriptios Covered? See the prescriptio drug services sectio o the Medical Optios At-a-Glace charts. The use of geeric drugs, if available, is madatory. If you obtai a brad ame drug whe a geeric is available, regardless of the circumstaces, you will pay more. Is a Mail Order Program Offered? Yes. The ESI mail order program provides you with the coveiece of receivig up to a 90-day supply of prescriptio maiteace medicatios at your home. You ca order refills usig ESI s automated touch-toe refill system or by usig their Web site at com. Your medicatios will be delivered by the U.S. Postal Service or UPS withi seve busiess days of receipt at ESI. To obtai further iformatio about the mail order program, call ESI at (877) Order forms are available from the Office of Beefits, Leaves ad Retiremet. Note: If you chage your address, cotact the Office of Payroll at BCPS. BCPS will update all address iformatio with each vedor with the exceptio of Express Scripts mail order. You must cotact the mail order umber directly to chage your mailig address. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

25 23 About Kaiser Permaete It s oe eat package At Kaiser Permaete, we combie health plas, facilities, ad practitioers i oe eat package makig your membership coveiet ad easy to use. Our members have relied o this all-i-oe model of health care for more tha 65 years, ad it s somethig we cotiue to perfect. Your Medical Optios Highlights Your health pla made simple Your health pla is the key to the care you eed ad so much more, icludig: u Freedom to your doctor s office, aytime, day or ight. u Olie tools that let you make appoitmets, order most prescriptio refills, ad read most lab test results (ad so much more). u Urget care cliics ope o eveigs ad weekeds to suit your eeds. u Health ad welless programs, both olie ad off, to help you stay well. Where you go for persoalized care Every Kaiser Permaete facility i our area is coected to your electroic health record, which keeps your care team iformed ad ready to give you the right care at the right time. Our medical ceters combie state-of-the-art techology ad expert physicias i coveiet medical ceters. Most iclude pharmacy, lab, ad X-ray services o site so you ca sped more time o thigs you ejoy. A care team focused o you With Kaiser Permaete, you get a choice of persoal physicias for you ad your family. To fid oe that s right for you, just go olie to kp.org/doctor. All of our Kaiser Permaete physicias work closely together to help you get well ad stay well. This teamwork is part of our focus o prevetio ad our commitmet to providig you with persoalized care. Baltimore See page 24 Couty for a Public quick-referece Schools guide with phoe umbers, addresses, ad other resources. Beefits Erollmet & Referece Guide 1

26 24 Your Medical Optios Highlights Gettig started Good health begis with your doctor Your experiece with the total health approach of Kaiser Permaete begis with your selectio of your primary care physicia (PCP) who takes a iterest i your well-beig, ultimately promotig a healthier life for you. You ad your PCP will review your medical backgroud together ad discuss your health goals (such as reducig stress, quittig smokig, lowerig your cholesterol, or lowerig your blood sugar). You have access to the almost 1,000 physicias i the MidAtlatic Permaete Medical Group, P.C., alog with etwork physicias who do ot practice i our medical ceters but are i private practice. Lookig for the best? Whe you search for the best of aythig, you do t begi with a field of thousads. You start with a pre-screeed set of trusted, highquality optios, ofte verified by third parties. That s what you get with the Mid-Atlatic Permaete Medical Group, P.C. a group of physicias whose credetials, educatio, ad traiig are certai, ad who practice evidece-based medicie ad prevetive care. Before ay physicia begis practicig with Kaiser Permaete, he or she must first udergo a screeig process. Physicias are board certified or become board certified withi five years of beig hired or joiig the medical group. This meas they have had additioal traiig i their specialty ad successfully completed a medical specialty exam. I additio, all physicias ad surgeos go through a review process every two to three years to verify that their credetials, icludig licese ad board certificatio, are up-to-date. Whe you choose a Kaiser Permaete physicia, you re assured that we have already reviewed ad cofirmed his or her credetials. It s tough to become oe of our doctors Oly 1 i 10 who applies is accepted as a Kaiser Permaete doctor. kaiser Permaete physicias promote a healthy lifestyle, disease prevetio, educatio, ad ope commuicatio. improvig patiet health usig these approaches, combied with maagemet of chroic diseases, is a corerstoe of kaiser Permaete medicie. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide5

27 25 Your primary care physicia (PCP) It s our goal to help you create the healthiest life possible for you ad your family. That begis by establishig a relatioship with a PCP ad seeig him or her regularly so you get cosistet ad persoalized care. Your PCP is your persoal physicia who will care for your total wellbeig helpig you stay healthy, as well as treatig you if you get sick. This doctor is resposible for coordiatig your health care eeds, icludig hospital ad specialty care, if eeded. Each family member may select his or her ow PCP. Adults should select a doctor who specializes i iteral medicie or family practice. For members uder age 18, physicias i pediatrics are available. You may also choose a family practitioer who cares for your etire family. Your obstetricia/ gyecologist (Ob/Gy) Wome will choose a Ob/Gy i additio to their PCP. Your relatioship with your Ob/Gy is a special oe that s importat throughout your life. As with your PCP, your Ob/Gy is your persoal physicia ad will coordiate your Ob/Gy related health care eeds while commuicatig with your PCP, providig you with cosistet, persoalized care. You may make appoitmets directly with your Ob/Gy. The Kaiser Permaete team advatage Small teams of physicias practice i the same office with a group of urses ad other professioals. This team approach helps maitai the cotiuity of your care ad, whe your doctor is uavailable, provides you with a doctor o the same team to see. As ecessary, your PCP or Ob/Gy also cosults with ay umber of physicia specialists or other health care professioals, such as utritioists or physical therapists, who practice at the same medical ceter or at other Kaiser Permaete locatios. If you choose a doctor i the etwork, talk with that physicia about how his or her health care team is orgaized to support your care. Choose your physicia Each Kaiser Permaete PCP ad Ob/Gy has a pael (roster) of patiets composed of members who have either selected or bee assiged to that physicia. Occasioally, it is ecessary to temporarily close a physicia s pael because of high demad by patiets to see that particular physicia. If you are told the physicia you have selected is ot acceptig ew patiets, we will try to offer you aother physicia who is a member of your origially requested physicia s health care team. 1. Lear about the doctors u Browse idividual physicia Web pages at kp.org/doctor. u Review a list of physicias i the prited physicia directory. u Cotact Member Services for assistace. 2. Choose your PCP If you do t choose a PCP whe you eroll, we ll sed you a letter askig you to make a selectio. If you still do ot choose oe, we ll make a selectio for you, based o where you live, ad otify you i writig. Of course, you ca chage your PCP ay time you like. 3. Choose your Ob/Gy Wome choose a Ob/Gy i additio to the PCP (your Ob/Gy caot be your PCP). We recommed that you make your selectio whe you eroll. If you do ot make your selectio withi the first moth of becomig a member, we will select oe for you. Of course, you ca chage your Ob/Gy ay time you like. 4. Tell us your choices. You ca: u Choose your physicia by registerig at kp.org ad visitig kp.org/doctor, or by callig Member Services. u Use the selectio form icluded i the physicia directory. u Idicate your selectios o the form provided by your employer. Your Medical Optios Highlights 6 Baltimore See page Couty 24 Public for a quick-referece Schools guide with phoe umbers, addresses, ad other Beefits resources. Erollmet & Referece Guide

28 26 Your Medical Optios Highlights How to chage your PCP or Ob/Gy You may choose a differet physicia at ay time for ay reaso. Simply: u Visit kp.org/doctor, or u Call Member Services You ll receive a letter ackowledgig the chage. If you must chage from a Kaiser Permaete physicia who practices i oe of our medical ceters to a etwork physicia who does ot practice at a medical ceter (or vice versa), you will eed to request that your medical records be set to your ew doctor s locatio. If you choose a etwork physicia If you select a etwork PCP or Ob/Gy who practices i the commuity, you may use the services (such as the pharmacy ad lab) i Kaiser Permaete medical ceters. Keep i mid that whe you use a etwork physicia, you will ot have the beefit of: 1. The coectivity betwee Kaiser Permaete physicias ad other caregivers made possible by our electroic medical record, 2. The coveiece of havig may services i oe buildig, ad 3. Fuctios available to registered users of My Health Maager at kp.org/myhealthmaager, such as: u u u u ig your doctor s office, Maagig appoitmets olie, Requestig most prescriptio refills, Viewig most lab test results, ad more. We will otify you about physicia chages If your PCP or Ob/Gy leaves Kaiser Permaete (or chages office locatio), we will mail you a letter explaiig the chage ad whe the chage is effective. If a ew physicia is ot amed to take your doctor s patiets, you will be asked to select aother physicia. If a replacemet is amed, you will receive a letter about the ew physicia. Of course, if your physicia is chagig to aother Kaiser Permaete medical ceter KP.ORG/DOCTOR locatio ad you would like to cotiue seeig him or her at the ew locatio, you may. If you select a etwork physicia, we will otify you of chages i his or her status as we are iformed of them by the doctor. As always, you may chage your PCP or Ob/Gy at ay time for ay reaso. New member orietatio Talk directly with our staff at a ew member orietatio about a rage of topics such as choosig a PCP, where to call for medical care, how to take advatage of our self-care ad prevetive care classes, what to do i a emergecy, ad more. Call Member Services for iformatio o whe ad where ew member orietatio meetigs will be held. Read about Kaiser Permaete physicias o their persoal Web pages. You ll fid iformatio about their educatio ad credetials, ad a lik to the doctor s office. Some physicias iclude details about their special professioal iterests ad persoal hobbies ad provide geeral medical iformatio for their patiets. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide7

29 27 What s ew i your area With medical ceters close to where you live ad work, health care has ever bee more Marylad coveiet. To fid a locatio ear you, visit kp.org/facilities or dowload a free app for your Virgiia smartphoe or mobile device from the App Store or from Google Play. Washigto, D.C. Your Medical Optios Highlights 1 Aapolis Medical Ceter 2 Camp Sprigs Medical Ceter 3 City City Plaza Medical Ceter 4 Columbia Gateway Medical Ceter Ceter 5 5 Kaiser Kaiser Permaete Permaete Frederick Frederick Medical Ceter Medical Ceter 6 NEW Gaithersburg 6 Gaithersburg Medical Ceter Medical Ceter 7 Kesigto Medical Ceter 7 Kesigto Medical Ceter 19 EXPANDED Ashbur Medical Ashbur Ceter Medical Ceter 20 Burke Medical Ceter 20 Burke Medical Ceter 21 Fair Oaks Medical Ceter 21 Fair Oaks Medical Ceter 22 Falls Church Medical Ceter 22 Falls Church Medical Ceter 23 Kaiser Permaete 23 Kaiser Fredericksburg Permaete Medical Ceter Fredericksburg Medical Ceter 24 Maassas Medical Ceter 24 Maassas Medical Ceter 25 MOVING Pederbrook Medical 25 MOVING Pederbrook Ceter Medical Ceter 30 Kaiser Permaete Capitol Hill Medical Ceter Northwest NEW Northwest D.C. Medical D.C. Medical Office Office Buildig Buildig 8 8 EXPANDING EXPANDING Largo Largo Medical Medical Ceter Ceter 9 Marlow Heights Medical Ceter Ceter Price George s Medical Ceter Ceter Severa Park Park Medical Ceter Resto Resto Medical Medical Ceter Ceter Sprigfield Sprigfield Medical Medical Ceter Ceter NEW Tysos Tysos Corer Corer Medical Ceter 29 Medical Woodbridge Ceter Medical Ceter 29 Woodbridge Medical Ceter Shady Grove Medical Ceter Silver Sprig Medical Ceter COMING South Baltimore SOON South Couty Baltimore Medical Couty Ceter Medical Ope Ceter 24/7/365 Days 15 Summit Behavioral Health Ceter Ceter 16 Towso Medical Ceter 16 Towso Medical Ceter 17 White Marsh Medical Ceter 17 White Marsh Medical Ceter 18 Woodlaw Medical Ceter 18 Woodlaw Medical Ceter For iformatio about the services all our medical ceters provide, visit kp.org/facilities. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide 21

30 28 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels Caledar Year Deductible (Ja 1 - Dec 31) - Idividual - Family Idividual $0 Family $0 Coisurace You pay 0% Pla pays 100% Caledar Year Out-of-Pocket Maximum - Idividual - Family Lifetime Maximum PROFESSIONAL SERVICES Office Visits - PCP - Specialist Physical/Speech/Occupatioal Therapy Office Visit Medical: Idividual $1,100 Family $3,600 Ulimited Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit You pay $20 per visit 40 days for each therapy per caledar year Prescriptio: Idividual $5,500 Family $9,600 Chiropractic Office Visit Diagostic Laboratory Tests, X-Rays You pay $20 per visit Limited to 40 days per caledar year Physicia s Office You pay 0% Pla pays 100% Associated PCP or Specialist visit copay may apply. Allergy Shots/Other Covered Ijectios You pay 0% Pla pays 100% Allergy Serum You pay 0% Pla pays 100% Allergy Testig You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

31 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO Idividual $200 Family $400 Idividual $300 Family $600 Noe Noe You pay 15% Pla pays 85% after the deductible is met Medical: Idividual $1,000 Family $2,000 Prescriptio: Idividual $5,600 Family $11,200 You pay 25% Pla pays 75% after the deductible is met Medical Idividual $1,500 Family $3,000 Prescriptio: Idividual $5,600 Family $11,200 N/A Idividual $3,500 Family $9,400 Ulimited Ulimited Ulimited Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit You pay $30 per visit 100 days all therapies combied per caledar year (I-etwork ad Out-of-etwork) You pay $30 per visit Ulimited days per caledar year Physicia s Office You pay 0% Pla pays 100% Associated PCP or Specialist visit copay may apply. You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 15% Pla pays 85% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100 days all therapies combied per caledar year (I-etwork ad Out-of-etwork) You pay 25% Pla pays 75% after the deductible is met Ulimited days per caledar year You pay 25% Pla pays 75% after deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100% after $5 copay 100% after $5 copay (referral required) 100% after $5 copay (maximum 30 visits or 90 days per cotract year) Discouts available- o referral 100% 100% after $5 copay 100% 100% after $5 copay Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

32 30 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels PREVENTIVE CARE Well Child Visit/Immuizatio You pay 0% Pla pays 100% Routie Gyecological Exam (o referral required) You pay 0% Pla pays 100% Routie Pap Smear (o referral required) You pay 0% Pla pays 100% Routie Mammogram (oce per 12 moths) You pay 0% Pla pays 100% Routie Adult Physical You pay 0% Pla pays 100% PSA Testig You pay 0% Pla pays 100% HOSPITAL SERVICES (Ipatiet & Outpatiet) Semi-Private Room ad Board Lab Tests ad X-Rays (Outpatiet) $100 copay per admissio, the You pay 0% Pla pays 100% Physicia s Office You pay 0% Pla pays 100% Associated PCP or Specialist visit copay may apply. Home Health Care You pay 0% Pla pays 100% Ulimited days per caledar year Skilled Nursig Facility/Rehab Facility Care You pay 0% Pla pays 100% 100 days per caledar year Physicia/Surgical Services You pay 0% Pla pays 100% Aesthesia Services You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

33 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 0% Pla pays 100% o deductible You pay 0% Pla pays 100% o deductible You pay 25% Pla pays 75% after the deductible is met You pay 0% Pla pays 100% o deductible 100% 100% 100% 100% 100% (oce per caledar year) 100% You pay 15% Pla pays 85% after the deductible is met Physicia s Office You pay 0% Pla pays 100% Associated PCP or Specialist visit copay may apply. You pay 0% Pla pays 100% o deductible 130 days per caledar year (I-etwork ad Out-of-etwork) You pay 15% Pla pays 85% after the deductible is met 120 days per caledar year (I-etwork ad Out-of-etwork) You pay 15% Pla pays 85% after the deductible is met You pay 15% Pla pays 85% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after deductible is met You pay 25% Pla pays 75% after the deductible is met 130 days per caledar year (I-etwork ad Out-of-etwork) You pay 25% Pla pays 75% after the deductible is met 120 days per caledar year (I-etwork ad Out-of-etwork) You pay 25% Pla pays 75% per visit after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100% 100% 100% 100% (maximum of 100 days per pla year) 100% 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

34 32 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels HOSPITAL SERVICES (Ipatiet & Outpatiet) (CONT.) Medical Cosultatios Outpatiet - Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet - You pay 0% Pla pays 100% ICU/CCU $100 copay per admissio, the You pay 0% Pla pays 100% Hospice Care You pay 0% Pla pays 100% Dialysis/Radiatio/Chemotherapy (Ipatiet) Dialysis/Radiatio/Chemotherapy (Outpatiet) Physical/Speech/Occupatioal Therapy (Ipatiet) $100 copay per admissio the You pay 0% Pla pays 100% You pay 0% Pla pays 100% $100 copay per admissio the You pay 0% Pla pays 100% Physical/Speech/Occupatioal Therapy (Outpatiet) You pay $20 per visit, 40 days for each therapy per caledar year Outpatiet Diagostic Services You pay 0% Pla pays 100% SUPPLIES Durable Medical Equipmet You pay 0%, pla pays 100%,(ulimited maximum) Hearig aids for adult ad childre: Ulimited dollar amout, 2 hearig aids every three years Prosthetic Devices ad Orthopedic Braces You pay 0% Pla pays 100% Ulimited Maximum per Caledar Year Diabetic Supplies You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

35 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO Outpatiet - Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet - You pay 15% Pla pays 85% after the deductible is met You pay 15% Pla pays 85% after the deductible is met You pay 0% Pla pays 100% o deductible You pay 15% Pla pays 85% after the deductible is met You pay 0% Pla pays 100% o deductible You pay 15% Pla pays 85% after the deductible is met 100 days per caledar year (I-etwork ad Out-of-etwork) You pay $30 per visit 100 days per caledar year (I-etwork ad Out-of-etwork) You pay 0% Pla pays 100% Outpatiet ad Ipatiet You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 0% Pla pays 100% o deductible You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100 days per caledar year (I-etwork ad Out-of-etwork) You pay 25% Pla pays 75% after the deductible is met 100 days per caledar year (I-etwork ad Out-of-etwork) You pay 25% Pla pays 75% after the deductible is met 100% 100% 100% 100% 100% after $5 copay 100% 100% after $5 copay 100% You pay 0%, pla pays 100%,(ulimited maximum) Hearig aids for adult ad childre: Ulimited dollar amout, 2 hearig aids every three years You pay 0% Pla pays 100% o deductible Ulimited Maximum per Caledar Year You pay 0% Pla pays 100% o deductible Baltimore Couty Public Schools You pay 0%, pla pays 100%,(ulimited maximum) Hearig aids for adult ad childre: Ulimited dollar amout, 2 hearig aids every three years You pay 25% Pla pays 75% after deductible is met Ulimited Maximum per Caledar Year You pay 25% Pla pays 75% after deductible is met 100% of allowed beefit for basic DME; Hearig aids for adults ad childre 1 per ear every 36 moths to $1,000 max per ear for adults; $1,400 max per ear for childre. 100% of allowed beefit 80% of allowed beefit Beefits Erollmet & Referece Guide

36 34 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels EMERGENCY SERVICES Emergecy Room if admitted if discharged Urget Care Ambulace (Air Ambulace if medically ecessary) MATERNITY/INFERTILITY SERVICES 2 Pre- ad Postatal Care ad Delivery Sterilizatio/Reverse Sterilizatio Elective Abortios i Ipatiet ad Outpatiet Facility You pay $50 per visit (copay waived if admitted) Copay waived if admitted, You pay $25 per visit, o deductible You pay 0% Pla pays 100% Iitial Visit to cofirm pregacy Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Global Materity Professioal Fees You pay 0% Pla pays 100% Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Physicia s Office Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Outpatiet Facility You pay 0% Pla pays 100% Excludes reversal of sterilizatio Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Outpatiet Facility; Physicia s Services You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

37 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO You pay $70 per visit o deductible (copay waived if admitted) Copay waived if admitted, You pay $30 per visit, o deductible You pay 0% Pla pays 100% o deductible You pay $70 per visit o deductible (copay waived if admitted) Copay waived if admitted, You pay $30 per visit, o deductible You pay 0% Pla pays 100% o deductible 100% 100% after $35 copay 100% if medically ecessary Iitial Visit to cofirm pregacy Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Global Materity Professioal Fees You pay 5% Pla pays 95% after the deductible is met Ipatiet Facility, Outpatiet Facility You pay 15% Pla pays 85% after the deductible is met Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85% after the deductible is met Excludes reversal of sterilizatio You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met Excludes reversal of sterilizatio 100% Applicable cost share based upo place of service. Reverse sterilizatio ot covered. Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85% after the deductible is met You pay 25% Pla pays 75% after deductible is met Applicable cost share based upo place of service Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

38 36 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels MATERNITY/INFERTILITY SERVICES 2 Artificial Isemiatio (requires pre-authorizatio) IVitro Fertilizatio (requires pre-authorizatio) MENTAL HEALTH AND SUBSTANCE ABUSE 3 Pre-authorizatio Required Metal Health Ipatiet Services Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Outpatiet Facility; Physicia s Services You pay 0% Pla pays 100% Ulimited dollar maximum Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Outpatiet Facility; Physicia s Services You pay 0% Pla pays 100% Ulimited dollar maximum Max (10) EAP visits with Ciga Behavioral or BCPS Call or Ciga Behavioral Yes $100 copay per admissio, the You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

39 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85% after the deductible is met Ulimited dollar maximum You pay 25% Pla pays 75% after deductible is met $100,000 lifetime maximum Applicable cost share based upo place of service Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85% after the deductible is met Ulimited dollar maximum You pay 25% Pla pays 75% after deductible is met $100,000 lifetime maximum 50% of allowed beefit lifetime maximum of $100,000 per member Max (10) EAP visits with Ciga Behavioral or BCPS Call or Ciga Behavioral Max (10) EAP visits with Ciga Behavioral or BCPS Call or Ciga Behavioral Yes Yes Yes You pay 15% Pla pays 85% after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100% Max (10) EAP visits with Ciga Behavioral or BCPS Call or Ciga Behavioral BCPS offers a Employee Assistace Program at o cost to employees. See page 42. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

40 38 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels MENTAL HEALTH AND SUBSTANCE ABUSE 3 Metal Health Outpatiet Services Office Visit You pay $20 per visit Outpatiet Facility You pay 0% Pla pays 100% Substace Abuse Ipatiet Services Substace Abuse Outpatiet Services $100 copay per admissio, the You pay 0% Pla pays 100% Office Visit You pay $20 per visit Outpatiet Facility You pay 0% Pla pays 100% OTHER SERVICES Kidey, Corea, Boe Marrow Trasplats Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Heart, Heart-Lug, Lug, Pacreas, Liver Trasplats (requires preauthorizatio) Outpatiet Facility; Physicia Services You pay 0% Pla pays 100% Primary Care Physicia You pay $15 per visit Specialist You pay $20 per visit Ipatiet Facility $100 copay per admissio, the You pay 0% Pla pays 100% Outpatiet Facility; Professioal Fees You pay 0% Pla pays 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

41 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO Office Visit You pay $30 per visit Outpatiet Facility You pay 0% Pla pays 100% after the deductible is met You pay 15% Pla pays 85% after the deductible is met Office Visit You pay $30 per visit Outpatiet Facility You pay 0% Pla pays 100% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met You pay 25% Pla pays 75% after the deductible is met 100% after $5 copay for idividual visits; $5 copay for group therapy visits. 100% 100% after $5 copay for idividual visits; $5 copay for group therapy visits. Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85% after the deductible is met (covered at 100% at LifeSource Ceter) You pay 25% Pla pays 75% after deductible is met 100% Primary Care Physicia You pay $20 per visit Specialist You pay $30 per visit Ipatiet Facility, Outpatiet Facility, Physicia s services You pay 15% Pla pays 85 % after the deductible is met (covered at 100% at LifeSource Ceter) You pay 25% Pla pays 75% after deductible is met 100% Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

42 40 Medical Optios At-a-Glace Medical Optios At-a-Glace Chart (cotiued) (Summary Pla Documet Prevails; visit for full details) Pla Facts Pla Name Member Services Ciga OAPIN Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Group Number Beefit Levels OTHER SERVICES (cotiued) Orga Trasplat Procuremet Orga Trasplat Travel Cardiac Rehabilitatio Ulimited Travel maximum $10,000 per trasplat (oly available if usig Lifesource Facility) You pay $20 per visit 40 days per caledar year PRESCRIPTION DRUG SERVICES Retail Prescriptio services provided through Express Scripts. Copays are per fill at participatig pharmacies up to a 30-day supply. Patiets may purchase up to 90 day supply at retail, however (3) copays will apply for 90 day supply. Madatory geeric $10 Formulary brad $20 No-formulary brad $35 Mail Order Prescriptio services provided through Express Scripts. Copays are per fill up to a 90-day supply. Madatory geeric $20 Formulary brad - $40 No-formulary brad - $70 VISION DENTAL COMMENTS Routie visio services ot covered Routie detal services ot covered Chiropractic care, Acupucture & massage therapy discout available. No referral required. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

43 I-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Ciga OAP Jauary 1, 2015 to December 31, 2015 Out-of-Network Ciga (Medical) Express Scripts (Prescriptio) Ciga (Metal Health) EAP - CIGNA Behavioral Health Kaiser Permaete Kaiser (Metal Health) Medical Optios At-a-Glace HMO Ulimited Ulimited 100% covered if recipiet is the member Travel maximum $10,000 per trasplat (oly available if usig Lifesource Facility) You pay $30 per visit Ulimited days per caledar year Prescriptio services provided through Express Scripts. Copays are per fill at participatig pharmacies up to a 30-day supply. Patiets may purchase up to 90 day supply at retail, however (3) copays will apply for 90 day supply. Madatory geeric $10 Formulary brad $20 No-formulary brad $35 Not Applicable You pay 25% Pla pays 75% after the deductible is met Ulimited days per caledar year Prescriptio services provided through Express Scripts. Copays are per fill at participatig pharmacies up to a 30-day supply. Patiets may purchase up to 90 day supply at retail, however (3) copays will apply for 90 day supply. Madatory geeric $10 Formulary brad $20 No-formulary brad $35 Limited beefit 100% after $5 copay Copays are per fill up to a 60-day supply. Madatory geeric $5 Brad $5 At a participatig commuity pharmacy: Madatory geeric $15 Brad $15 Prescriptio services provided through Express Scripts. Copays are per fill up to a 90-day supply. Madatory geeric $20 Formulary brad - $40 No-formulary brad - $70 Routie visio services ot covered Routie detal services ot covered Chiropractic care, Acupucture & massage therapy discout available. No referral required. Prescriptio services provided through Express Scripts. Copays are per fill up to a 90-day supply. Madatory geeric $20 Formulary brad - $40 No-formulary brad - $70 Routie visio services ot covered Routie detal services ot covered Chiropractic care, Acupucture & massage therapy discout available. No referral required. Copays are per fill for maiteace prescriptios up to a 90-day supply. Madatory geeric $5 Brad $5 $5 copaymet for routie exam; discout o leses & frames available Noe Chiropractic care, acupucture & massage therapy discout available. No referral required. my.kp.org/mida/bcps or Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

44 42 Refereces From Beefit Chart Refereces from Beefit Chart 1 Federally Required Iformatio o Mastectomy Services for All Medical Plas Uder all the medical plas, coverage is provided for a perso receivig beefits for a medically ecessary mastectomy who elects breast recostructio after the mastectomy, for: Recostructio of the breast o which the mastectomy has bee performed. Surgery ad recostructio of the other breast to produce a symmetrical appearace. Prostheses. Treatmet of physical complicatios for all stages of a mastectomy, icludig lymphedemas (swellig associated with the removal of lymph odes.) This coverage is provided i cosultatio with the attedig physicia ad patiet. These beefits are subject to the same deductibles ad coisurace amouts that apply to other beefits provided uder your medical pla. 2 Importat Notice About Materity Coverage ad Newbor Legth of Stay Uder federal law, group health plas ad health isurace issuers offerig group isurace coverage geerally may ot restrict beefits for ay hospital legth of stay i coectio with childbirth for the mother or ewbor child to: Less tha 48 hours followig a ormal vagial delivery or Less tha 96 hours followig a cesarea sectio However, the pla or health isurace issuer may pay for a shorter stay if the attedig provider (e.g., your physicia, urse midwife, or physicia assistat), after cosultatio with the mother, discharges the mother or the ewbor earlier. I additio, uder federal law, plas ad issuers may ot set the level of beefits or out-of-pocket costs so that ay later portio of the 48-hour (or 96-hour) stay is treated i a maer less favorable to the mother or the ewbor tha ay earlier portio of the stay. I additio, a pla or issuer may ot, uder federal law, require that a physicia or other health care provider obtai authorizatio for prescribig a legth of stay up to 48 hours (or 96 hours). However, to use certai providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtai precertificatio. Please cotact your health pla s member services uit. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

45 43 Utilizig the Services of the Employee Assistace Program (EAP) The EAP is the first place to start whe seekig couselig, cosultatio ad other work/life services ad supports. The EAP is a o cost ad cofidetial beefit available to BCPS employees ad their household members. You do ot eed to have health isurace with BCPS to take advatage of the EAP. BCPS has both a exteral EAP through Ciga Behavioral Health ad a iteral EAP. To arrage for a cofidetial cosultatio, couselig or work/life support services through the exteral EAP cotact Ciga EAP at Ciga EAP is available 24 hours a day, 365 days a year. The BCPS iteral EAP ca be cotacted at durig ormal busiess hours. Employee Assistace Program (EAP) Idividuals seek help from the EAP for persoal issues such as stress, axiety, relatioship or family problems. Additioally, the EAP ca assist with other issues icludig substace abuse, job stress or other persoal difficulties, icludig those resultig from fiacial, legal or health problems. Ciga s EAP ca provide telephoic cosultatios, face to face couselig sessios (up to 10 visits per problem), ad a host of work/life support services. Those work/life support services iclude iformatio ad referral about child care, seior care ad pet care. Ciga s EAP also offers fiacial ad legal cosultatio services ad a 60 miute free cosultatio if you are the victim of idetity theft. Our Ciga EAP ad the BCPS iteral EAP ca aswer questios you may have about the EAP ad other metal health services, resources ad support available through the BCPS health isurace plas or iformatio about commuity resources. Remember, whether life s challeges are big or small, our Employee Assistace ad Work/Life Support Program is available to help you ad your household members fid a solutio ad restore your peace of mid. You ca also go olie to: Employer ID: baltimore. Ciga s Website has a host of resources available to you as well. You ca also go to the BCPS Beefits, Leaves ad Retiremet Webpage, offices/beefits, ad click o EAP. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

46 44 Your Detal Optios Highlights Your Detal Optios Highlights BCPS Offers Three Detal Optios: CareFirst BlueCross BlueShield Regioal Detal PPO CareFirst BlueCross BlueShield Regioal Detal Traditioal Ciga Detal Care DHMO Regioal Detal PPO The CareFirst Detal PPO Program offers two levels of beefits i oe pla. Whe you eed detal care, you may see the detist of your choice. Beefit levels ad out of pocket expeses are determied based upo whether you receive detal care from a preferred detist. I-Network Beefits Whe you use a Preferred Provider, you receive the highest level of coverage with the least amout of out-of-pocket expese. I order to choose a preferred detist, please refer to the Preferred Detal Provider directory or cotact Member Services at (866) Out-of-Network Beefits You may choose to use detists outside of the etwork, but your costs may be higher. There are two types of out-ofetwork detists: Participatig detists are ot preferred detists, but they have agreed to bill oly up to the allowed beefit amout by CareFirst BlueCross BlueShield, thus limitig your out-of-pocket expese. No-participatig detists have o agreemet with CareFirst BlueCross BlueShield ad may bill you up to their charges, which may icrease your out-of-pocket expese. Members who receive care from o-participatig detists must pay for their services at the time the services are redered ad must file a claim for reimbursemet directly from CareFirst BlueCross BlueShield. Pla Highlights Each erolled family member receives up to $1,000 i paid beefits per caledar year Flexibility to choose ay detist CareFirst Preferred ad Participatig Providers will file claims for you ad caot balace bill you Prevetive care is available with o out-of-pocket expese if a CareFirst Preferred Provider is used Regioal Detal Traditioal The CareFirst Traditioal Detal Program allows you the freedom to choose ay detist. If you seek care from a CareFirst participatig provider, the detist caot bill you the differece betwee their charge ad the allowed amout. You are oly resposible for deductibles ad coisurace. A o-participatig provider will bill for ay amout over CareFirst s allowed beefit. Pla Highlights Each erolled family member receives up to $750 i paid beefits per caledar year. Flexibility to choose ay detist. CareFirst s Participatig Providers will file claims for you ad caot balace bill. Ciga Detal Care Ciga Detal Care is a detal health maiteace orgaizatio (DHMO). You must select ad seek services from your DHMO facility. No beefits are available if o-participatig detists are used. For the most curret iformatio regardig participatig detists i your area, call (800) You may also visit Ciga s Web site at Both resources are available 24 hours a day. You may chage your primary detist selectio by callig Member Services. I most cases, the chage will take effect o the first day of the followig moth. Pla Highlights There is o deductible. There are o aual dollar maximums. There are o claim forms for you to file. All prevetive care ad some restorative care is available with zero copaymets from you. Complex procedures are available for low, pre-set patiet charges that are published i the Patiet Charge Schedule. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

47 45 Your Detal Beefits At-a-Glace Chart Detal Plas Covered Service Deductible per caledar year** Maximum Beefit per Caledar Year** Prevetive Care Exams, Cleaigs, X-rays, Fluoride Restorative Care Filligs, Crows, Root Caals Periodotic Services CareFirst BlueCross BlueShield Regioal Detal PPO Group# 7 91 I-Network (Preferred) $10 per perso $20 per family Out-of-Network (Participatig or o-participatig*) $25 per perso $50 per family CareFirst BlueCross BlueShield Regioal Detal Traditioal Group# 7 91 $10 per perso $25 per family Participatig or o-participatig* $-0- $1,000 per perso $750 per perso Ulimited PLAN PAYS: 100% 80% 100% whe usig a Participatig Provider (No-Participatig Providers ca balace bill) 80% after deductible 80% for limited services after deductible 60% after deductible 60% for limited services after deductible 100% Ciga Detal DHMO Group# I-Network Oly 80% after deductible* Most filligs ad root caals: o out-of-pocket expese; copaymets for other covered procedures rage from $0 to $220 80% for limited services after deductible Copaymets for covered procedures rage from $15 to $335, o deductible Detal Beefits Prosthetic Services, Detures, Bridgework Emergecy Care Orthodotia Services 50% after deductible 30% after deductible Paid accordig to covered service. No additioal emergecy provisios are provided. 50% after deductible ($1,500 lifetime maximum) 50% after deductible ($1,000 lifetime maximum) (for depedet childre oly) 50% after deductible Copaymets for covered procedures rage from $15 to $335; o deductible 50% after deductible ($1,000 lifetime maximum) (for depedet childre oly) $0 ($54 after regularly scheduled hours) Copaymets vary from case to case. Maximum beefit of 24 moths. See patiet charge schedule for details. * CareFirst paymets based o allowed beefits. No-participatig providers ca bill ay amout over the CareFirst BlueCross BlueShield allowed beefit. ** Caledar Year meas Jauary 1 through December 31. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

48 46 Visio Beefits Visio Isurace Davis Visio, oe of the atio s leadig maaged visio care compaies, will cotiue to provide visio beefits. Davis Visio has a provider etwork cosistig of 22,000 private practitioers, idepedet optometrists ad ophthalmologists, opticias, ad retailers atiowide. Collectio of covered frames If you select a frame from the Davis Visio Tower Collectio, available at idepedet providers, you will ot have a copay. If you select a o-tower frame, you will be give up to $130 towards the retail cost. Expaded etwork May atioal ad regioal retail stores are ow i etwork, icludig Wal-Mart, Target Optical, Sears Optical, Pearle Visio, ad Doctor s Visioworks! To fid a visio provider, please visit ad click o Fid a Doctor or call Davis Visio at Who is eligible All employees who have a full-time equivalecy of.500 or greater are eligible for the visio care pla. The Board pays 100% of the cost for eligible employees. You have the optio of coverig your depedets. Beefit From Davis Visio Provider From Out-Of-Network Provider* Examiatio (every 12 moths 1 ) Spectacle Leses (every 24 moths 2 ) $20 Copay Covered up to $35 $20 Copay Covered up to $25/sigle visio Covered up to $40/bifocal Covered up to $55/trifocal Covered up to $80/leticular Frames (every 24 moths) Tower Collectio No-Tower Frames Covered i full Covered up to $130 Covered up to $35 Cotact Leses 3 (every 24 moths 2 ) Elective (i lieu of frames & leses) Medically Necessary** Covered up to $130 $20 Copay Covered up to $130 Covered up to $210 Laser Visio Correctio Discouted services Noe 1 Based o your last date of service. 2 Basic sigle visio, lied bifocal or lied trifocal leses. 3 Patiets choosig cotacts use their eligibility for a frame ad leses. Fittig is icluded if Davis Visio Collectio cotact leses are prescribed. You are resposible for all charges after the allowed amout for o-davis Viso Collectio cotact leses. * You are resposible for all charges for services received out-of-etwork ad must file a claim for reimbursemet up to the pla beefit. Claims must be submitted withi twelve moths of the date of service. ** Medically Necessary Cotact leses prescribed for coditios where visual acuity caot be adequately corrected with eyeglasses but ca be corrected by cotact leses. Preapproval required. I-Network Providers All i-etwork or participatig Davis Visio providers will offer the followig services at o additioal cost. Oe year breakage warraty o pla eyeglasses Plastic or glass leses Oversized leses Before selectig your eyewear, ask your doctor what is fully covered by your visio pla through Baltimore Couty Public Schools. To fid a provider ear you, please visit ad click o Fid a Doctor or call CareFirst Davis Visio at Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

49 47 Visio Isurace Out-of-Network Providers Should you choose to visit a eye care professioal ot i the Davis Visio etwork, you will still receive coverage; however, your out-of-pocket costs will be higher tha if you had visited a etwork provider. Note: Please be aware that o-davis Visio providers will expect the etire paymet up-frot. You may the seek reimbursemet by submittig a claim form to CareFirst Davis Visio. You will be reimbursed up to your allowed amouts. Visio Isurace Discouted Rates o Special Services I additio to your stadard eye glass coverage, you will also be offered discouts or pre-egotiated fees for additioal optios. Laser Visio correctio whe usig a provider i the Davis Visio Laser Visio etwork, you are etitled to a discout of up to 25% off providers usual ad customary charge or a 5% discout from the Laser ceter s advertised special. Les 123 Mail Order Replacemet Cotact Les Program allows sigificat savigs of up to 50% o replacemet cotact leses. Les 123 will guaratee the lowest price. You would simply call LENS123 with a valid prescriptio for replacemet cotacts or additioal boxes. 20% courtesy discout at most Davis Visio participatig offices towards the purchase of items ot covered, such as a secod pair of glasses. Prescriptio Chages If your les prescriptio chages before you are eligible for ew leses ad that prescriptio meets at least oe of the followig criteria, leses ad frames will be replaced at a 12-moth frequecy: a. a ew prescriptio differs from the origial by at least.50 diopter sphere or cylider; b. a axis chage of 15 degrees or more; c. a.5 prism diopter chage i at least oe eye. For more iformatio Call Davis Visio s dedicated Baltimore Couty Customer Service Departmet at , Mo. Fri., 8 a.m. 11 p.m., Sat. 9 a.m. 4 p.m., Su. oo 4 p.m., Easter time. To access the Davis Visio website, visit ad click o Fid a Doctor i the Solutio Ceter. The click o Visio uder Search by Provider Type. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

50 48 Flexible Spedig Accout (FSA) Highlights Flexible Spedig Accouts (FSA) Highlights Flexible Spedig Accout (FSA) Highlights Who is Eligible? All active employees workig for Baltimore Couty Public Schools are eligible to participate i the Flexible Spedig Accouts (FSA). How Do Flexible Spedig Accouts Work? Flexible Spedig Accouts allow you to set aside dollars from your salary, before payig taxes, to pay for certai out-of-pocket health ad depedet care expeses. Tax savigs result because you do ot have to pay icome or FICA taxes o the amout withheld from your paycheck or the reimbursemet amout. You choose the amout to be deducted from your gross pay by projectig your health care ad depedet care expeses for the Pla Year. The Pla Year starts Jauary 1st ad eds December 31st. BCPS has pre-fuded the elected amout for health care spedig accouts, but ot the depedet care accouts. Through automatic payroll deductios, the elected amout for health care ad depedet care accouts is deposited ito your flexible spedig accout. You ca the use your debit card to pay for services or submit a claim to be reimbursed for your expeses. How Do I Eroll? You may eroll by completig a paper erollmet form i the back of this guide. Mail or fax it to the Office of Beefits, Leaves ad Retiremet before the ope erollmet eds. New erollees will receive their debit cards o or before Jauary 1st. As log as you reew your flexible spedig accout o a aual basis, the beefit card is valid for three years from the date of issue. copaymets, deductibles, acupucture, chiropractic care, hearig aids ad batteries, eyeglasses, smokig cessatio expeses, LASIK eye surgery, prescriptio drug copaymets, ad prescribed OTC Medicatios. For orthodotia reimbursemet, sed a copy of your orthodotia agreemet (orthodotia cotract) alog with your completed claim form whe treatmet begis. The orthodotic agreemet must state: The begiig date of service The approximate legth of service Total cost of service Record fee Iitial fee (dow paymet) Subsequet mothly fees Total isurace coverage (if applicable) The fee for orthodotic records is eligible for reimbursemet o the date of the x-rays, photos, ad casts are take. Proper documetatio is a statemet of services redered from a orthodotist. The iitial fee (dow paymet) is eligible for reimbursemet o the date of the first treatmet. Agai proper documetatio is a statemet of services redered from a orthodotist. Subsequet mothly fees are eligible for reimbursemet as mothly orthodotic adjustmets occur. Proper documetatio is a statemet of services redered, a receipt from orthodotist showig date of paymet ( orthodotic clearly oted o receipt), or a copy of paymet stub from a orthodotic paymet booklet. Type of FSA Miimum Aual Cotributio Health Care Spedig Accout You may set aside $100 to $2550 aually i a Health Care Spedig Accout to pay for qualified medical, prescriptio, over-the-couter (OTC) medical supplies, prescribed over-the-couter (OTC) medicatios, detal ad visio care expeses. The health care expeses may be for you, your spouse, or your depedets (as log as you claim them as depedets o your tax retur). Some examples of eligible medical expeses are: orthodotia, Baltimore Couty Public Schools Maximum Aual Cotributio Health Care $100 $2,550 Depedet Care $500 $5,000 Special paymet schedules, which do ot coicide with dates of service (such as full paymet at badig) will be paid accordig to the paymet schedule provided (i.e. if full paymet is made up frot, TASC will reimburse the full amout up frot). If the participat requests that the fee be pro-rated over future pla years, TASC will require a itemized bill icludig the value of services. How Do I Use My Health Care FSA? Employees erolled i the health care FSA will receive a pre-fuded health care beefit card which is similar to a debit card. The card ca be used to pay for health care goods ad services at the time of service or purchase. The card ca be used at all medical providers who accept MasterCard, icludig physicia offices, urget care facilities, ad hospitals. The card may also be used to Beefits Erollmet & Referece Guide

51 49 Flexible Spedig Accout (FSA) Highlights (cotiued) pay for your prescriptio ad eligible over-the-couter (OTC) items at participatig pharmacies. A list of these Authorized Merchats ca be foud o the TASC Web site at If the retailer for prescriptio or OTC drugs does ot participate, the purchase will be deied through the beefit card. You will eed to file a paper claim with TASC for reimbursemet usig the claim form available at OTC prescribed medical supplies cotiue to be eligible expeses. A list of all eligible expeses ca be foud o the HFS Web site at You may also choose to submit paper claims o lie to TASC for health care FSA reimbursemet. After payig for qualified expeses, you may submit the FSA claim form alog with required documetatio to the pla admiistrator o lie. With each reimbursemet, you ll receive a statemet showig the status of your accout. The pla admiistrator will sed you a check reimbursig you up to the amout of your aual electio. You also have the optio of your FSA reimbursemets beig deposited directly ito your bak accout. You may use your FSA beefit card ad/or submit paper claims o lie at Depedet Care Spedig Accout The Depedet Care Spedig Accout helps you pay the cost of day care for your depedets so you ad your spouse ca work. Eligible depedets for this accout must be claimed as depedets o your federal tax retur ad are either: Flexible Spedig Accout (FSA) Highlights Uder age 13 or Metally or physically uable to care for him/ herself regardless of age (this may be a spouse or older relative) If you are sigle or are joitly filig a tax retur, you may cotribute up to $5,000 each caledar year. If you are married ad filig separately, you may cotribute up to $2,550 per year. If you eroll, you must cotribute a miimum of $500 per year. Eligible depedet care expeses iclude: Licesed Day Care Facility (child or adult), Preschool or Nursery School (ot Kidergarte), Before/After-School Programs, Care i Someoe Else s Home, Housekeeper who performs depedet care duties, ad Day Care Provided by a No- Depedet Relative over the age of 19 *. If you siged up for a depedet care FSA oly, you will ot receive a beefit debit card. Depedet claims may be submitted usig the debit card or filig a paper claim o lie. * The o-depedet relative must claim this icome o their tax retur. Additioal Flexible Spedig Accouts Iformatio IRS regulatios impose a use it or lose it rule that requires you to forfeit ay moey ot used by the ed of the Pla Year. BCPS ca either refud moey, or carry it forward from oe Pla Year to the ext. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

52 50 Flexible Spedig Accout (FSA) Highlights Flexible Spedig Accout (FSA) Highlights You must re-eroll i FSAs each Pla Year, eve if the amout of your cotributio remais the same. You may participate i oe or both of the Flexible Spedig Accouts; but Health Care ad Depedet Care Spedig Accouts are treated separately. Moey caot be trasferred from oe accout to the other. You may choose either the pre-tax advatage of the Depedet Care Spedig Accout, or claim a tax credit o your federal icome retur. I the evet that you have paid childcare expeses i excess of your Depedet Care FSA electio, you may be eligible to claim the differece (up to the $3,000 or $6,000 limit) o your tax retur. Cosult your tax advisor to determie eligibility. You may also elect either the pre-tax beefit of a health care spedig accout or you ca deduct medical expeses from your tax retur. However if you choose to deduct your medical expeses, they must exceed 7.5% of your gross icome. I the evet that you have paid medical expeses i excess of your Medical FSA electio, you may be eligible to claim the excess o your tax retur. Cosult your tax advisor to determie eligibility ad which optio gives you the greater tax advatage. New hires ad erollmet chages due to a qualified life evet, which occur after the begiig of the Pla Year, should determie the umber of payroll deductios that remai. The elected amout will be deducted equally from the remaiig pay periods i the academic year. Payroll deductios are take from 20 pays betwee Jauary 1 ad December 31. No deductios for beefits are made i July ad August. The Iteral Reveue Service (IRS) determies which expeses are eligible ad which are ieligible. For a detailed list of examples, cotact our third party admiistrator TASC or visit their Web site at See Importat Resources at the back of this guide for cotact iformatio. FSA Grace Period (Health Care accouts oly) Grace period applies to Health Care accouts oly. Not applicable for Depedet Care accout. Expeses icurred durig the Grace Period (Jauary 1st through March 15th), ad approved for reimbursemet, will first be paid from ay remaiig amout from the precedig Pla Year. Ay expeses beyod the precedig Pla Year s balace will be reimbursed from the curret Pla Year s electio. Claims Baltimore Couty Public Schools will be paid i the order i which they are approved. All Grace Period expeses must be submitted to TASC by March 31st. It is importat to keep the extesio i mid whe you determie your ew FSA cotributios. Amouts remaiig i your accout at the ed of the Pla Year, that are ot applied to pay expeses submitted o or before the March 31st deadlie, will be forfeited. Claim Substatiatio With each claim submitted or debit card trasactio substatiatio, you may be asked to submit a Explaatio of Beefits (EOB), receipt or statemet with the followig iformatio: Provider/Vedor Name, Date(s) of Service, Descriptio of Service, ad Your Portio of Cost. TASC will sed you a mothly statemet of all debit card trasactios that require substatiatio. This statemet will either be ed to you or mailed to your home address. You ca submit documetatio with the statemet or with the debit card substatiatio form. Debit cards will be deactivated if substatiatio iformatio is ot received i a timely maer. A statemet will ot be set if you have o pedig trasactios. IMPORTANT: Please submit all documetatio withi 30 days of the trasactio. It is strogly recommeded that for ay out-of-pocket costs where you will be reimbursed i part by the isurace carrier, you should request reimbursemet from TASC after the carrier has adjudicated the claim. You ca submit the claim(s) to TASC via a reimbursemet form alog with a copy of the Explaatio of Beefits received i the mail from the isurace carrier. This is to avoid duplicatio i paymet of beefits sice some outof-pocket costs may apply after the beefit is processed. Please ote that the beefit card may be used directly for procedures where the isurace amout is kow up frot or o isurace paymet is allowed (i.e. Lasik surgery, eyeglasses, cotact leses, o-cosmetic detal work, etc.). Please remember to save all paperwork ad receipts for FSA card trasactios i case TASC would request documetatio to support a expese. Pre-Paid Services Pre-paid services caot be reimbursed util the service(s) has bee icurred. Orthodotia has differet guidelies. OTC Medical Supplies Accordig to IRS regulatios, stockpilig of eligible OTC medical supplies (i.e., aspiri, cold medicatios, etc.) is ot permitted. Beefits Erollmet & Referece Guide

53 51 Flexible Spedig Accout (FSA) Highlights (cotiued) Medical Necessity Services/procedures requirig a doctor s ote must state the specific medical coditio, treatmet pla ad duratio. Claim Filig Deadlie The claim filig deadlie is March 31, 2016 for claims icurred betwee Jauary 1, 2015 (or your erollmet date) ad December 31, Employees who ed employmet with BCPS (i.e. termiatio, resig, retiremet) have 90 days from the last day worked to submit claims. Ay claims filed after this date will be deied ad you will forfeit ay moey remaiig i your accout. Access to Forms ad Iformatio You may access geeral FSA pla iformatio ad forms from the Web site (click o Offices, the Beefits, the Beefits Summary, the Flexible Spedig Accouts i the right had colum). O the page there is also a lik to TASC at This Web site permits you to check your accout balace, idetify which expeses qualify, obtai further details about the beefit card, calculate your estimated tax savigs, ad cotact TASC via . Where Do You Submit Claims ad Debit Card Substatiatio? All correspodece should be set to TASC Beefits. You have 4 optios for submittig your request: Fax: (608) Claims Submissio: Mail to: TASC, P.O. Box 7308, Madiso, WI Customer Service Team A dedicated TASC customer service team is available Moday through Friday from 8:00 a.m. to 5:00 p.m. to assist you with geeral FSA questios as well as provide you with FSA card trasactios ad balaces. You ca cotact TASC Beefits customer service uit at I additio, you ca a customer service represetative at customerservice@hfsbeefits. com. Iformatio regardig your accout, eligible expese lists ad claim forms are available 24/7 from Flexible Spedig Accout (FSA) Highlights Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

54 52 Life Isurace Life Isurace Basic Life Isurace BCPS provides $15,000 of basic term life isurace coverage, at o cost, to all permaet full ad part-time employees. Prudetial is the isurer of the program. Optioal Life Isurace All permaet full ad part-time employees may request optioal life isurace to supplemet the basic life isurace coverage. Additioal coverage ca be purchased i icremets of your aual salary, with a miimum of 1 times your salary ad maximum of 10 times your aual salary, ot to exceed $1,000,000. Note: The multiple of your salary that you select for optioal coverage will automatically result i a icrease i isurace coverage wheever your salary icreases. Similarly, the premium that you pay will be adjusted automatically as a result of chages to your salary or age. Requestig Optioal Life Isurace Employees may icrease, decrease, or cacel the amout of life isurace by completig a erollmet applicatio. Employees icreasig isurace must complete a short form health statemet questioaire. Requested icreases are subject to approval by Prudetial. Optioal coverage of $35,000 or less, or the miimum aual salary icremet above $35,000, may oly be cacelled durig ope erollmet sice this coverage is purchased pre-tax. Amouts over $35,000 may be cacelled at aytime. Note: Chage amouts must be a multiple of salary. Requestig Optioal Life Isurace as a New Hire Employees electig optioal life isurace coverage withi 60 days of employmet, may obtai coverage up to 3.0 times their aual base salary ot to exceed $500,000 without providig proof of isurability. Simply select the multiple of salary that you wish to purchase o your Prudetial/BCPS erollmet applicatio. Optioal Life Isurace for Your Spouse & Childre You may purchase coverage for your spouse i $25,000 icremets ot to exceed the total amout of employee coverage to a maximum of $500,000. Eligible childre may be isured for $10,000. Optioal life isurace for a spouse or child(re) may be requested or cacelled at ay time. The beeficiary for this coverage is always the employee. Employees may purchase up to $50,000 of isurace for a spouse withi 60 days of hire without evidece of isurability. If you ad your spouse are both employees of BCPS, you may ot isure each other ad oly oe of you may provide coverage for your childre. See the Prudetial erollmet packet for more iformatio. Employees with depedet childre who are BCPS employees are ot eligible for depedet life isurace. Requestig Additioal Optioal Life Isurace Due to a Chage I Status Employees may request a chage i the amout of life isurace by completig a erollmet applicatio withi 30 days of the evet. Requested icreases are subject to approval by Prudetial. Cacellig or Reducig Optioal Life Isurace The first $35,000, or the lowest multiple that does ot go below $35,000, of optioal life isurace is paid o a pre-tax basis. Therefore, it may oly be cacelled or reduced durig ope erollmet. Amouts over $35,000, or the lowest multiple that does ot go below $35,000, may be cacelled at ay time. Examples: Base Salary Multiple of Salary Elected Total Amout of Optioal Life Isurace Amout (or Multiple) that may be cacelled outside Ope Erollmet $16,000 3x $48,000 May ot be chaged $65,000 3x $195,000 May reduce to 1x salary ($65,000) Effective Date of Life Isurace Basic Life Isurace is effective the first day of the moth after your hire date. Optioal Life Isurace that requires o medical uderwritig is effective the first day of the moth after you eroll. Call the BCPS Office of Beefits, Leaves ad Retiremet at or [email protected]. Certificates of Isurace are available at Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

55 Life Isurace Optioal Life Isurace that requires medical uderwritig is effective the first day of the moth after Prudetial has approved the applicatio. Features of the Pla Waiver of Life Isurace Premium Disability Beefit: Prudetial will waive each Life Isurace premium that becomes due for you uder the Group Policy while you are totally disabled uder certai coditios listed. Whe a premium is waived, the amout of Life Isurace equals the amout that would have bee provided if you had ot become totally disabled. That amout will reduce accordig to the Schedule of Beefits i effect o the date total disability begis. Whe a premium is waived it icludes (basic ad optioal) Life Isurace, Accelerated Death Beefit, ad Waiver of Premium. It does ot iclude ay other beefits as elected uder this certificate which were effective at the time of disability. Travel Assistace Services: As part of the Basic Life isurace, Prudetial offers a Travel Assistace Beefit to all permaet full- ad part-time employees. This program, offered through the AXA Travel Assistace Program, is a travel assistace service provided to isureds ad their depedets while travelig iteratioally or domestically over 100 miles from home. The program provides medical, Baltimore Couty Public Schools travel, legal ad fiacial assistace, 24 hours a day, 365 days a year, icludig the followig services: Geeral travel iformatio about visa, passport, ioculatio requiremets ad local customs Legal referrals Assistace with pet friedly hotel accommodatios, boardig facilities ad travel home for pets Lost documet ad luggage assistace Emergecy cash/bail assistace 24-hour pre-departure iformatio (weather, currecy, holidays) Urget message trasmissio Political evacuatio The Repatriatio Beefit is described below, but is oly icluded for employees with optioal PAI coverage (Persoal Accidet Isurace): Retur of Remais (Repatriatio) Beefit If loss of life occurs outside a 100 mile radius from your home, the pla pays the lesser of the cost to retur your remais or $5,000. Retur of remais expeses iclude embalmig, crematio, coffi, ad trasportatio of remais. Accelerated Death Beefit: If you become termially ill with less tha 12 moths to live, you may apply to receive up to 80% of your life isurace beefit to a maximum of $600,000. There are o restrictios o how this moey ca be spet, ad o fees will be charged. Portability: If you termiate your employmet, you may be able to port your provided coverage. You must complete a applicatio to port your coverage withi 31 days of the date that your coverage eds through BCPS. Coversio: If you are ieligible for the portability provisio, the you have the optio to covert your term life isurace policy to a idividual whole-life level premium pla without havig to provide evidece of isurability. You must complete a coversio applicatio withi 31 days of the date that your coverage eds through BCPS. Call the BCPS Office of Beefits, Leaves ad Retiremet at or [email protected]. Certificates of Isurace are available at offices/beefits. Beefits Erollmet & Referece Guide 53 Life Isurace

56 54 Life Isurace Life Isurace How Do I Chage My Beeficiary Electio? You may desigate or update your life isurace beeficiary iformatio quickly ad easily at If you have ay questios about Prudetial s Web site, your user profile or eed additioal assistace, cotact Prudetial s Customer Service at , Moday-Friday, 8:00am-8:00pm EST. Your basic life isurace beefit plus your optioal beefit (if elected) will be paid to the beeficiary(ies) amed. You may select a perso(s), your estate, or a orgaizatio, such as a charity, as your beeficiary(ies). You must desigate a primary beeficiary ad have the optio of desigatig cotiget beeficiaries. A primary beeficiary is the perso(s) who will receive a beefit upo your death. If you ame more tha oe primary beeficiary, the the beefit will be split equally amog the survivig beeficiaries if o allocatio was made. A cotiget beeficiary is the perso(s) who will receive a beefit i the evet that all of the desigated primary beeficiaries die before you. It is very importat that you update your beeficiary desigatios as your life situatio chages (e.g., marriage, divorce, death, birth of a child, etc.) to esure that your life isurace proceeds are paid to the appropriate perso(s). A chage i your life isurace beeficiary electio does ot chage your pesio beeficiary desigatio; they are separate electios ad must be updated separately. Optioal Life Calculatio Worksheet Step 1: Eter your aual basic salary (ot icludig bous or overtime). Step 2: Eter the ew multiple of salary requested. Step 3: Multiply the result of Step 1 & 2. Step 4: Roud the result i Step 3 up or dow to the earest $1,000. This is your requested amout of optioal isurace. Step 5: Divide by 1,000. Step 6: Look o the table to the right for the rate for your age. Eter the rate. Step 7: Multiply the result of Step 5 by the result i Step 6. This is your bi-weekly deductio. Your Calculatio Example (30 years old) $21, $42,418 $42, $.04 $1.68 Requested icreases are subject to medical uderwritig approval. Complete the Prudetial Short Form Health Statemet Questioaire located i the back of this guide. Prudetial will cotact you directly if additioal medical uderwritig is required. Your payroll deductio ad level of coverage will ot chage util your request is approved by Prudetial. Bi-Weekly Isurace Rates Beefit deductios will be take from 20 pays. Age Rate* Uder *Rate chages o birth dates ad is the rate per thousad dollars of coverage. The same rate table is used for your spouse/parter Child Coverage $10,000 $1.20 bi-weekly Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

57 55 Volutary Whole Life Isurace Who is eligible? All regular full-time employees ad part-time employees workig.5 FTE or more are eligible to participate.. What is Whole Life Isurace? Whole Life Isurace gives you permaet life isurace with cash value that grows over time. You get tax-deferred cash accumulatio (based o curret tax laws). Beefit paymets are reduced by proportioate amouts of ay outstadig policy loa. About the Pla The volutary Whole Life pla is isured by ING Employee Beefits (ING). You ca choose to isure yourself, yourself ad your eligible depedet childre, ad your depedet gradchildre. I the Volutary Whole Life Pla you ca: Elect to purchase the greater of $5,000 or the amout that $5 per week will purchase, up to $500,000 for o tobacco users or $250,000 for tobacco users Cover your spouse for the greater of $5,000 or the amout that $5 per week will purchase, up to $500,000 for o tobacco users or $250,000 for tobacco users Cover your childre for either $12,500, $15,000, $20,000 or $25,000 (Rules of depedet eligibility apply) Requestig Whole Life Isurace as a ew hire Employees electig volutary whole life isurace coverage withi 30 days of employmet may obtai coverage up to $50,000 without providig proof of isurability if they are betwee the ages of 15 ad 55. Features of the Pla Several optioal riders are available to ehace coverage: Log-Term Care Coverage Rider with restoratio ad extesio of beefits: Log-term care beefits are paid through a acceleratio of the life isurace death beefit. The duratio ad amout of log-term care beefits will vary based o the type of care required log-term care, assisted livig care, home health care, or adult day care. Each moth a log-term care paymet is made, the life isurace death beefit will be restored. The full isurace amout remais available after the log-term care beefit has bee paid. Waiver of Premium Rider: If you become totally disabled for at least four cosecutive moths, your life isurace coverage ad ay riders will be cotiued without paymet of further premiums while you remai totally disabled. This rider is available to employees who are uder age 56. Accidetal Death Beefit Rider: Coverage equal to the base policy face amout up to a maximum beefit of $150,000 is available for you ad your spouse if betwee the ages of 15 ad 60. Beefits are payable for death due to a covered accidet (death due to certai causes is ot covered). Childre s Term Life Isurace Rider: If you are uder age 61, you ca add coverage from $2,000 to $10,000 i $1,000 icremets for your eligible depedet childre who are uder age 24 for a modest premium amout. Oce you add this rider, ay ewly eligible childre are automatically covered from the age of 15 days, provided they are ot hospitalized. You ca also cover your gradchildre who are fiacially depedet o you ad meet the policy s defiitio of a depedet child. Volutary Whole Life Isurace Baltimore Couty Public Schools How to Lear More For iformatio regardig how to eroll i the volutary Whole Life isurace thru the Volutary Beefits Call Ceter, please either call , or volutarybeefits@ lwarer.com. Beefit Specialists from The Warer Compaies will be available Moday through Friday from 9 a.m. util 5 p.m. EST to eroll you. Please ote that this umber is oly active durig Ope Erollmet. For questios ad service durig the year, please either call or sed a to [email protected]. Please visit for more iformatio. Beefits Erollmet & Referece Guide

58 56 Volutary Critical Illess Isurace Volutary Critical Illess Isurace Who is eligible? All regular full-time employees ad part-time employees workig.5 FTE or more are eligible to participate. What is Critical Illess Isurace? Critical Illess Isurace ca help relieve the fiacial impact of a sudde, life-threateig evet by helpig to pay the direct ad idirect costs of the illess. The policy provides a lump-sum cash beefit upo the iitial positive diagosis for the first ever occurrece of a covered critical illess after the policy effective date (Covered critical illesses are limited to the specific defiitios foud i the policy.) About the Pla The volutary Critical Illess pla is isured by Trasamerica Life Isurace Compay, Cedar Rapids, Iowa. You ca choose to isure yourself, yourself ad your childre, or your etire family. I the Volutary Critical Illess Pla you ca: Elect to purchase from $5,000 to $50,000 of coverage Cover your spouse for 50% of your beefit amout Cover your childre for 50% of your beefit amout (Rules of depedet eligibility apply) Requestig Volutary Critical Illess Isurace as a ew hire Employees electig volutary critical illess isurace coverage withi 30 days of employmet may obtai coverage up to $20,000 without providig proof of isurability. Schedule of Beefits The volutary Critical Illess pla pays a lump sum beefit equal to the Beefit Electio multiplied by the applicable percetage show i the chart below upo the first diagosis withi each category. If the beefit paymet is less tha 100% of the selected beefit amout. Trasamerica will pay a lump sum beefit amout upo the diagosis of a differet type of critical illess withi the same category. Trasamerica will Covered Illess or Evet pay this % of the beefit amout Category 1 Heart 100% Stroke 100% Heart Trasplat Surgery 100% Coroary Bypass Surgery 25% Agioplasty/Stet 5% Category 2 Major Orga Trasplat 100% Surgery (excludig heart) Ed-Stage Real Failure 100% Paralysis Not due to Stroke all 4 limbs Burs (3rd degree of 50% coverage) 100%; 50% if fewer tha 4 limbs 100% Category 3 Ivasive Cacer 100% Carcioma 25% Prostate Cacer with TNM 25% Classificatio of T1 Ski Cacer 5% Cacer Screeig Beefit $50 per caledar year How to Lear More For iformatio regardig how to eroll i the volutary Critical Illess isurace thru the Volutary Beefits Call Ceter, please either call , or [email protected]. Beefit Specialists from The Warer Compaies will be available Moday through Friday from 9 a.m. util 5 p.m. EST to eroll you. Please ote that this umber is oly active durig Ope Erollmet. For questios ad service durig the year, please either call or sed a to [email protected]. Please visit for more iformatio. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

59 57 Persoal Accidet Isurace (PAI) Who Is Eligible? All permaet full ad part-time employees are eligible to participate. If you ad your spouse are both employees of BCPS, you may ot isure each other ad oly oe of you may provide coverage for your childre. Employees with depedet childre who are BCPS employees are ot eligible for depedet PAI Isurace. See the Prudetial erollmet packet for more iformatio. About the Pla The volutary PAI pla is isured by Prudetial. You ca choose to isure yourself ad your family members agaist the risk of death or dismembermet from accidetal causes. I the PAI Pla You Ca: Elect to purchase from $25,000 to $500,000 of coverage if less tha 10 times your salary Cover your spouse for the same beefit amout that you have elected (up to $500,000) or cover your spouse for half your amout Cover your childre for 10% of your beefit amout (Rules of depedet eligibility apply) Beeficiary Iformatio Whe you elect PAI, you do ot eed to desigate a beeficiary. The policy will pay based o the life isurace beeficiary desigatio o file at Prudetial. Prudetial will pay the full beefit amout for accidetal loss of life occurrig withi 365 days of a covered accidet. To help survivors of severe accidets adjust to ew livig circumstaces, Prudetial will pay beefits for paralysis, dismembermet ad loss of eyesight, speech, or hearig accordig to the chart provided. If withi 365 days of a covered accidet, bodily ijuries result i: Prudetial will pay this % of the beefit amout For you or your spouse: For your childre: Loss of life 100% 100% Quadriplegia; Loss of 100% 200% ay two: had, foot or eyesight; Loss of speech ad hearig i both ears Hemiplegia ad Paraplegia; 50% 100% Loss of oe eye, had or foot; Loss of speech or loss of hearig i both ears Loss of thumb ad idex 25% 50% figer of the same had Coma Beefit 1% of the pricipal sum for up to 11 moths ad full pricipal sum after the 12th moth 1% of the pricipal sum for up to 11 moths ad full pricipal sum after the 12th moth Child Care Beefit 5% to $5,000 per N/A year up to 4 years Spouse Retraiig Beefit Lesser of 5% of the pricipal sum or $5,000 per year. N/A Chagig from the Group Pla to Idividual Coverage If, this group coverage eds for ay reaso except opaymet of premium, you may be able to port your coverage. No medical certificatio is eeded. To cotiue coverage, you must complete a applicatio for portability withi 31 days after your group coverage eds. Call Prudetial at Persoal Accidet Isurace Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

60 58 Persoal Accidet Isurace Persoal Accidet Isurace (PAI) Cost Per 20 Pay Periods The followig chart illustrates examples of the beefit amout ad related pay period cost for several pla optios. Add the idividual costs together to determie your total bi-weekly cost. Your Beefit Amout Rate Per $1,000 You Pay Period Cost For: Your Spouse at 100% Your Spouse at 50% Your Childre at 10% $500,000* $0.012 $3.60 $3.60 $1.80 $0.36 $400,000* $0.012 $2.88 $2.88 $1.44 $0.29 $300,000* $0.012 $2.16 $2.16 $1.08 $0.22 $200,000 $0.012 $1.44 $1.44 $0.72 $0.14 $100,000 $0.012 $0.72 $0.72 $0.36 $0.07 $75,000 $0.012 $0.54 $0.54 $0.27 $0.05 $50,000 $0.012 $0.36 $0.36 $0.18 $0.04 $25,000 $0.012 $0.18 $0.18 $0.09 $0.02 *Beefit amouts over $250,000 caot be greater tha 10 times your aual earigs. Example: Beefit Amout Cost Yourself $200,000 $1.44 = $1.44 Your Spouse (100%) Your Childre (10%) $200,000 $1.44 = $1.44 $20,000 = $ 0.14 Total Pay Period Cost $3.02 Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

61 59 Persoal Accidet Isurace (PAI) (cotiued) For You ad Your Spouse For Your Childre Seat Belt Beefit 10% to $25,000 Air Bag Beefit 5% to $5,000 Commo Disaster Spouse Beefit: 100% to $600,000 combied with employee beefit Special Educatio Beefit 10% to $10,000 per chid per year up to 4 years; $1,000 if o depedets qualify Persoal Accidet Isurace Spouse Retraiig 5% to $5,000 Icreased Depedet Child Beefit Child Care Beefit Coma Beefit 200% to $60,000; if death occurs withi 90 days, 100% to $30,000 5% to $5,000 per year up to 4 years (age 13 maximum) 1% up to 11 moths, the 100% after 12th moth Mothly Medical Premium Beefit 1% to $200 per moth, o more tha 12 moths while ot workig Feloious Assault Beefit Emergecy Disaster Respose Team Beefit Exposure ad Disappearace 10% to $10,000 for a physical attack cosidered a feloy or misdemeaor 10% to $10,000 if o BCPS s emergecy respose team Disappearace will be cosidered as loss of life after oe year, ad Exposure will be treated as a accidetal ijury Repatriatio Up to $5,000 Travel Assistace Services Icluded Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

62 60 Savigs ad Retiremet Beefits Savigs ad Retiremet Beefits Baltimore Couty Public Schools offers you several ways to begi savig moey through payroll deductios. Defied Beefit Pesio Pla Tax Sheltered Auities ad Custodial Accouts Defied Beefit Pesio Pla Did you kow that the average perso eeds to replace 60% to 80% of his fial icome i order to afford retiremet? Whe it comes to retiremet plaig, it s ever too soo to start. Your retiremet icome will come from more tha oe source. However, the pricipal sources of icome whe you retire are persoal savigs, Social Security, ad your pesio from oe of the systems i which Baltimore Couty Public Schools participates. It is importat to uderstad which retiremet pla you are eligible for, how to eroll, ad the beefits your pla will provide at retiremet. Which Retiremet Pla am I Eligible For? Depedig o your job classificatio ad the date you were employed, you may be eligible for oe of three retiremet programs listed below: If you are eligible for the Baltimore Couty Employees Retiremet System (ERS) ad you did ot joi whe you were first employed, remember that you may oly eroll withi sixty days of your employmet. Employees who waive membership i the ERS will be ieligible to participate i retiree life ad health isurace programs. I order to be eligible to apply for a disability retiremet as a member of the Baltimore Couty Employees Retiremet System, you must be i positive pay status at the time of applicatio. Cotact ERS for more iformatio. Marylad State Teachers Retiremet System Must have erolled prior to 1980 as a public school educator, admiistrator, or clerical employee. Marylad State Teachers Pesio System Automatic membership after 1980 for eligible employees as defied by Code of Marylad Regulatios (COMAR). Baltimore Couty Employees Retiremet System (ERS) Employees i job classificatios ieligible for the State Teacher s pesio system are eligible for ERS. Participatio is volutary, subject to the 60 day erollmet widow. Eligibility provisio To lear more about eligibility for these plas ad the specific beefits provided ad erollmet procedures, please call the Office of Beefits, Leaves ad Retiremet at ( ) for ay questios related to State beefits. For BCERS, please call Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

63 61 Savigs ad Retiremet Beefits (cotiued) 403(b), 403(b)(7), ad 457(b) Plas Tax-Deferred Auity Plas ad Custodial Accouts You may save for retiremet ad reduce your curret taxes by participatig i a Tax-Deferred Auity Pla or Custodial Accout ad/or a Deferral Compesatio Pla. Sectios 403(b), 403(b)(7) ad 457(b) of the Iteral Reveue Code authorize a tax-deferred retiremet savigs program for employees of public schools. The accout shelters your moey from taxes i two ways: Pre-tax ivestig Ivestmets are made through the coveiece of automatic payroll deductios before federal ad state taxes are calculated o your icome. FICA tax is also withheld ad this lowers your curret taxable icome. Tax-deferred compoudig Your cotributios ad ivestmet earigs accumulate tax-free while i your 403(b) accout. You pay taxes oly whe you withdraw the moey. Your savigs i these accouts are geerally ot available util age uless you have a fiacial hardship, as defied by the IRS. If you meet the hardship requiremets, you may be able to borrow or withdraw moey from your accout before Note: Distributios from a 457(b) pla are ot subject to the 10% early withdrawal pealty that applies to the 403(b) ad 403(b)(7) plas. You may choose from two mai categories of ivestmet choices. Oe is referred to as a auity ad the other is called a ivestmet. There are some differeces betwee these two types of ivestmets that you should uderstad whe evaluatig your optios. Be sure to ask these questios whe speakig with the compay represetatives: What are the fees ad charges for this ivestmet? What has bee the fud s ivestmet retur, mius expeses, for the past year, 3 years, 5 years ad the life of the fud? Are there ay loa provisios? Hardship withdrawals? Are there ay surreder charges? Are there ay fiacial guaratees regardig this ivestmet? What happes to the moey whe I die? If you would like more iformatio about participatig i oe of these plas, call the Office of Beefits, Leaves ad Retiremet at (410) to obtai a copy of the booklet etitled Cosider the Beefits! You may also go to the Beefits Web site at ad click o Cosider the Beefits. Key Poits: All employees are eligible to participate i the 403(b)/(b)(7) pla while all employees may participate i the 457(b) pla. There is o waitig period to begi savig i a pla. You may eroll or diseroll at ay time. Participatio is 100% volutary. Baltimore Couty Public Schools does ot cotribute to your accout. Deductios are take from 24 paychecks per caledar year for 12-moth employees ad from 20 paychecks per caledar year for 10-moth employees. You decide how to ivest your cotributios ad how much of your salary to ivest. IRS regulatios permit you to set aside up to $17,500 for caledar year A additioal cotributio ca be made if you are age 50 or older by the ed of the caledar year. Cotact your approved vedor to assist you i determiig your persoal aual maximum. You may obtai the curret listig of authorized providers or other iformatio o the web at: beefits. There are curretly five 403(b)/ ( b)(7) providers. Natiowide is the oly 457(b) provider. Savigs ad Retiremet Beefits Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

64 62 Savigs ad Retiremet Beefits Savigs ad Retiremet Beefits Retiree Isurace Beefits Your retiree isurace beefits are provided by Baltimore Couty Public Schools regardless of the retiremet pla from which you are receivig your pesio. Please ote that the isurace beefits ad the Board s cotributio percetages as show o the followig page are subject to chage i the future depedig upo the agreemets reached by the Board, its bargaiig uits, ad its fudig authorities. While you may be vested i your pesio pla, your ability to participate i the retiremet isurace plas of BCPS may be limited. I order to be eligible to participate i retiree beefits ow or i the future, you must begi to receive a mothly pesio directly followig active employmet with Baltimore Couty Public Schools. A employee who does ot qualify to receive a pesio curretly or who elects to defer pesio beefits is ieligible for future participatio i the Board s beefit plas. Erollig i Your Retiree Isurace Members of the Marylad State Teacher s Retiremet or Pesio System may cotact the Office of Beefits, Leaves ad Retiremet to schedule a retiremet coferece. Members of the Baltimore Couty Employees Retiremet System should cotact the BCERS to schedule a retiremet coferece. Prior to retiremet, you must complete a resigatio form ad submit to your supervisor, otify the Office of Huma Resources ad your pesio system of your itetio to retire. The Office of Beefits, Leaves ad Retiremet will be otified of your retiremet directly from the Office of Huma Resources. At that time, the Office of Beefits, Leaves ad Retiremet will sed the appropriate retiree beefits electio forms to you. These forms must be completed ad retured to the Office of Beefits, Leaves ad Retiremet. Upo retiremet, you are ot required to eroll i a health isurace pla of Baltimore Couty Public Schools i order to preserve your right to eroll at a later date. As a retirig employee of Baltimore Couty Public Schools, you may eroll i a health pla ad/or chage your erollmet selectio i the future. Retiree Health Isurace The cost of your health isurace is paid by you ad Baltimore Couty Public Schools. The Board cotributes a specified percetage of the total cost of your health isurace based upo your years of service to BCPS ad the specific health isurace pla i which you ad your depedets, if applicable, choose to eroll. It is importat to ote that for purposes of calculatig the Board s cotributio, oly years of service to Baltimore Couty Public Schools ad military service are credited. Time o upaid leaves of absece is ot credited. No distictio is made betwee part-time ad full-time service. Health isurace premiums are deducted from a retiree s mothly pesio check. Normally, retiremets occur at the ed of a school year ad employees have already paid premiums for coverage through August 31. Therefore, if a employee retires o July 1, the first health isurace premium deductio will be take from the September pesio check. Special hadlig is required for retirig idividuals ad/or their spouses who are age 65 or will reach 65 before September. The same plas available to active employees are available to retiree s who are ieligible for Medicare. Upo reachig eligibility for Medicare (usually at age 65 or if eligible due to disability) retiree s ad/or their spouses must eroll i Medicare Parts A & B i order to cotiue participatio i the Board s health isurace plas, ad they must the eroll i a differet health pla which coordiates with Medicare. Please ote that each of the medical plas offered by Baltimore Couty Public Schools icludes coverage for prescriptio drugs. Visio ad Detal Coverage Visio ad detal coverage may be cotiued ito retiremet. The cost for both plas, if elected, will be deducted from your pesio check. Life Isurace If elected, the cost of life isurace is paid etirely by the retiree. Premiums are deducted from your pesio check. Upo retiremet, a retiree s life isurace coverage reduces to o more tha $50,000, icludig the $15,000 of basic isurace ad up to $35,000 of optioal coverage. The amout of isurace reduces through the fourth aiversary of your retiremet. Note: Please refer to the summary of beefits o the followig page. To obtai a copy of the Retiree Beefits Guide, call the Office of Beefits, Leaves ad Retiremet or visit our Web site. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

65 63 Savigs ad Retiremet Beefits (cotiued) Plas Retiree Beefits Additioal Details No-Medicare (< 65) Ciga OAPIN Ciga OAP Kaiser Permaete HMO Medicare Eligible Ciga Medicare Surroud (Part A & B) Pla Kaiser Permaete- Medicare Plus HMO Survivig Spouse s Beefit Cacer Isurace BCPS cotributes toward health care premiums for employees with 10 or more years of service who are approved for retiremet from the Marylad State Retiremet ad Pesio Systems, or the Baltimore Couty Employees Retiremet System. Additioal credit may be give for military service. Board cotributios are: Years of Service to BCPS* Ciga Medicare Surroud Kaiser Med Plus yrs. 36% 68% yrs. 66% 100% 30yrs. & up 84% 100% * For ew hires after Jauary 1, 2011, Board of Educatio cotributios for retiree beefits have chaged. Please cotact the Office of Beefits, Leaves ad Retiremet for more iformatio at Upo eligibility for Medicare (usually at age 65 or if eligible due to disability), retiree s ad/or their Medicare-eligible depedets are eligible to covert to coverage which supplemets Medicare. Upo retiree s death, if the spouse has bee covered uder a BCPS health care pla, he or she will have the optio to cotiue coverage. The Board pays the cotributio i effect for oe year after the retiree s death. After oe year, coverage may cotiue without ay Board cotributio uless the spouse has bee a employee of BCPS. The Board cotributio for premiums show above would cotiue as log as the survivig spouse elects to cotiue coverage. If you had cacer isurace as a active employee, you may elect to cotiue this coverage as a retiree. Cotiuatio of Isurace After Retiremet If you retire o July 1, health isurace remais i effect util August 31. Deductios begi with the September pesio check from the applicable retiremet system. Oce you become etitled to Medicare Part B, you may elect to choose Medicare as your primary payor ad elect ot to participate i the group pla. For retirees ot medicare eligible (<65), please review the retiree beefit guide for premium costs. Billed quarterly by BCPS Deducted mothly from pesio i combiatio with health isurace. Savigs ad Retiremet Beefits Detal Isurace ad Visio Care Retirees may elect to cotiue to participate i the detal plas or visio pla offered to active employees. Retirees pay the COBRA rates for detal ad 100% of the cost for visio. Life Isurace Retirees pay the cost of life isurace. The $15,000 basic life isurace will cotiue with o reductio i value. However, a reductio schedule applies to optioal life isurace. Persoal Accidet Isurace Retirees may elect to covert to a idividual policy withi 31 days of termiatio by callig Prudetial. The cost is paid etirely by the retiree. Deducted mothly from pesio i combiatio with health isurace. Deducted mothly from pesio i combiatio with health isurace. Billed by Prudetial Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

66 64 Savigs ad Retiremet Beefits Savigs ad Retiremet Beefits What is Creditable Coverage? Begiig Jauary 1, 2006, Medicare beeficiaries will have the opportuity to receive subsidized prescriptio drug coverage through the ew Medicare Part D program. Beeficiaries who choose ot to sig up at the first opportuity may have to pay more if they wait to eter the program later after the ope erollmet period. Beeficiaries who have other sources of drug coverage through a curret or former employer or uio, may stay i that pla ad choose ot to eroll i the Medicare drug pla. If their other coverage is at least as good as the ew Medicare drug beefit, it is cosidered creditable coverage, the the beeficiary ca cotiue to get the high quality care they have ow as well as avoid higher paymets if they sig up for the Medicare drug beefit. Uder Sectio (a) of the fial regulatio, coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of stadard prescriptio drug coverage uder Medicare Part D, as demostrated through the use of geerally accepted actuarial priciples ad i accordace with CMS actuarial guidelies. I geeral, the actuarial equivalece test measures whether the expected amout of paid claims uder the etity s prescriptio drug coverage is at least as much as the expected amout of paid claims uder the stadard Part D beefit. Required Disclosures to Medicare Beeficiaries Baltimore Couty Public Schools must provide a otice of creditable prescriptio drug coverage to Medicare beeficiaries who are covered by, or who apply for, prescriptio drug coverage uder ay of the Baltimore Couty Public Schools plas. For a copy of this otice, please visit our Web site at: www. bcps.org/offices/beefits/beefits_erollmet/ or www. bcps.org/offices/beefits/retiree_be/. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

67 65 Log Term Disability Isurace (LTD) How Do I Eroll? Make the selectio for LTD o the Flexible Beefits Erollmet/Chage Applicatio Form i the back of this guide. Who Is Eligible? Ay regular, actively at work employee over age 18 whose full-time equivalecy equals.5 or more is eligible to joi the Volutary Log Term Disability (LTD) pla isured by Assurat Employee Beefits, uderwritte by Uio Security Isurace Compay. (Your uio may also offer a members-oly LTD Pla. You caot participate i both.) Pre-Existig Coditio Limitatio Proof of good health is ot required. Istead, this pla pays o beefit for ay ijury or sickess, which begis i the first 12 moths of your coverage, if the disability results from a preexistig coditio. A pre-existig coditio is oe for which you have see a medical practitioer or take medicatio i the 3 moths before your coverage effective date, ad for which you did ot go treatmet-free for 3 moths before your disability bega. How Much Will My Coverage Cost? You ca determie how much your coverage will cost by followig the four steps below: Four Steps: Step 1. Eter your gross or pre-tax pay (ot icludig bous or overtime) Step 2. Eter your rate based o your age ad Sick Leave Bak eligibility from the table below Step 3. Multiply Step 1 by Step 2 Step 4. Divide Step 3 by 20 to determie the amout of premium that will be deducted from each paycheck Calculatio Example (30 yr. old No SLB member) $ $35,000 $ $ $51.10 $ $2.55 Rate Chart Rates Chage o Birth Dates Log Term Disability Isurace Pla Highlights LTD provides cotiuig icome ad protectio if you become disabled due to a ijury, accidet, or sickess. If you are qualified as disabled for 180 cotiuous days, you will be eligible for beefits. The pla pays % of your base mothly salary up to a maximum of $10,000 each moth while you are disabled. This % of your salary is offset by ay icome from Social Security, workers compesatio, or retiremet pla(s) if ay of these beefits are beig received. Pla Features Paymets to You Beefits Start Combied Beefits Duratio of Beefits Pla Coverage % less applicable offset After 180 days of disability or oce sick leave is exhausted, whichever is later Guaratees total Combied Beefits Paymets whe this pla is added to Social Security, Workers Compesatio, ad Sick Leave Beefits Maximum beefit period: Uder 60 the day before retiremet age moths moths moths moths 72 or over 12 moths If you are betwee For Sick Leave Bak* For No-Sick Leave these ages: Participats: Bak Participats: 18 to to to to to to to to *For iformatio regardig the Sick Leave Bak, TABCO Members cotact TABCO; others cotact the Office of Payroll. Where To Get More Details About This Pla For a full descriptio of the pla beefits, limitatios, ad exclusios please refer to the Log Term Disability Icome Pla Booklet available olie at beefits ad click o Pla Documets. For specific beefit questios, you may also cotact Workforce Tactix at (888) Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

68 66 Aual Ope Erollmet Curret Employees Aual Ope Erollmet Curret Employees Ope Erollmet The Basics This is the time of year whe you have the opportuity to review your beefit choices ad make chages that best suit you ad your family s eeds. Before you get started, here are some thigs you should kow: Ope Erollmet electios must be completed ad received by the Office of Beefits, Leaves ad Retiremet by 4:45 p.m. o November 10, If you do ot eroll by this deadlie, your coverage will default. (Except for FSA which must be re-elected aually.) The beefit electios you make ow stay i effect util the ed of the 2015 Pla Year (Jauary 1, 2015 to December 31, 2015). Chages durig the Pla Year (to all pre-tax beefits) will be permitted oly if you have a qualified life evet chage a chage i family or employmet status that affects your beefit coverage. Chages must be requested withi 30 days of the qualified life evet, alog with copies of proof of eligibility or ieligibility. Whe you elect a medical, detal, or visio pla you ca choose which eligible family members you wat to cover uder each pla. It does t have to be the same family members i each pla. For example, you ca cover yourself ad your depedets for medical beefits, but oly yourself for detal care. If you ad your spouse are both employees of BCPS, you ca 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 cover each other as depedets ad your eligible depedet child(re) may oly be covered by oe of you. You Must Eroll to: Add, chage or waive your medical pla ad/or your detal optio Add or waive family visio care Add or delete eligible depedets. Note: If addig a depedet see the sectio o Ope Erollmet Depedet Eligibility Verificatio for requiremets Participate i a Health Care or Depedet Care Spedig Accout, eve if you already have oe. This is the oly beefit you must re-eroll i each year. Note: Domestic Parters ad their depedets typically do ot qualify as eligible depedets. Cotact your tax advisor for clarificatio. Elect or make chages to Optioal Life Isurace for you ad/or your eligible depedets. Note: If you wat to icrease your life isurace, you will be asked to provide proof of good health by completig a Evidece of Isurability (EOI) form. Go to for the Prudetial Erollmet ad Statemet of Health forms. Your ew coverage level does ot become effective util your form is approved by the isurace compay. To cacel, complete the Prudetial Erollmet/Chage form ad sed to the Office of Beefits, Leaves ad Retiremet. Elect or make chages to Persoal Accidet Isurace (PAI) for you ad/or your eligible depedets. Elect Log Term Disability (LTD). NOTE: To termiate LTD you must complete the paper erollmet form. Ope Erollmet Depedet Eligibility Verificatio I order to protect the pla assets, we ow require proof of depedet eligibility for all ADDITIONS to coverage durig ope erollmet. Proof icludes copies of marriage certificate, a birth certificate, or adoptio papers. Documetatio may be set via iteroffice mail to the Office of Beefits, Leaves ad Retiremet, Greewood or via fax to (410) Copies are acceptable; please do ot sed origials to our office. Providig False Iformatio Employees who submit false iformatio iteded to provide health care coverage for alleged depedets ot eligible for such coverage may be subject to disciplie up to ad icludig discharge. Such employees will also be held fiacially resposible for all claims filed, ad will be required to reimburse the Board for ay paymets made o behalf of or for the beefit of a ieligible perso claimed as a depedet. Oly Need to Chage Your Primary Care Physicia? You ca make this chage at ay time by cotactig Member Services. You do ot eed to wait util ope erollmet. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

69 67 Aual Ope Erollmet Curret Employees If you do ot eroll, coverage will default to the coverage listed below. Medical Detal Visio Health Care or Depedet Care FSA Curret Coverage Noe Ciga OAPIN Ciga OAP Kaiser Permaete HMO Noe CareFirst Regioal Detal PPO CareFirst Regioal Detal Traditioal Ciga DHMO Employee oly Free if.5 FTE or greater If curretly erolled i Family coverage Noe if curretly erolled i either or both Default Coverage Noe Ciga OAPIN with same coverage category Ciga OAP with same coverage category Kaiser Permaete with same coverage category Noe CareFirst Regioal Detal PPO with same coverage category CareFirst Regioal Detal Traditioal with same coverage category Ciga DHMO with same coverage category Coverage will default to same coverage with CareFirst Davis Visio Coverage will default to same coverage with CareFirst Davis Visio Optioal Life Noe if curretly erolled i pla Noe coverage will cotiue Persoal Accidet Isurace (PAI) Log Term Disability (LTD) Cacer & Itesive Care Noe if curretly erolled i pla Noe if curretly erolled i pla Noe if curretly erolled i pla Noe you must re-eroll each year i order to participate i either pla Noe coverage will cotiue Noe coverage will cotiue Noe coverage will cotiue Aual Ope Erollmet - Curret Employees How to Eroll 1. For 2015, you may use the paper beefit erollmet form. Employee Self Service (ESS) is available to make ay chages. 2. For 2015, if you are ot makig ay chages to your beefits, you do ot eed to complete a erollmet form. You must complete a FSA electio form to participate i 2015 Flexible Spedig Accout. 3. You must submit Depedet Eligibility Verificatio for ay additios. See the form at the back of the guide. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

70 68 Aual Ope Erollmet - Curret Employees Aual Ope Erollmet - Curret Employees Gettig Started Followig are the steps you eed to take to eroll. If you have ay questios alog the way, please call the Office of Beefits, Leaves ad Retiremet at (410) , [email protected] or visit our Web site ad click o Ope Erollmet to review additioal iformatio. Step 1 Review your Pre-Erollmet Cofirmatio Statemet Beefit-eligible employees will receive this statemet prior to Ope Erollmet. Step 2 Review this Guide Be sure to read What s New. Step 3 Preparig to Eroll Makig Decisios ad Gatherig Required Data Have the followig iformatio available: l If chagig medical plas to Kaiser, you will eed the Primary Care Physicia s (PCP) or facility ID umber that you will use ad the first ad last ame for each family member you are erollig. l If electig Ciga Detal, you will eed the Detal Facility Number for each family member you are erollig. l If addig a ew depedet: date of birth, Social Security umber, ad Ciga detal facility umber, if applicable. l The bi-weekly amout you wat to cotribute to your Health Care ad Depedet Care Flexible Spedig Accout. l Your pre-erollmet form. Step 4 Complete the Erollmet form Fill out the paper erollmet form or eroll olie usig ESS. Erollmet form is located at the back of the guide Mail or fax the completed form to the beefits office Step 5 Review Your Post-Erollmet Cofirmatio Statemet This statemet will be delivered to you i December. It will show your ew beefits ad covered depedets that will be i effect o Jauary 1. You are ot permitted to make electio chages whe you receive this statemet. If, however, the Beefits Office has made ay errors i processig, the we will be able to correct them at this time. Step 6 ID Cards If you made ay medical, detal or visio pla chages, you will receive ew ID cards i December. A separate ID card is issued for the Express Scripts prescriptio drug pla. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

71 69 How to Eroll - New Hires You must elect or declie beefits withi 60 days of your first day of employmet or wait util the ext ope erollmet period. If you do ot make a electio, you will have to wait util ope erollmet to get ito the pla, uless you have a qualified life chage. Chages must be requested withi 30 days of the qualified life evet, alog with copies of proof of eligibility or ieligibility. Note: If you do ot wish to make ay electios, you must idicate this o the erollmet form ad submit the form to the Beefits Office. Olie Erollmet This is ot curretly a optio for ew hires. Paper Erollmet All electios must be made o paper. See istructios that follow. Gettig Started Step 1 - Review this Guide The Beefits Erollmet ad Referece Guide icludes importat iformatio that you should kow. Keep this guide as a hady referece all year. Step 2 Preparig to Eroll Visit our Web site to review additioal iformatio to assist you i makig your electios. Step 3 Erollig What Form Do I Fill Out? There are two paper forms. The BCPS Flexible Beefits Applicatio Form ad the Flexible Spedig Accout (FSA) Electio Form. The FSA electio form is used to make your aual FSA electios oly. The other form is used for all other erollmets. Where Do I Sed the Forms? Retur them to the Office of Beefits, Leaves ad Retiremet at the address o each form. What is the Deadlie to Sed Forms? You must submit your completed, siged forms to the Office of Beefits, Leaves ad Retiremet withi 60 days of your date of hire. Forms received before the ed of the moth ca be processed for coverage to be effective the first of the moth. If the form is received o or after the first of the moth, coverage is effective o the first of the followig moth. Late erollmet forms caot be accepted. Whe Do My Beefits Begi? Beefits begi o the first day of the moth followig either your employmet date or the date that you submit your forms to the Office of Beefits, Leaves ad Retiremet, whichever is later. Step 4 Review Your Paystub A post erollmet cofirmatio letter is ot geerated. Therefore, you must check your paystub to make sure the proper deductios are beig take. Cotact the Office of Beefits, Leaves ad Retiremet immediately if you otice a discrepacy. Step 5 If you choose to ot eroll i ay of the BCPS beefit plas, you must idicate your choice o the flexible beefits erollmet form ad submit the form to the Beefits Office. How to Eroll New Hires Do I Need to Prove My Depedets Are Eligible? Yes, proof icludes copies of a marriage certificate, a birth certificate, or adoptio papers. Copies are acceptable please do ot sed origials to our office. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

72 70 Frequetly Asked Questios Frequetly Asked Questios (FAQs) How Do I Add A New Child To My Isurace Coverage? Cotact the Beefits Office to obtai a Erollmet/ Chage Applicatio to add your ew child. You may also obtai the form at Attach a photocopy of the child s birth certificate, hospital discharge papers, or adoptio papers, if applicable. You have 30 days from the child s birth date/adoptio date to add him/her to your health plas. Coverage will take effect retroactively to the child s date of birth/date of adoptio. If you miss this 30-day period, the ext opportuity to add would be durig the ope erollmet period held aually. The bi-weekly cost of your health pla will icrease if you do ot already have family coverage. Ca I Chage My Electios Durig the Year? IRS regulatios require you to keep your electios through December 31 uless you have a Qualified Life Evet. Chages must be requested withi 30 days of the Qualified Life Evet. If I am Erolled i a Medical Pla ad My Doctor Leaves the Network, Ca I Chage My Electio? No. This is ot cosidered a qualified life chage. If a HMO Participat s Family Member Moves to Aother Locatio, Such as a Depedet Child Starts ad Resides at School, Do I Need to Chage the PCP Elected? Yes. It is also possible that the depedet child may ot be able to cotiue with a etwork doctor because there may ot be a etwork doctor available i the ew locatio. No coverage will be available except for life threateig situatios. Therefore, you may wat to eroll i the Ciga Ope Access Plus I-Network (OAPIN) or Ciga OAP Pla. Cotiuatio of Coverage While o a Approved Leave of Absece If you are o a approved leave of absece from BCPS, your health pla cotributios will cotiue to be deducted from your paycheck as log as you have paid leave (i.e. sick leave, vacatio, holiday, etc.) available. Whe your accrued leave is exhausted or whe you cease to be paid by BCPS, you must cotact the Office of Beefits, Leaves ad Retiremet to make arragemets to cotiue paymet of your health pla cotributios to esure cotiued coverage. Whe Does Coverage Ed? If your employmet eds followig the close of the school year, the your medical, detal ad visio beefits termiate as of August 31st. If your employmet eds durig the school year, beefits termiate o the last day of the moth i which you are i active pay status. If Medicare Eligible at the time of retiremet or employmet edig, you must eroll i Medicare Plas Part A ad B. Coverage cotiues for a child util the ed of the moth i which the child turs 26. For example, a child whose 26th birthday is o October 11 ca be covered util October 31. Cotiuig Coverage Upo Retiremet Baltimore Couty Public Schools cotributes toward the cost of health care plas for employees who: Have bee approved for retiremet by the Marylad State Retiremet ad Pesio System or the Baltimore Couty Employees Retiremet System. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

73 71 Chages to Beefits Coverage Due to a Qualified Life Evet A employee may chage his/her electio durig the Pla Year withi 30 days whe ay of the followig chages i status occurs: A chage i status such as gai or loss of o-bcps beefits by the employee s spouse or domestic parter (i.e. ope erollmet). A reductio or icrease i hours of employmet by the employee, icludig a switch betwee parttime ad full-time, or commecemet or retur from a upaid leave of absece. A chage i legal marital status, icludig marriage, death of spouse, divorce, legal separatio, or termiatio of domestic partership. Your depedet satisfies or ceases to satisfy the requiremets for depedets, due to attaimet of age, or ay similar circumstaces as provided i the health pla uder which the employee receives coverage. A judgmet, decree or order resultig from a divorce, legal separatio, or chage i legal custody (icludig a qualified medical child support order) that requires health coverage for a employee s child. The employee ca chage his/her electio to provide coverage for the child if the order requires coverage uder the employee s pla; or, the employee ca make a electio chage to cacel coverage for a child if the order requires the former spouse to provide coverage. Eligibility for Medicare or Medicaid. Birth of Child or Adoptio. Ay ew electio based upo the qualifyig life evets oted above must be o accout of ad cosistet with the chage i status that affects eligibility for coverage uder the Pla. Call the Office of Beefits, Leaves ad Retiremet at (410) or sed a to [email protected] for aswers to specific questios o life chages. Qualified Life Evets Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

74 72 COBRA COBRA Cotiuatio Coverage Rights Uder COBRA Itroductio Oce you become covered uder a group health pla (the Pla) you have COBRA rights. This summary cotais importat iformatio about your right to COBRA cotiuatio coverage, which is a temporary extesio of coverage uder the Pla. The right to COBRA cotiuatio coverage was created by a federal law, the Cosolidated Omibus Budget Recociliatio Act of 1985 (COBRA). COBRA cotiuatio coverage ca become available to you whe you would otherwise lose your group health coverage. It ca also become available to other members of your family who are covered uder the Pla whe they would otherwise lose their group health coverage. What is COBRA Cotiuatio Coverage? COBRA cotiuatio coverage is a cotiuatio of Pla coverage whe coverage would otherwise ed because of a life evet kow as a qualifyig evet. After a qualifyig evet, COBRA cotiuatio coverage must be offered to each perso who is a qualified beeficiary. You, your spouse, ad your depedet childre could become qualified beeficiaries if coverage uder the Pla is lost because of the qualifyig evet. Uder the Pla, qualified beeficiaries who elect COBRA cotiuatio coverage must pay for COBRA cotiuatio coverage. The cost is the mothly premium equivalet to the full cost of coverage plus a admiistrative charge of 2%. If you are a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because either oe of the followig qualifyig evets happes: Your hours of employmet are reduced or Your employmet eds for ay reaso other tha your gross miscoduct. If you are the spouse or domestic parter of a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because ay of the followig qualifyig evets happes: Your spouse or domestic parter dies. Your spouse s or domestic parter s hours of employmet are reduced. Your spouse s or domestic parter s employmet eds for ay reaso other tha his or her gross miscoduct. Your spouse or domestic parter becomes etitled to Medicare beefits (uder Part A, Part B, or both.) You become divorced or legally separated from your spouse, or termiate domestic partership. Your depedet childre will become qualified beeficiaries if they lose coverage uder the Pla because ay of the followig qualifyig evets happes: The paret-employee dies. The paret-employee s hours of employmet are reduced. The paret-employee s employmet eds for ay reaso other tha his or her gross miscoduct. The paret-employee becomes etitled to Medicare beefits (Part A, Part B, or both.) The parets become divorced or legally separated The child stops beig eligible for coverage uder the pla as a depedet child. Whe is COBRA Coverage Available? The Pla will offer COBRA cotiuatio coverage to qualified beeficiaries oly after the Office of Beefits, Leaves ad Retiremet has bee otified that a qualifyig evet has occurred. Whe the qualifyig evet is the ed of employmet or reductio of hours of employmet, or the death of the employee, the Office of Beefits, Leaves ad Retiremet will otify the COBRA Admiistrator of the qualifyig evet. You Must Give Notice of Some Qualifyig Evets For some qualifyig evets icludig divorce or legal separatio of the employee ad spouse, domestic partership, or a depedet child s losig eligibility for coverage as a depedet child, you must otify the Office of Beefits, Leaves ad Retiremet withi 30 days after the qualifyig evet occurs. You must provide writte otice to: The Office of Beefits, Leaves ad Retiremet, 6901 N. Charles Street, Buildig B, Towso, MD Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

75 73 COBRA (cotiued) Cotiuatio Coverage Rights Uder COBRA COBRA How is COBRA Coverage Provided? Oce the COBRA Admiistrator receives otice that a qualifyig evet has occurred, COBRA cotiuatio coverage will be offered to each of the qualified beeficiaries. Each qualified beeficiary will have a idepedet right to elect COBRA cotiuatio coverage. Covered employees may elect COBRA cotiuatio coverage o behalf of their spouses, ad parets may elect COBRA cotiuatio coverage o behalf of their childre. COBRA cotiuatio coverage is a temporary cotiuatio of coverage. Whe the qualifyig evet is the death of the employee, a divorce or legal separatio, or a depedet child losig his/her eligibility as a depedet child, COBRA cotiuatio coverage lasts for up to a total of 36 moths. Whe the qualifyig evet is the ed of employmet or the reductio of the employee s hours of employmet, COBRA cotiuatio coverage geerally lasts for oly up to a total of 18 moths. There are two ways i which this 18-moth period of COBRA cotiuatio coverage ca be exteded. Disability Extesio of 18-Moth Period of Cotiuatio Coverage If you or ayoe i your family covered uder the Pla is determied by the Social Security Admiistratio to be disabled ad you otify the Office of Beefits, Leaves ad Retiremet i a timely fashio, you ad your etire family may be etitled to receive up to a additioal 11 moths of COBRA cotiuatio coverage, for a maximum total of 29 moths. The disability would have to have started at some time before the 60th day of COBRA cotiuatio coverage ad must last at least util the ed of the 18-moth period of cotiuatio coverage. You must provide writte otice to: The Office of Beefits, Leaves ad Retiremet, 6901 N. Charles Street, Buildig B, Towso, MD This extesio may be available to the spouse ad ay depedet childre receivig cotiuatio coverage if: The employee or former employee dies; The employee or former employee gets divorced or legally separated or If the depedet child stops beig eligible uder the Pla as a depedet child, but oly if the evet would have caused the spouse or depedet child to lose coverage uder the Pla had the first qualifyig evet ot occurred. If You Have Questios Questios cocerig your Pla or your COBRA cotiuatio coverage rights should be addressed to the Office of Beefits, Leaves ad Retiremet. For COBRA rates, please visit the beefits Web site. Keep Your Pla Iformed of Address Chages I order to protect your family s rights, you should keep the COBRA Admiistrator iformed of ay chages i the addresses of family members. You should also keep a copy, for your records, of ay otices you sed to the Office of Beefits, Leaves ad Retiremet. Secod Qualifyig Evet Extesio of 18-Moth Period of Cotiuatio Coverage If your family experieces aother qualifyig evet while receivig 18 moths of COBRA cotiuatio coverage, the spouse ad depedet childre i your family ca get up to 18 additioal moths of COBRA cotiuatio coverage, for a maximum of 36 moths, if otice of the secod qualifyig evet is properly give to the Pla. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

76 74 Health Care Reform Impact HEALTH CARE REFORM IMPACT ON BALTIMORE COUNTY PUBLIC SCHOOLS EMPLOYEE BENEFIT PLANS To maitai status as a gradfathered health pla, a employer beefit pla or health isurace coverage must have had idividuals erolled i the pla o the date the Patiet Protectio ad Affordable Care Act (PPACA) was eacted (March 23, 2010). Accordigly, Baltimore Couty Public Schools believes that the Kaiser Staff Model HMO plas meet the criteria to operate as gradfathered health plas. The ew Ciga Ope Access HMO (OAPIN) ad Ciga Ope Access Plus PPO pla does ot meet the criteria ad thus will be required to comply with all the cosumer protectios of the PPACA. As permitted by the Affordable Care Act, a gradfathered health pla ca preserve certai basic health coverage that was already i effect whe that law was eacted. Beig a gradfathered health pla meas the plas that qualify for gradfather status may ot iclude certai cosumer protectios of the Affordable Care Act that apply to other plas, for example, the requiremet for the provisio of prevetive health services without ay cost sharig. However, gradfathered health plas must comply with certai other cosumer protectios i the Affordable Care Act, for example, coverage of adult depedet childre to age 26, elimiatio of lifetime beefit maximums ad other provisios. Detailed beefit charts for each of the plas sposored by Baltimore Couty, Marylad are icluded i this beefit guide please review them carefully for pla coverage differeces. Questios regardig which protectios apply ad which protectios do ot apply to a gradfathered health pla ad what might cause a pla to chage from gradfathered health pla status ca be directed to the Baltimore Couty Public Schools Office of Beefits, Leaves ad Retiremet at Iformatio o gradfathered plas ca also be foud olie at This website has a table summarizig which protectios do ad do ot apply to gradfathered health plas. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

77 75 October 2014 TO: BCPS employees ot curretly eligible for healthcare beefits RE: New Health Isurace Marketplace Coverage Optios Exchage Ope Erollmet November 15 Jauary 15, 2015 Due to the health care reform law there will be a ew type of olie marketplace for purchasig health isurace coverage. I Marylad, this marketplace is referred as the Marylad Health Coectio (MHC). The Marketplace is desiged to offer optios for health isurace that meets your eeds ad your budget. BCPS is required to provide this iformatio to help you uderstad the health isurace coverage optios that will be available startig i Begiig i November 2014, idividuals ot covered by employer plas, or idividuals who have to cotribute more tha 9.56% of their salary toward their beefit plas will be able to fid ad compare health isurace plas through the MHC Marketplace ad may qualify for a federal subsidy to help pay for the premium based o icome levels. Coverage through the MHC Marketplace plas may start as early as Ja. 1, If you purchase coverage through the MHC, you may be eligible for a federal subsidy that lowers your mothly premiums or reduces your cost sharig. Please ote that i order to receive the federal subsidy, you caot be eligible for health pla coverage through BCPS that is affordable ad provides miimum value. More iformatio o the health care reform law ad the Marketplaces i states outside Marylad is available at Frequetly asked questios about the Marylad Health Coectio ca be foud at or call or for TTY service Sicerely, Office of Employee Beefits, Leaves ad Retiremet Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

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83 81 Affordable Care Act Health Care Reform Law Frequetly Asked Questios (FAQs) Geeral What is the curret status of health care reform? The health care reform law, which was siged by Presidet Obama i 2010, is cotiuig to be implemeted. May requiremets of the law have already take effect ad additioal chages will cotiue to be itroduced over the ext several years. How will health care reform chage our compay s medical beefits i 2015? Several major requiremets or provisios of the law will take effect i BCPS meets the curret requiremets of the law ad offers beefits to more tha 95% of our employees. Employees who are i positios that are classified as temporary, substitutes or cotractual are ot eligible for BCPS beefits. This group of employees may be eligible for medical beefits usig the State of Marylad Health Care Exchage. Our erollmet materials provide additioal iformatio that explais ay chages that may affect you ad your family. Idividual Madate What is the idividual madate? A ew requiremet called the idividual madate is takig effect o Jauary 1, All U.S. citizes ad legal residets, with a few exceptios, are required to have miimum essetial coverage or pay a pealty. Erollig i our medical coverage if you are eligible will meet this requiremet. What is miimum essetial coverage? Coverage uder oe of the followig types of plas qualifies as miimum essetial coverage. There are o specific requiremets about what services are covered or the level of beefits. Employer coverage Coverage through a govermet pla such as Medicare or Medicaid Idividual health isurace If you are erolled i our medical coverage i 2015, you have miimum essetial coverage ad meet the idividual madate requiremet. Who is required to have medical coverage? All U.S. citizes ad legal residets, with a few exceptios, are required to have miimum essetial coverage. Exceptios iclude idividuals: With religious objectios Not livig i the Uited States I priso Not able to pay for coverage because it costs more tha eight percet of their household icome Whose household icome is below 100 percet of the federal poverty level Who have a hardship waiver Who are without coverage for o more tha three cotiuous moths i a caledar year What happes if someoe does t have medical coverage? If a perso does ot have miimum essetial coverage, the Iteral Reveue Service may collect a pealty from him or her. The aual pealty is the greater of: For 2014: $95 per uisured adult i the household (maximum of $285 per household) or oe percet of the household icome over the icome tax filig threshold For 2015: $325 per uisured adult i the household (maximum of $975 per household) or two percet of the household icome over the icome tax filig threshold For 2016: $695 per uisured adult i the household (maximum of $2,085 per household) or 2.5 percet of the household icome over the icome tax filig threshold The pealty will be half of the amouts oted above for ayoe uder age 18. Pealties are determied o a mothly basis, so a idividual who had coverage for six moths of the year would pay half of the aual pealty. Affordable Care Act Health Care Reform Law Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

84 82 Affordable Care Act Health Care Reform Law Affordable Care Act Health Care Reform Law Frequetly Asked Questios (FAQs) (cotiued) Employer Madate What is the employer madate? Begiig i 2015, employers with 50 or more full-time employees, workig 30 hours a week o average, or fulltime equivalets may be subject to a pealty if they do ot offer health coverage to full-time employees ad their childre up to age 26. This is referred to as the employer madate. The coverage must be affordable ad provide miimum value. Affordable meas that the employee cotributio for employee-oly coverage for the lowest-cost pla is o more tha 9.56% of the employee s W-2 wages. Miimum value meas that the pla pays for at least 60% of allowed charges for covered services. If I m ot eligible for employer coverage, where ca I get health isurace? Begiig i 2015, every state will have a Health Isurace Marketplace, also kow as a Exchage, where idividuals ca compare isurace policies ad buy health isurace. Depedig o your household icome, you may be eligible for a subsidy to help cover part of the cost of your coverage. You ca also purchase coverage directly from a isurace compay that sells health isurace i your area. What if a idividual has a pre-existig health coditio? Begiig i 2015, o oe ca be tured dow for coverage based o a pre-existig health coditio. Marketplace/Exchage What is the Marketplace/Exchage? Health Isurace Marketplaces, or Exchages as they are also sometimes called, will be available startig this fall i every state. Marketplaces are beig developed as a optio for people to compare ad purchase health isurace. Federal subsidies will be available to assist low to moderate icome idividuals i payig the premium for health isurace purchased through the Health Isurace Marketplaces. Eligibility for a subsidy is based o icome. However, idividuals who are erolled i employer coverage or eligible for employer coverage that is affordable ad provides miimum value are ot eligible for the subsidy. Idividuals ca begi erollig i plas available through the Marketplace o October 1, 2014, ad coverage uder policies purchased through the Marketplace ca begi o Jauary 1, Ca I go to the Marketplace ad compare coverage there with our compay s beefits? Ayoe ca go to their state s Marketplace Web site to review the coverage optios ad apply for coverage. Some people will be eligible for subsidies based o their aual household icome if they are ot covered by a employer health pla or offered employer coverage that is affordable ad provides miimum value. Where ca I get iformatio about coverage available through the Marketplace i my state? Visit the website for more iformatio o the Marketplace. For Marylad residets visit or call or for TTY service Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

85 83 Affordable Care Act Health Care Reform Law Frequetly Asked Questios (FAQs) (cotiued) Will I be eligible for a subsidy to help pay for my health isurace? Federal subsidies will be available to assist low to moderate icome idividuals i payig the premium for health isurace purchased through the Health Isurace Marketplaces. Eligibility for a subsidy is based o your family size ad your household icome. If you are erolled i our BCPS medical pla or are eligible for coverage through our medical pla that provides miimum value ad is affordable, you will ot receive a subsidy if you purchase coverage through the Marketplace. Please ote that the BCPS medical plas provide miimum value ad are affordable as defied by the Affordable Care Act. For employees (temporary, substitutes or cotractual) who are ot eligible for BCPS beefits that meet the miimum value ad affordability requiremets, you may be eligible for a subsidy based o your household icome if you purchase coverage through the Marketplace. Essetial Health Beefits What are Essetial Health Beefits? Startig i 2015, isured group health plas provided by small employers with o more tha 50 full-time employees are required to cover a set of essetial health beefits. There are 10 geeral categories of essetial health beefits. Each state will determie exactly what is covered i each of these 10 categories. Ambulatory patiet services Emergecy services Hospitalizatio Materity ad ewbor care Metal health ad substace abuse disorder services, icludig behavioral health treatmet Prescriptio drugs Rehabilitative ad habilitative services ad devices Laboratory services Prevetive ad welless services ad chroic disease maagemet Pediatric services, icludig oral ad visio care Group health plas provided by larger employers with more tha 50 full-time employees are t required to cover essetial health beefits. However, if there are ay essetial health beefits that are covered uder the pla they must be covered without aual or lifetime dollar limits. Affordable Care Act Health Care Reform Law How will Essetial Health Beefits affect our compay s medical pla? Ay essetial health beefits that are icluded i our medical pla will be covered without ay aual or lifetime dollar limits. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

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87 85 Depedet Eligibility Verificatio Baltimore Couty Public Schools Ope Erollmet Depedet Eligibility Verificatio As commuicated i the What s New sectio of this guide, BCPS has implemeted Depedet Eligibility Verificatio durig ope erollmet. This process requires documetatio to verify coverage eligibility for the depedets that you add durig the ope erollmet process. If you eroll o-lie or via paper you must also submit depedet eligibility verificatio. Failure to comply will result i cacellatio of health care coverage for that depedet. Note: You are ot required to provide verificatio for ay depedets curretly covered by ay BCPS health pla. Do NOT sed origial documets or the actual certified copy, which would have a raised seal. A copy of the documet with the seal clearly visible is acceptable. Retai the origial documet(s) as we will NOT retur the documets you submit. Depedet Eligibility Verificatio Form Each piece of documetatio must have the employee s ame o it ad the last four digits of the employee s social security umber. BCPS has the authority to determie whether or ot the documetatio satisfies the Pla s requiremets. Ay fees associated with obtaiig documets are your resposibility. Use the followig table as a referece whe submittig documetatio: Relatioship Spouse Domestic Parter Natural Child Stepchild Legally Depedet Child Required Documets Copy of certified marriage licese or copy of your most recet Federal Tax Retur (filed joitly with spouse) with fiacial iformatio blacked out ad showig the spouse s sigature. Completed BCPS domestic parter affidavit. Origial otarized form required. Form is located o the BCPS Web site at Copy of certified birth certificate. 1. Copy of birth certificate showig your spouse is the atural paret; ad 2. Copy of marriage licese showig the atural paret is your spouse. 1. Copy of court decree showig your fiacial resposibility for the depedet; ad 2. Copy of birth certificate. Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

88 86 Depedet Eligibility Verificatio Form Depedet Eligibility Verificatio Attached are documets for Last 4 digits of Social Security Number are Employee Name Please choose oly oe of the followig methods to retur this iformatio to our office. Fax To: Office of Beefits, Leaves ad Retiremet From: Fax: Date: Phoe: Pages: Re: Ope Erollmet Depedet Eligibility Verificatio Iteroffice Mail Attach this completed form to all documets ad sed to: Office of Beefits, Leaves ad Retiremet Greewood, Bldg. B U.S. Post Office Sed to: Office of Beefits, Leaves ad Retiremet 6901 North Charles Street, Buildig B Towso, Marylad Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

89 Prit Your Name Your Social Security #: Date of Birth: Address (work or persoal): Flexible Spedig Accouts Electio Form For the Jauary 1, 2015 through December 31, 2015 Pla Year Ope Erollmet Chage i Status New Hire Last First Middle Iitial Health Care Flexible Spedig Accout Each participat is etitled to receive reimbursemet for eligible health care expeses icurred durig the pla year. To be eligible for reimbursemet, these expeses must be for care provided to the participat, his/her spouse, ad depedets. Expeses caot be covered by medical, detal or other health plas ad must be eligible expeses as determied by the Iteral Reveue Service. Note: There are oly 20 payroll deductios for beefits durig the Pla Year. If you are erollig outside of the begiig of the Pla Year, cotact the Office of Payroll to determie how may pay periods remai. Note: There are oly 20 payroll deductios for beefits durig the Pla Year. If you are erollig outside of the begiig of the Pla Year, cotact the Office of Payroll to determie how may pay periods remai. I request to ope a health care flexible spedig accout i the amouts that follow: 87 Flexible Spedig Accouts Electio Form Bi-Weekly Deductio $.00 (Miimum= $5, Maximum= $127.50) Aual Electio $.00 (Miimum= $100, Maximum= $2,550 i whole dollars) I hereby authorize Baltimore Couty Public Schools (BCPS), its proper officers, agets ad employees to reduce my salary as idicated above. I uderstad that this electio will remai i effect util the last day of the pla year. I further uderstad that I may ot make a chage to this request uless there is a chage i my family status ad that the Office of Beefits, Leaves ad Retiremet must be otified withi 30 days of the chage. Moies caot be trasferred to the depedet care flexible spedig accout. Moies remaiig i the accout 90 days after the ed of the pla year caot be refuded. Sigature Date Depedet Care Flexible Spedig Accout Each participat is etitled to receive reimbursemet for eligible expeses for household services, depedet s child care ad/ or adult day care required for the participat to be gaifully employed. A qualifyig depedet is geerally a child uder age 13 (claimed o the participat s federal icome tax form) or other depedets, such as parets, spouse, or older childre who are uable to care for themselves, require full-time care, ad are claimed by the participat for federal icome tax purposes. Note: There are oly 20 payroll deductios for beefits durig the Pla Year. If you are erollig outside of the begiig of the Pla Year, cotact the Office of Payroll to determie how may pay periods remai. Note: There are oly 20 payroll deductios for beefits durig the Pla Year. If you are erollig outside of the begiig of the Pla Year, cotact the Office of Payroll to determie how may pay periods remai. I request to ope a depedet care flexible spedig accout i the amouts that follow: Bi-Weekly Deductio $.00 (Miimum= $5, Maximum= $250 i whole dollars) Aual Electio $.00 (Miimum= $100, Maximum= $5,000 i whole dollars) I hereby authorize Baltimore Couty Public Schools (BCPS), its proper officers, agets ad employees to reduce my salary as idicated above. I uderstad that this electio will remai i effect util the last day of the pla year. I further uderstad that I may ot make a chage to this request uless there is a chage i my family status ad that the Office of Beefits, Leaves ad Retiremet must be otified withi 30 days of the chage. Moies caot be trasferred to the health care flexible spedig accout. Moies remaiig i the accout 90 days after the ed of the pla year caot be refuded. Sigature Date Submit completed form to: Baltimore Couty Public Schools, Office of Beefits, Leaves ad Retiremet, 6901 N. Charles Street, Buildig B, Towso, MD or fax to: (410) or sca ad to [email protected] (Retai a copy for your records)

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91 89 Make sure to sig ad date the order form. For assistace call Have your order form ad 12 digit TASC ID umber ready. Please prit. 1. This form replaces the Letter of Medical Necessity. Use this form to be reimbursed for products ad services that require physicia authorizatio such as Over-the-Couter (OTC) medicies or drugs ad other o-otc medicie products ad services. 2. Complete Sectio I (icludig your sigature ad the date) ad Sectio II (Patiet Name, Treatmet Prescribed ad Reaso for Treatmet) prior to visitig your Medical Practitioer. 3. Brig this form with you to your ext medical appoitmet ad request that the attedig Medical Practitioer complete Sectio II (Istructios/Restrictios) ad Sectio III. 4. Istruct them to follow the specific pharmacy/prescriptio laws i their respective state whe completig the Istructios/ Restrictios portio (Sectio II). 5. You may use the same form for each idividual i your household for whom you purchase healthcare expeses, as log as the same Medical Practitioer is completig the form. 6. TASC Card purchases of OTC medicies or drugs require a prescriptio from your medical practitioer. Do ot use this Prescriptio Order Form whe usig your TASC Card to purchase OTC medicies or drugs. The Prescriptio Order Form may be used i place of a prescriptio for all other methods of Requests for Reimbursemet (olie, faxed, or mailed). 7. FlexSystem ad DirectPay Participats must submit a copy of this completed form to TASC with each Request for Reimburse met (if submittig olie, iclude a copy with your receipts ad Veriflex (FlexSystem oly) Cover sheet). Prescriptio Order Forms received without a Request for Reimbursemet or Veriflex (FlexSystem oly) Cover Sheet will ot be processed. AgriPlaNOW ad BizPlaNOW Participats should retai the completed Form for their ow records. SECTION 1 Employer (Compay) Name Participat (Employee) TASC 12-Digit ID: Participat s Last Name: First Name: M.I.: Sigature: Date: / / The statemets o this documet are complete ad true, to the best of my kowledge ad belief. I uderstad that the IRS regulates my employee beefit accout ad that the guidelies are implemeted as a meas of esurig compliace. I further uderstad that it is my resposibility to comply with these guidelies ad to avoid submittig duplicate or ieligible requests. SECTION II Patiet s Name Prescribed Reaso for Treatmet Istructio/Restrictios (if applicable) Treatmet Products/Services SECTION III I hereby certify that the treatmet pla(s) listed above is medically ecessary to treat the ailmet or medical coditio listed above. This treatmet pla is either for cosmetic reasos or for geeral health ad well-beig. Medical Practitioer s Name (PLEASE PRINT) State of Prescriptive Authority / / Medical Practitioer s Sigature Date 44 FlexSystem Cliet Admiistratio Maual

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93 BALTIMORE COUNTY PUBLIC SCHOOLS FLEXIBLE BENEFITS ENROLLMENT/CHANGE APPLICATION JANUARY 1, 2015 December 31, 2015 ACTIVE EMPLOYEES (Please prit)* 91 Retur completed form to: 1. TYPE OF REQUEST- This applicatio is for oe of the followig: New hire (Effective / / ) Ope Erollmet Chage i status (Check below) (Effective / / ) If you have experieced a chage i status outside of Ope Erollmet, complete this sectio Add Depedet(s)**: Date of evet: Remove depedet(s)**: Reaso for termiatio: Date of evet: Spouse Death / / Marriage / / Child/childre Divorce / / Birth of child / / Child reached age limit / / Adoptio of child / / Other (explai) / / Other (explai) / / **Must submit request withi 30 days of evet ad attach supportig documetatio 2. SUBSCRIBER INFORMATION LAST NAME FIRST NAME M.I. MAIDEN/FORMER NAME (If Applicable) SOCIAL SECURITY NUMBER Medical Pla optios: Check a pla ad a level of coverage Kaiser Permaete HMO Ciga OAPIN (i-etwork oly) Ciga OAP (i/out of etwork) Idividual Paret & Child (childre for Kaiser oly) Two Adults Family I cacel/waive medical coverage persoal accidet isurace: Employee Beefit Amout $,000 Spouse (circle oe): 50% or 100% Childre: 10% I cacel/waive PAI isurace 4. COVERED EMPLOYEE AND DEPENDENT(S) INFORMATION Please list all members to be covered. If you are addig or removig coverage for a depedet, please check the appropriate box below ad complete all of the iformatio. If Kaiser idicate primary care physicia or medical ceter ad I.D. #. LAST NAME FIRST M.I. Baltimore Couty Public Schools, Office of Employee Beefits, Leaves ad Retiremet 6901 N. Charles Street, Buildig B, Towso, MD Phoe: (410) Fax: (410) SCAN AND form to: [email protected] SEX DATE OF BIRTH PHONE NO. MARITAL STATUS Date of Evet M F Sigle Married Parter / / 3. ELECTION OF BENEFITS - Refer to the Beefits Erollmet ad Referece Guide for Details. Visio Isurace: CareFirst Davis Pla - Employee coverage is free if your FTE is.500 or greater Idividual Family I cacel/waive family visio isurace Log Term Disability: I elect LTD coverage I cacel/waive LTD isurace Cacer & Itesive Care Isurace I cacel cacer isurace Optioal life isurace: I cacel/waive optioal life isurace RELATIONSHIP EMPLOYEE/ APPLICANT SPOUSE/ PARTNER ADD REMOVE CHILD ADD REMOVE CHILD ADD REMOVE CHILD ADD REMOVE CHILD ADD REMOVE S EX DATE OF BIRTH SOCIAL SECURITY NUMBER PRIMARY CARE / FACILITY # PHYSICIAN INFO KAISER ONLY NAME: NAME: NAME: NAME: NAME: NAME: / / STREET ADDRESS APT. NO. DATE OF HIRE (New Hire Oly) / / CITY STATE ZIP Detal Pla optios: Check a pla ad level of coverage CareFirst BlueCross BlueShield Regioal Detal PPO CareFirst BlueCross BlueShield Regioal Detal Traditioal Ciga Detal DHMO You must select a Ciga detist i sectio 4 below. Idividual Paret & Child (childre for Ciga oly) Two Adults Family I cacel/waive detal coverage Ciga DHMO Facility Number If you have ay questios cocerig the beefits ad services that are provided by or excluded uder the agreemet, please cotact the applicable pla s membership services represetative before sigig the applicatio form. I hereby apply for myself ad ay depedets listed o this applicatio for the coverage idicated ad authorize my employer to deduct from my earigs the amout required to participate i the elected plas. I uderstad that the electios that I make o this form will remai i effect for the etire Pla Year, uless I am permitted to chage them durig the Pla Year uder special rules cotaied i the pla that apply oly i very limited situatios. If I do ot complete ad file a ew erollmet form durig the ext aual erollmet period, the electios I make o this form will cotiue i effect idefiitely util chaged by me durig a aual erollmet period or i coectio with the special rules discussed above. I also uderstad that the electios I make o this form are subject to modificatio by the Employer to isure that the Pla complies with applicable laws or to reflect icreases i the cost of the elected coverage(s) that occur durig the Pla Year. I hereby coset, for myself ad for all idividuals covered by the Pla through me, to ay ivestigatios or iquiries ito medical coditio that are deemed ecessary or appropriate by the Pla Admiistrator ad to ay disclosures of medical records by ayoe deemed ecessary or appropriate by the Pla Admiistrator. I have carefully read this applicatio ad agree to its terms. The statemets are true ad complete ad are represetatios made to iduce the issuace of the subscriptio agreemet(s) for which I have applied. EMPLOYEE S SIGNATURE DATE retai a copy for your records

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95 93 GROUP LIFE ENROLLMENT/CHANGE CARD Please refer to the descriptio of your pla for coverage optios ad amouts available to you. Baltimore Couty Public Schools Please mark the appropriate box accordig to your pla. add additioal depedets o page 3 Note: Depedet child is eligible through the ed of the moth the child attais the age of 26. If your spouse or child is a employee, you caot elect spouse or child coverage for them Oly oe employee may elect coverage for a child. However, depedet child coverage eligibility may vary by state - refer to the Booklet-Certificate issued by Prudetial. FLORIDA RESIDENTS NEW YORK RESIDENTS to accidet ad disability icome coverage. This otice ONLY applies SIGNATURE I have read ad uderstad the terms ad requiremets of the fraud warigs icluded as part of this form.

96 94 Retur the erollmet/chage form to: Baltimore Couty Public Schools Office of Beefits, Leaves ad Retiremet 6901 N. Charles Street, Buildig B Towso, MD Fax: For residets of all states except Alabama, the District of Columbia, Florida, Ketucky, Marylad, New Jersey, New York, Pesylvaia, Puerto Rico, Rhode Islad, Utah, Vermot, Virgiia ad Washigto; WARNING ALABAMA RESIDENTS DISTRICT OF COLUMBIA ad RHODE ISLAND RESIDENTS KENTUCKY RESIDENTS MARYLAND RESIDENTS NEW JERSEY RESIDENTS PENNSYLVANIA ad UTAH RESIDENTS PUERTO RICO RESIDENTS VERMONT RESIDENTS VIRGINIA RESIDENTS WASHINGTON RESIDENTS

97 Accelerated Death Beefit optio is a feature that is made available to group life isurace participats. It is ot a health, ursig home, or log-term care isurace beefit ad is ot desiged to elimiate the eed for those types of isurace coverage. The death beefit is reduced by the amout of the accelerated death beefit paid. There is o admiistrative fee to accelerate beefits. Receipt of accelerated death beefits may affect eligibility for public assistace ad may be taxable. The federal icome tax treatmet of paymets made uder this rider depeds upo whether the isured is the recipiet of the beefits ad is cosidered ["termially ill"]. You may wish to seek professioal tax advice before exercisig this optio. 95 Employee Sigature MICHIGAN RESIDENTS: DEPENDENT CONSENT FOR COVERAGE Date (Moth, Day, Year) CHANGED AMOUNT OF INSURANCE COVERAGE CHANGE 1 CHANGE 2 CHANGE 3 CHANGE 4 Eff. Date Amout Eff. Date Amout Eff. Date Amout Eff. Date Amout

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102 100 Importat Resources Office of Beefits, Leaves ad Retiremet Phoe: Fax: Web site: (Visit our Web site for may of the forms we use) Office Hours: Moday through Friday, 8:30 a.m. 4:45 p.m. Importat Resources Express Scripts (for Ciga OAPIN & Ciga OAP Members oly) Iteret Web site See Web site for registratio. Member Services TDD Lie (Member Services) Mail Order Medical Optios HMOs Kaiser Permaete Ciga OAPIN & OAP BCPS Service Area Natioal Group Number Iteret Web site my.kp.org/mida/bcps or Provider Listig my.kp.org/mida/bcps or Member Services (ID cards, verify provider participatio, claims) Hospital Precert/Health Cosult Service Healthy Pregacy Program TDD Lie Network Metal Health Providers Metal Health TDD Lie Detal Optios CareFirst CareFirst Ciga-DHMO Maaged Detal Pla Name Regioal Detal PPO Regioal Detal Traditioal DHMO Network Provider Preferred Participatig I-Network Oly Group Number Iteret Web site Provider Listig Member Services (ID cards, claims) Provider Services Other Numbers Flexible Spedig Accouts TASC / CareFirst Davis New cards oly Metal Health Provider EAP CIGNA Behavioral Health or (password: Baltimore) Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

103 101 Importat Resources Importat Resources (cotiued) BCPS Pesio, 403(b), ad 457(b) plas BCPS offers employees oe of two pesio plas depedig upo your job classificatio. Marylad State Retiremet Agecy (SRA) Madatory Erollmet (Icludes Superitedet, Pricipals, Asst. Pricipals, Teachers, Paraeducators, Bus Attedats, Clericals, Occupatioal Therapists, Physical Therapists, Speech Pathologists, Psychiatrists, Psychologists, Registered Nurses, Social Workers, Supervisors) Office of Retiremet Phoe: ; Fax: Web site: Marylad State Retiremet Agecy Phoe: or ; Fax: Web site: Baltimore Couty Employees Retiremet System (BCERS) (Icludes Tradesme, Grouds Me, Custodias, Bus Drivers, Buildig Service Workers, Cafeteria Workers ad those ot eligible for SRA) BCG Retiremet Office Phoe: ; Fax: Web site: 403(b) ad 457(b) Pla Iformatio ad Erollmet Office of Beefits, Leaves Phoe: ; Fax: ad Retiremet Web site: Visio CareFirst Davis First Fiacial Federal Credit Uio ( EAP CIGNA ( password: Baltimore EAP Iteral Coordiator Jaice Zimmerma Sick Bak Erollmet TABCO employees Sick Bak Erollmet All other employees Log Term Disability Workforce Tactix Ext. 4 or Cacer Coseco (Washigto Natioal Isurace Co) COBRA Admiistratio Prudetial Life Isurace Baltimore Couty Public Schools Beefits Erollmet & Referece Guide

104 NOTES

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108 New Employee Orietatio Meetigs are typically held i Greewood. Days ad hours vary; Cofirm with the Office of Persoel at for teacher persoel or for support service persoel. Greewood Campus Buildig B ad E, 6901 North Charles Street, Towso, Marylad, From I-695, take Exit 25 to Charles Street from the West tur right oto Charles Street. From the East tur left o Belloa Aveue ad left o Charles Street. Cotiue o Charles Street approximately 1 mile to Greewood Road. Tur left o Greewood Road. Proceed approximately.2 miles to etrace to parkig lot o the right. Buildig E is o your left. New hire orietatio is typically held o the first floor of Buildig E. The Departmet of Huma Resources Office of Beefits, Leaves ad Retiremet 6901 N. Charles Street, Buildig B, Towso, MD /14