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2021 Plan Year
Retiree Benefits Guide
Bringing what matters into focus.
Welcome
Dear District Retirees, FOR PRE-65 RETIREES:
Pre-65 benefits continue through the District
We welcome you to view the benefits information
included in this reference guide. We’ve compiled all the
information about benefits available to you as a retiree POST-65 MEDICARE ELIGIBLE PLANS - FSRBC
of The School District of Palm Beach County. As you know, Palm Beach County School District has joined
the Florida School Retiree Benefits Consourtium (FSRBC).
MEDICAL The Consourtium will be providing enhanced retiree
We offer several options for retirees and are confident benefits through their partners Aon and bswift. The Retirees
you will find a plan that meets your needs and budget. of Palm Beach County School District can expect changes
to begin Jan. 1, 2021 and beyond.
DENTAL AND VISION COVERAGE FSRBC will now administer post-65 Retiree Medicare,
Dental and Vision Insurance are important optional Dental, and Vision benefits for Palm Beach County School
benefits that are not part of most medical plans. District. This means all Medicare eligible retirees over the
age of 65 will now enroll in benefits coverage through the
MEDICARE PART D for Post-65 Retirees FSRBC.
Your existing prescription coverage with the School
District of Palm Beach County is on average as good Retirees of Palm Beach County School District will begin
as standard Medicare prescription drug coverage. the transition to the FSRBC program during the 2021 Open
You can keep this coverage and not pay extra if you Enrollment, which starts Oct. 15, 2020 for a coverage
later decide to enroll in Medicare prescription drug effective date of Jan. 1, 2021.
coverage. You should also know that if you drop or lose During this transition period YOU WILL BE REQUIRED TO
your coverage with the School District of Palm Beach TAKE ACTION IN ORDER TO CONTINUE COVERAGE in
County and don’t enroll in Medicare prescription drug 2021.
coverage when your current coverage ends, you may
For additional information Post-65 Retirees may visit:
pay more (a penalty) to enroll in Medicare prescription
drug coverage later. https://myfsrbc.com or call 1-833-686-0983 (TTY 711)
Monday - Friday 8 a.m. - 8 p.m. Eastern time
Sincerely, You can also contact Humana for any questions
Dr. Donald E. Fennoy II regarding your transition to FSRBC dental and vision at:
1-888-393-6765.
2
Table of
Welcome 2
Contents
Benefits Directory 4
Important Enrollment Information 5
for Pre-65 Retirees:
School District of Palm Beach County Non-
Discrimination Statement Medical Benefits At-A-Glance 11
The School Board of Palm Beach County, Florida, prohibits
discrimination in admission to or access to, or employment
in its programs and activities, on the basis of race, color,
national origin, sex or sexual orientation, marital status, Health Savings Account (HSA) 14
age, religion, disability, genetic information, gender identity
or expression, or any other characteristic prohibited by law.
The School Board also provides equal access to the Boy When & Where to Get Care 17
Scouts and other designated youth groups. The School
District of Palm Beach County offers the following career
and technical programs, including career academies Dental Benefits 18
wherein students may earn industry certification, visit the
Programs of Study page for more information as well as
a list of classes. Lack of English language skills will not
be a barrier to admission and participation. The district
Vision Benefits 23
may assess each student’s ability to benefit from specific
programs through placement tests and counseling, and,
if necessary, will provide services or referrals to better
prepare students for successful participation. for 65+ Retirees:
Medicare Part D 25
Important Notices 26
If you (and/or your dependents)
have Medicare or will become eligible
for Medicare in the next 12 months,
a Federal law gives you more choices
about your prescription drug coverage.
Please see page 25 for more details.
Benefits Directory
Risk & Benefits Management Florida Retirement System (FRS)
https://www.palmbeachschools.org/careers/benefits/ www.myfrs.com
retiree_health_benefits Payroll (pension checks):
Retiree Benefits Desk: 1-850-488-4742 or 1-844-377-1888
3370 Forest Hill Blvd, Suite A-103 Disability:
West Palm Beach, FL 33406-5870 1-850-488-2968
Phone: 1-561-434-8673
Calculations:
Fax: 1-561-434-8103
1-850-488-6491 or 1-888-738-2252
Survivor Benefits:
Pre-65 Medical Plans 1-850-488-5207
UnitedHealthcare® Special Retirement Plan Administrator
Group Number All Plans: 704471 BENCOR Administrative Services
www.myuhc.com www.bencorplans.com
Member Service Numbers Group Number: 100260
Low Option HMO (EPO): Phone: 866-296-9712
Email: questions@bencorplans.com
1-888-380-0389
High Option HMO:
1-888-380-0389 Post-65 Retiree Benefit Options
CDHP (High Deductible): Florida School Retiree Benefits Consortium (FSRBC)
1-888-380-0389
Medical
Pre-65 Vision Plan https://myfsrbc.com
Group Number: 9705435 1-833-686-0983 (TTY 711)
www.eyemed.com Open Enrollment October 15 - November 5, 2020
EyeMed Vision Care:
1-866-723-0514 Humana Dental
https://myfsrbc.com
Pre-65 Dental Insurance 1-888-393-6765 (pre-enrollment line)
Humana Dental®
Group #: 830206 Humana Vision
DHMO & PPO Plans: 800-233-4013 https://myfsrbc.com
myhumana.com 1-888--393-6765 (pre-enrollment line)
Medicare
Critical HealthEvents Universal LifeEvents www.medicare.gov
Insurance Accident Insurance 1-800-MEDICARE (1-800-633-2273)
Trustmark Insurance Company
www.trustmarksolutions.com
Phone: 866-636-5525
Email: pbsd@trustmarkins.com
U.S. Social Security Administration
www.ssa.gov
1-800-772-1213
4
Important Enrollment Information
New Pre-65 Retirees New Administrator for Post-65
As a new retiree, you have the opportunity to continue your Medical, Dental & Vision benefits
current plan coverage for medical, dental and vision. Each Effective January 1, 2021 Florida School Retiree Benefits
year following your retirement, you will have the opportunity Consortium (FSRBC) will administer all plan enrollment for
to make plan changes. post-65 Retirees.
Current Retirees FSRBC will extend plans including medical, dental and vision
to all post-65 Medicare eligible employees and eligible
Pre-65 retirees have a choice of any of the District’s medical
dependents.
plans as offered to active employees:
1. Low Option HMO
2. High Option HMO or
Other Plan Options for Retirees
3. Consumer Driven Health Plan (CDHP) Eligible for Medicare
Retirees who are enrolled in Medicare will still be You may be able to find Medicare Supplement Plans
responsible for all UnitedHealthcare’s copayments and or Medicare Advantage Plans at better premiums than
deductibles. continuing under the District’s plan. We encourage you to
review your options by looking at the Medicare website:
Tobacco Use Surcharge www.medicare.gov.
The School District of Palm Beach County will add a tobacco You may also want to take advantage of discussing your
surcharge to medical plan premiums for retirees who options with one of the insurance agents listed in the
use any tobacco products and elect medical coverage. advertisement section of this book. All of the agents are well
The same surcharge will apply if a tobacco status was versed in Medicare plans and have a good understanding of
not declared. The School District of Palm Beach County the District’s plans.
encourages you to take steps to quit the use of all tobacco
products. This tobacco premium surcharge will be strictly
Plan information and rates included in this document
enforced for all retirees covered under the group
apply to plans offered to retirees who are not eligible for
medical plan.
Medicare plans.
Post-65 Medicare eligible Retirees must refer to the
FSRBC website or contact FSRBC directly for plan and
rate information.
5
2021 Monthly Rates
2021 MEDICAL PLANS - UNITEDHEALTHCARE
NON-TOBACCO USERS TOBACCO USERS
Retiree Only $540 $590
Retiree + Child(ren) $896 $946
Low Option HMO (EPO) Retiree + Spouse/
DP* $1,013 $1,063
Retiree + Full Family $1,283 $1,333
Retiree Only $630 $680
Retiree + Child(ren) $1,080 $1,130
High Option HMO Retiree + Spouse/
DP* $1,200 $1,250
Retiree + Full Family $1,540 $1,590
Retiree Only $430 $480
Retiree + Child(ren) $786 $836
CDHP Medical Plan
(High Deductible Plan) Retiree + Spouse/ $868 $918
DP*
Retiree + Full Family $1,142 $1,192
* DP = domestic partner
2021 DENTAL PLANS - HUMANA 2021 VISION PLANS - EYEMED
Retiree Only $14.40 COST
DHMO Enhanced Retiree + Child(ren) $30.60 Retiree Only $5.45
(Florida Dentist) Retiree + Spouse/DP* $25.20
Retiree + Full Family $39.60 Retiree + Full Family $14.00
Retiree Only $10.94
DHMO Basic Retiree + Child(ren) $23.40
(Florida Dentist) Retiree + Spouse/DP* $19.03
Retiree + Full Family $29.96
Retiree Only $31.96
PPO High Retiree + Child(ren) $87.89
(Orthodontia) Retiree + Spouse/DP* $78.31
Retiree + Full Family $118.27
Retiree Only $25.20
PPO Low Retiree + Child(ren) $69.30
(NO Orthodontia) Retiree + Spouse/DP* $61.74
Retiree + Full Family $93.25
* DP = domestic partner
6
New Retirees
Benefits Available for New Retirees If you are eligible for Medicare upon retirement, Medicare
will become the primary payer on the first of the month
Your benefits as an active employee will end on the last
following your retirement date, regardless of your
day of the month in which you retire. For example, if an
coverage through the district.
employee retires on June 5, Medicare will become the
primary payer of coverage starting July 1. However, for all POST-65 MEDICARE ELIGIBLE PLANS - FSRBC
employees (with the exception of 12-month employees) who
As you know, Palm Beach County School District has joined
retire at the end of a school year and work through their
the Florida School Retiree Benefits Consourtium (FSRBC).
contract period — coverage will end on July 31 of
The Consourtium will be providing enhanced retiree
that year.
benefits through their partners Aon and bswift. The Retirees
As a retiree of the School District of Palm Beach County, of Palm Beach County School District can expect changes to
you are eligible to continue your health, dental and vision begin Jan. 1, 2021 and beyond.
coverage if you pay the monthly premium in full. For more
In order to be eligible to continue health insurance benefits,
information regarding benefits, policies and premiums,
you have to be retired and receiving monthly payments
please refer to the school district’s website at:
from FRS. Enrollment in the FRS investment plan may limit
http://l.sdpbc.net/t72rt
your eligibility to continue health benefits upon retirement.
Note: Your retirement date must be in a month in which Please refer to School Board Policy 6Gx50-3.79 for more
you are covered under the district’s benefits plan in order information.
to continue benefits as a retiree. For less than 12-month
employees, the same rules apply except that at the end of Term Life Plans
the school year, if you complete your contract, most benefits MetLife is the district’s provider for Term Life Insurance. You
will remain in place through the end of July. If you do not may continue the Term Life insurance as follows:
physically return to work in August, your benefits ended in
July, so your retirement date must be in July. Continuing Optional Life - In order to continue your current life
with this example, if you choose an August retirement date, insurance coverage with MetLife upon retirement, you must
you will not be eligible to continue benefits as a retiree. convert your coverage to individual plans within 31 days of
the date your coverage terminated. Proof of insurability is
not required in order to convert. Premiums are paid directly
to the carrier.
IMPORTANT The carrier must receive the completed application and
For example, for 12-month employees, benefits are
payment within 31 days after your life insurance ends.
provided for active employees until the end of the
month in which you retire, provided you have actually
worked the majority of duty days during that month.
7
Retirees
Annual Enrollment Benefits Plan Premium Payments
Available Premium payments are due by the first day of the month.
Every year, we have an annual enrollment period during Monthly premiums can be taken from your Florida
which retirees have the opportunity to switch from one Retirement System (FRS) check. We are also pleased to offer
health or dental plan to another. Retirees may also add ACH (debit from other accounts) to retirees as an alternative
or drop dependent coverage. Retirees who wish to add a method of payment for retiree health insurance premiums.
dependent to the medical, dental and/or vision plan must
provide documentation; Social Security information is
required for all enrolled dependents.
Please note that once you drop an area of coverage, you will not be eligible to enroll in that area of coverage at any
time in the future. Refer to this booklet for information on the health, dental and vision plans.
8
UnitedHealthcare
myuhc.com
Medical Plans
UnitedHealthcare is pleased that the School District of Palm
Beach County has chosen us as the health plan provider for
Find a Network Doctor or Hospital
Search by facility, location, gender, and languages spoken.
you and your family.
1. www.myUHC.com
Welcome - We’re Glad You’re Here 2. Click “Find Medical and Mental Health Providers”
3. Choose “Medical Directory” or “Mental Health
While no one can predict the future, you can prepare for it. Directory”
Your UnitedHealthcare benefits provide you with access to 4. Click the “All UnitedHealthcare Plans icon”
people, resources and tools to help you when you aren’t 5. For the Low or High HMO plan, select the
feeling your best. We have also created unique programs “Choice” plan
to help you improve your health and wellness. We believe 6. For the CDHP plan, select UnitedHealthcare
knowledge is the heart of your healthcare, so we want to “Choice Plus”
give you resources to help you:
• Be active with your healthcare
• Make healthy choices Your Coverage Plan
• Find answers Your benefit plan is an important part of your daily life,
• Save money even if you don’t need services every day. It protects you
• Take charge of your health and helps you better manage your health. Right now is the
perfect time to find out all you can about your coverage
Benefits You’ll Appreciate before you need it, especially how it works and where to go
for care.
Your doctor is likely already in our network. Whether you
are at home, traveling or you have a covered child going
to school out-of-state, a network doctor or hospital is likely
Always Carry your ID Card
Your ID card has key information about you and your
close by. In addition, there are no referrals. You can see the
coverage. Put your card in your wallet or your pocketbook
specialist you want. Emergencies are covered anywhere in
so you won’t forget it. When you’re at doctors’ offices,
the world, and you usually don’t have to worry about claim
drugstores and hospitals, show it to make sure you are
paperwork for network care.
not billed unnecessarily. You may also be asked to show
a picture ID, such as your driver’s license or another
government ID card with a picture on it, so be sure to bring
this with you, too.
9
UnitedHealthcare
myuhc.com
Medical Plans
Additional Features of Each Plan UnitedHealth Premium® Care
When you enroll in a UnitedHealthcare health plan, you’ll Physician - Find Recognized Doctors
not only have the freedom to use any doctor or hospital in
our nationwide network, including specialists, but you’ll also
and Hospitals in the Network
be able to take advantage of many valuable programs and With the UnitedHealth Premium Tier 1 designation program*,
services to make your healthcare experience easier. we help you:
• Find doctors and hospitals in your area that meet quality
24-hour nurse services lets you speak with a registered and cost-efficiency criteria
nurse by phone anytime. Nurses can even help schedule • Find doctors you can call directly, without prior approval
doctor appointments. • Get names quickly online
Health coaches offer telephonic and online support to help • Access 27 specialties, including primary care,
you lose weight, stop smoking, manage diabetes and more. cardiology and orthopedics, as well as facilities in
specialties, including:
Health and wellness programs can help you eat right, stop
− congenital heart disease
smoking and relax. You can participate online, or by phone,
− cardiac care
in the comfort of your own home. − total joint replacement
Other helpful tools include: − spine surgery
• Healthcare cost estimator
• Physician match
• Hospital comparison
Finding a UnitedHealth
Premium® Care Physician
Visit your member website, myuhc.com, to search the
directory and look for this symbol next to your results.
*UnitedHealth Premium Tier 1 is not available in all geographic locations. For a complete description of the UnitedHealth Premium Tier 1 designation program, including details on the
methodology used, geographic availability and program limitation, please visit myuhc.com®.
Criteria for designation come from nationally recognized quality standards and market-based cost efficiency standards. For our members with special medical concerns, we also provide
information from the National Committee for Quality Assurance (NCQA) Doctor Recognition Program.
Tips to Make Your Doctor’s Visit Worthwhile
Before your appointment: During your appointment:
1. Make a list of all the questions you have for your 1. Tell your doctor if a family member has been
doctor, nurse or pharmacist. diagnosed with a serious disease or condition.
2. Write down medications you are currently taking, Also mention if you have or will be traveling outside
including prescriptions, over-the-counter medicines, the country.
and herbal supplements. 2. Ask your doctor at every visit to send any laboratory
3. Plan to bring a family member or friend to your visit test to a network facility.
if you have a hard time remembering what your 3. Before you leave, make sure you can read and/
doctor tells you. or understand your doctor’s or pharmacist’s
instructions. If you don’t, it’s okay to ask them to
explain until you understand.
10Medical Benefits At-A-Glance
Low Option HMO
UnitedHealthcare Medical Benefits-at-a-Glance
Our medical plan is provided by UnitedHealthcare. The pharmacy benefits are provided directly through Optum Rx. This
plan gives you the freedom to see any physician or other healthcare professional from our national network, including
specialists, without a referral. In addition, you do not have to worry about any claim forms or bills. The premiums are less
than the High Option HMO plan. However, the out-of-pocket expenses are slightly higher than the High HMO plan.
MEMBER PAYMENTS IN-NETWORK ONLY
Annual Medical Expense Deductible $500 for individual / $1,000 for family
Annual Out-of-Pocket Maximum $6,000 for individual / $12,000 for family
Coinsurance Rate / In-Patient Hospital 20% of eligible expenses after deductible
Primary Care Physician: Check United's provider Choose any physician from the United Open Access directory.
directory before making your decision regarding You may access any participating specialist without a referral.
your health care provider
Preventive Care No charge
$40 copayment /$30 copayment for UHC Premium Care
Physician Office Visit (Primary Care)
Physician / Deductible does not apply)
$60 copayment /$55 copayment for Premium Care Physician /
Specialist Office Visit
Deductible does not apply)
Outpatient Hospital and Surgical Services:
X-Ray, Other Diagnostic Services (MRI, CT scan, etc.), 20% of eligible expenses after deductible
Laboratory
Outpatient Rehabilitation Therapy $35 copayment per visit1 / Deductible does not apply
Approved Durable Medical Equipment 20% of eligible expenses after deductible
Emergency Ambulance Trip $150 copayment per trip
Hospital Pre-Admission Requirement Your physician will take care of all pre-notification requirements.
Emergency Room Care $250 copayment (waived if admitted)
Urgent Care Copayment $75 copayment / Deductible does not apply
District On-Site Clinic Visit $10 copay
Convenience Care Clinic $40 copayment / Deductible does not apply
• Virtual Office Visits $25 copayment / Deductible does not apply
Outpatient Mental Health & Substance Abuse Services $35 individual, $25 group / Deductible does not apply
Prescription Drugs Pharmacy Provider - Optum Rx Annual Rx deductible $100 individual (retail) / $200 family (retail)
• 30-day supply per prescription at participating pharmacists
$10 Tier 1, $30 Tier 2, $60 Tier 3, $100 Tier 4
Prescription benefits provided by Optum Rx
• Mail order for a 90-day supply of formulary maintenance No deductible for mail order –
medication per prescription $25 Tier 1, $75 Tier 2, $150 Tier 3, $250 Tier 4
Medical Network www.myuhc.com. Network name “UnitedHealthcare Choice.” This network is for both the Low/High Option HMO.
1. 20 visits of physical, occupational, pulmonary and speech therapy per calendar year, per therapeutic type. 36 visits per year for cardiac therapy.
11Medical Benefits At-A-Glance
High Option HMO
UnitedHealthcare Medical Benefits-at-a-Glance
Our medical plan is provided by UnitedHealthcare. The pharmacy benefits are provided directly through Optum Rx.
This plan gives you the freedom to see any physician or other healthcare professional from our national network, including
specialists, without a referral. In addition, you do not have to worry about any claim forms or bills.
MEMBER PAYMENTS IN-NETWORK ONLY
Annual Medical Expense Deductible $400 for individual/ $800 for family
Annual Out-of-Pocket Maximum $4,000 for individual/ $8,000 for family
Coinsurance Rate / In-Patient Hospital 10% of eligible expenses after deductible
Primary Care Physician: Check United's provider directory
Choose any physician from the United Open Access directory.
before making your decision regarding your health care You may access any participating specialist without a referral.
provider
Preventive Care No charge
$40 copayment / $30 copayment for UnitedHealth Premium Care
Physician Office Visit (Primary Care) Physician/ Deductible does not apply
$50 copayment / $40 copayment for UnitedHealth Premium Care
Specialist Office Visit Physician/ Deductible does not apply
Outpatient Hospital and Surgical Services:
X-Ray, Other Diagnostic Services (MRI, CT scan, etc.), 10% of eligible expenses after deductible
Laboratory
Outpatient Rehabilitation Therapy $20 copayment per visit1 / Deductible does not apply
Approved Durable Medical Equipment 10% of eligible expenses after deductible
Emergency Ambulance Trip 10% of eligible expenses after deductible
Hospital Pre-Admission Requirement Your physician will take care of all pre-notification requirements.
Emergency Room Care 15% of eligible expenses after deductible
Urgent Care Copayment $50 copayment / Deductible does not apply
District On-Site Clinic Visit $10 copay
Convenience Care Clinic $25 copayment / Deductible does not apply
• Virtual Office Visits $25 copayment / Deductible does not apply
Outpatient Mental Health & Substance Abuse Services $20 individual, $15 group / Deductible does not apply
Prescription Drugs Pharmacy Provider - Optum Rx Annual Rx deductible $100 individual (retail) / $200 family (retail)
• 30-day supply per prescription at participating pharmacists
$10 Tier 1, $30 Tier 2, $60 Tier 3, $100 Tier 4
Prescription benefits provided by Optum Rx
• Mail order for a 90-day supply of formulary maintenance No deductible for mail order –
medication per prescription $25 Tier 1, $75 Tier 2, $150 Tier 3, $250 Tier 4
Medical Network www.myuhc.com. Network name “UnitedHealthcare Choice.” This network is for both the Low/High Option HMO.
1. 20 visits of physical, occupational, pulmonary and speech therapy per calendar year, per therapeutic type. 36 visits per year for cardiac therapy.
12Medical Benefits At-A-Glance
Consumer Driven Health Plan (CDHP)
UnitedHealthcare Medical Benefits-at-a-Glance
Our medical plan is provided by UnitedHealthcare. The pharmacy benefits are provided directly through Optum Rx. The
Consumer Driven Health Plan (CDHP) puts you in control of your medical spending and gives you the ability to save money
through a Health Savings Account (HSA) for future healthcare needs (Eligibility requirements for a HSA and how to open
an HSA account are discussed on subsequent pages). This plan gives you the freedom to see any doctor or other health
professional from our national network, including specialists, without a referral. With this plan, you will receive the highest
level of benefits when you seek care from a network doctor, facility or other healthcare professional. You may also choose
to seek care outside the network without a referral. However, you should know that care received from a non-network
doctor, facility or other healthcare professional means a higher deductible and copayment. Federal guidelines limit who can
have an HSA account so please verify that you qualify prior to enrolling.
MEMBER PAYMENTS IN-NETWORK ONLY OUT-OF-NETWORK ONLY
Annual Medical Expense Deductible $3,000 for individual / $6,000 for family $4,500 for individual / $9,000 for family
Annual Out-of-Pocket Maximum $6,350 for individual / $12,700 for family $10,000 for individual / $20,000 for family
Coinsurance Rate / In-Patient Hospital 30% of contracted fee 40% of eligible expenses
Primary Care Physician: Check United's provider Choose any physician from the United
directory before making your decision regarding Open Access directory and access any Choose any licensed physician.
your health care provider participating specialist without a referral.
Preventive Care No charge 40% of eligible expenses after deductible
Physician Office Visit (Primary Care) 30% of contracted fee after deductible 40% of eligible expenses after deductible
Specialist Office Visit 30% of contracted fee after deductible 40% of eligible expenses after deductible
Outpatient Hospital and Surgical Services: X-Ray, Other
Diagnostic Services (MRI, CT scan, etc.), Laboratory 30% of contracted fee after deductible 40% of eligible expenses after deductible
Outpatient Rehabilitation Therapy 30% of contracted fee after deductible1 40% of eligible expenses after deductible
Approved Durable Medical Equipment 30% of contracted fee after deductible 40% of eligible expenses after deductible
Emergency Ambulance Trip 30% of contracted fee after deductible 30% of eligible expenses after deductible
Hospital Pre-Admission Requirement Your physician will take care of all It is your responsibility to see that your
pre-notification requirements. physician takes care of pre-notification.
Emergency Room Care 30% of contracted fee after deductible 30% of eligible expenses after deductible
Urgent Care Copayment 30% of contracted fee after deductible 40% of eligible expenses after deductible
District On-Site Clinic Visit $25 copay
Convenience Care Clinic Select any non-network physician,
30% of contracted fee after deductible
specialist or hospital.
• Virtual Office Visits $25 copayment after deductible n/a
Outpatient Mental Health & Substance Abuse Services 30% of contracted fee after deductible 40% of eligible expenses after deductible
Medical Network www.myuhc.com. Network name “UnitedHealthcare Choice.” This network is for both the Low/High Option HMO.
1. 20 visits of physical, occupational, pulmonary and speech therapy per calendar year, per therapeutic type. 36 visits per year for cardiac therapy.
RETAIL MAIL-ORDER Prescription Drugs
DED Subject to Deductible Subject to Deductible • 30-day supply per prescription at
participating pharmacies
Tier 1 $10 copay after deductible $25 copay after deductible • Mail order for a 90-day supply of
Tier 2 $30 copay after deductible $75 copay after deductible formulary maintenance medication
Tier 3 $60 copay after deductible $150 copay after deductible per prescription
Tier 4 $100 copay after deductible $250 copay after deductible
13Health Savings Account (HSA)
Introduction to Health Savings Accounts
A health savings account (HSA) allows you to save money for qualified
medical expenses that you’re expecting, such as contact lenses or monthly
Contribution limits
prescriptions, as well as unexpected ones — for this year and the future.
There are contribution limits, set
Why have an HSA? by the Internal Revenue Service
(IRS) and adjusted annually.
You own it
These limits are:
The money is yours until you spend it, even deposits made by others, such as
an employer or family member. You keep it, even if you change jobs, health • $3,550 for individual coverage in
plans or retire. 2020; $3,600 in 2021
Tax savings • $7,100 for family coverage in
2020; $7,200 in 2021
HSAs help you plan, save and pay for health care, all while saving on taxes.
• $1,000 extra if you’re 55 or
• The money you deposit is federal income tax-free. older, also known as catch-up
• Savings grow income tax-free. contributions
• Withdrawals for qualified medical expenses are also income tax-free.
It’s not just for doctor visits
Once you’ve contributed to your account, you can use the funds in your HSA
to pay for qualified medical expenses such as:
• Dental care, including extractions and braces
• Vision care, including contact lenses, prescription sunglasses and LASIK surgery
• Prescription medications
• Chiropractic services
• Acupuncture
Save for the future
Your HSA rolls over from year to year, so you can continue to grow your
savings and use it in the future - even into retirement.
14Health Savings Account (HSA)
Planning for retirement with an HSA
Health care expenses are one of the top financial worries in retirement —
especially for people with health conditions. As you’re planning for the future,
think about how your Optum Bank® health savings account (HSA) can help
ease your mind and prepare you for retirement by saving money tax-free.
Wondering how much you might need to save?
Good question. Here are the current health savings recommendations for
retirement:1
$635K
$500K for a
45-year-old couple
$405K for a
55-year-old couple
RETIRING 20 YEARS
FROM NOW
for a RETIRING IN 10 YEARS
65-year-old couple
RETIRING TODAY
Looking for a personalized estimate? Take the Optum Health Savings Checkup
at healthsavingscheckup.com. Answer a few questions about your health,
your HSA activity and retirement goals, and you will receive a personalized
snapshot of your potential health care expenses in retirement. You’ll also get
ideas to help you stay healthy, spend less and save more.
Investing with an HSA
Once your HSA reaches the investment threshold, you may choose to invest a
portion of your HSA dollars in mutual funds. Any investment earnings such as
interest or dividends are income tax free. This gives you the potential to grow
your HSA retirement savings even more.
15Health Savings Account (HSA)
Planning for retirement with an HSA
Catch-up contributions
Once you turn 55, you can contribute an additional $1,000 each year to your Hank saves for retirement
HSA, called a catch-up contribution. If you and your spouse are both over with his HSA.
the age of 55, you can each contribute an additional $1,000. Your spouse
Hank is 60 and preparing for
will just need to open their own HSA for their additional portion.
retirement. For the past five years,
HSAs and Medicare he has been contributing the
The benefits of an HSA don’t stop when you retire. While you are no longer maximum amount allowed by
allowed to contribute to your HSA after enrolling in Medicare, you can still use the IRS. See how fast his account
your HSA funds income tax free to pay for qualified medical expenses. You balance has grown — and how
can also use your HSA to pay for Medicare premiums and qualified out-of- much he’s saved on taxes.2
pocket expenses including deductibles, copays and coinsurance for:
• Part A (hospital and inpatient care)
• Part B (doctor and outpatient care)
• Part D (prescription drugs) TOTAL CONTRIBUTIONS
Keep in mind that Medicare does not cover hearing aids or vision, dental or $38,600
nursing home care. over the past 5 years
Withdrawing funds during retirement
You can use the money in your HSA to pay for qualified medical expenses at
any time. Once you turn 65, however, you can withdraw the money from your
HSA for nonqualified expenses without a penalty. You will just be required to
pay ordinary income tax on that amount. SAVED OVER
$14,530
Have questions? on taxes in the past 5 years
Visit optumbank.com or myuhc.com®.
Investments are not FDIC insured, are not guaranteed by Optum Bank®, and may lose value.
1. HealthView Services: 2017 Retirement Health Care Costs Data Report
2. Contributions are based on IRS contribution limits for family coverage from 2014-2018 and include catch-up contributions. Tax savings assumes a 25% federal tax
rate, 5% state tax rate and 7.65% FICA.
Health savings accounts (HSAs) are individual accounts offered or administered by Optum Bank®, Member FDIC, and are subject to eligibility requirements and
restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. This communication is not intended as
16
legal or tax advice. Federal and state laws and regulations are subject to change.
© 2018 Optum, Inc. All rights reserved. WF272686 67555A-062018When & Where to Get Care
Check. Choose. Go. SM
Check.
Check. Choose.
Choose. Go.
Go.
When you need care, call your primary care physician SM
SM
or family doctor first.
Your physician has easy access to your records, knows the bigger picture of your health and may even offer same-day appointments
to meetyou
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Average Cost*
place that’s right for you and help avoid financial surprises. Compare your choices today at uhc.com/checkchoosego.
Quick Care Options Needs
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(skin,
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Emergency Room (ER) • Chest pain
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• Major burns
For serious immediate needs. • Shortness of breath • Severe injuries $
1,700
Emergency Room (ER) • Severe asthma attack
Chest pain • Kidney stones
Major burns
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needs. (ER)
•
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For serious immediate Shortness injuries
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• Shortness of breath
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stones
• Severe asthma attack • Kidney stones
Freestanding ERs Ask before you enter:
Many people have been surprised by their bill after visiting a freestanding emergency room (FSER). • Is this an urgent care center
Freestanding ERs
FSERs, sometimes referred to as urgency centers, bill at ER rates (or higher) and can be $1,500 or an
Ask ER? you enter:
before
Freestanding ERs
more than an Urgent Care Center. Neither located in nor attached to a hospital, FSERs are able to
treat
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treat similar conditions as an ER but do not have an ER’s ability to admit patients. • Is this facility
network a
provider?
network provider?
Learn more at
uhc.com/checkchoosego.
Learn more at
Average allowed amounts charged by UnitedHealthcare Network Providers and not tied to a specific condition or treatment. Actual payments may vary depending upon
Learn more at
uhc.com/checkchoosego.
benefit coverage. UnitedHealthcare 2015 (Estimated $1,500.00 difference between the average emergency room visit and the average urgent care visit.) The information
uhc.com/checkchoosego.
and estimates provided are for general informational and illustrative purposes only and is not intended to be nor should be construed as medical advice or a substitute for
your doctor’s care. You should consult with an appropriate health care professional to determine what may be right for you. In an emergency, call 911 or go to the nearest
emergency room.
Average allowed amounts charged by UnitedHealthcare Network Providers and not tied to a specific condition or treatment. Actual payments may vary depending upon
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facility names, addresses, phone numbers and network statuses are subject to change without notice.
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17
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MT-1146579 8/17 ©2017 United HealthCare Services, Inc. 17-5438
Administrative services provided by United HealthCare Services, Inc. or their affiliates.
MT-1146579 8/17 ©2017 United HealthCare Services, Inc. 17-5438Dental Benefits
Getting started with Humana Dental Access your digital ID Card and
We’ve given you a reason to smile with a selection of four
keep it with you
flexible dental plans, paid through a voluntary, pretax benefit. You will have access to view and print your dental ID cards
via the Humana website or the Humana mobile app within 10
Register at Humana.com working days of enrollment. Here’s how:
As a Humana member, you have a secure website on Via the website:
Humana.com called MyHumana. With MyHumana, you have • Go to Humana.com and sign in/register for MyHumana
fast, easy access to your personalized benefits information. (Have your Humana member ID or Social Security
number available)
Some of what you can do on MyHumana: • Click “Access your ID Card” under “Tools & forms” in
• Claims – Check if a claim has been paid along with the lower right of your MyHumana home page or in the
yourW estimated cost, if any page’s footer under “Tools & Resources”
• ID cards – View, print and email up-to-date dental • A new window will appear with links to the ID card or
Humana member ID cards proof of coverage
• Coverage details – Review deductibles, coverage levels • Print if desired.
and limits
• Provider search – Use “Find a doctor” to find in-network Via the mobile app:
dentists near you • Download the MyHumana App for iOS or Android
• Manage access – Give other adults on your policy • Sign in using your MyHumana username and password
permission to access your health information • Click “ID Cards” on the dashboard
• Update your communications preferences – Select • Your dental ID card information and an image of the front
which communications you want to receive from and back of the ID card will be visible
Humana and how you want to receive them — via paper
or email Humana Customer Care
For assistance or more information on the Humana Dental
Registering is easy benefits simply call 1-800-233-4013 (TTY: 711), Monday
• Have your Humana member ID or Social Security through Friday, 8 a.m. to 6 p.m. Eastern Time
number available (TDD: 1-800-325-2025) to speak with a friendly,
• Go to Humana.com knowledgeableCustomer Care specialist, or visit
• Select “Register” at the top of the page HumanaDental.com.
• Choose “Member all other plan types”
• Fill in some basic information — like your Humana
member ID number or Social Security number, date of
birth, ZIP code, and email and click “next”
• Create a username, password and security prompt and
click “next” to finish
Also, you can download the MyHumana mobile app from the
app store on your smartphone to access plan information.
18Dental Benefits
The Four Dental Options Offered Are: Finding an in-network dentist
Managed Care Plans Go to https://www.humana.com/dental-insurance/find-a-
dentist anytime to find an in-network dentist.
Option 1 (DHMO Enhanced) & Option 2 (DHMO Basic)
provide a wide variety of benefits through your participating Under the Network drop down box, search for a provider by
dentist. At the time of service, you pay the dentist for any selecting one of the following networks:
applicable copayments according to your schedule of Palm Beach Schools DHMO
benefits. Palm Beach Schools PPO
Both plans feature: You can also access the list of in-network providers on your
• No primary dentist selection required MyHumana mobile app or by calling the customer care
• No maximums number on this page.
• No waiting periods
Extended Annual Maximum*
• No claims to file
• A large panel of providers to choose from As part of Humana’s dental PPO Plans, the Extended Annual
• Same copayment to participating general dentist or Maximum helps you save money by ensuring you have
specialist access to network discounts and 30% coinsurance, even
• No referrals required to see a participating specialist after you have reached your annual maximum. You can
• Pediatric specialist care for age 16 and under achieve and maintain your best health by getting dental
care when it’s needed, before oral health issues may affect
Orthodontics your overall health and well-being.
Both the DHMO Enhanced and DHMO Basic cover With Humana’s extended annual maximum, you won’t have
orthodontia services for both adults and children. to put off important dental care procedures for yourself or
Copayments under the DHMO Enhanced are set at $1,600 your covered dependents.
for children and adolescents; $1,950 for adults. Copayments *Excludes orthodontia
under the DHMO Basic are set at $2,200 for children,
$2,250 for adolescents and $2,350 for adults.
Increased Preventive Coverage
Early detection is the key to preventing more serious health
PPO Plans conditions including diabetes, heart disease and stroke.
Option 3 (PPO High) allows you and each covered family Humana’s enhanced preventive care benefits cover many
member to use the dentist of your choice; however, you’ll services to help you achieve and maintain your best oral
receive a higher level of coverage when you choose a health and save on out-of-pocket expenses.
participating dentist. There is a deductible of $50 per Our enhanced preventive care benefit covers four
person ($150 per family). There is no deductible for periodontal maintenance cleanings, as well as three
preventive and diagnostic services. This plan has an annual routine cleanings every year, whichever is needed,
maximum benefit of $1,000, plus an extended annual helping you prevent oral health issues from becoming
maximum benefit. This plan covers orthodontia for adults chronic conditions. Under enhanced preventive coverage,
and children up to the age of 18. The lifetime orthodontic periodontal maintenance cleanings are covered under
maximum benefit is $1,000 for adults and $2,000 for preventive services.
children. • Three routine cleanings per year
Option 4 (PPO Low) allows you and each covered family • Four periodontal maintenance cleaning procedures per
member to use the dentist of your choice; however, you’ll year—covered as a preventive service
receive a higher level of coverage when you choose a • Oral cancer screenings for members aged 40 plus
participating dentist. There is a deductible of $50 per
person ($150 per family). There is no deductible for
preventive and diagnostic services. This plan has an annual
maximum benefit of $1,000, plus an extended annual
maximum benefit. This plan does not cover orthodontic
services.
19Dental Benefits
2021 DENTAL PLANS - HUMANA
Retiree Only $14.40
DHMO Enhanced Retiree + Child(ren) $30.60
(Florida Dentist) Retiree + Spouse/DP* $25.20
Retiree + Full Family $39.60
Retiree Only $10.94
DHMO Basic Retiree + Child(ren) $23.40
(Florida Dentist) Retiree + Spouse/DP* $19.03
Retiree + Full Family $29.96
Retiree Only $31.96
PPO High Retiree + Child(ren) $87.89
(Orthodontia) Retiree + Spouse/DP* $78.31
Retiree + Full Family $118.27
Retiree Only $25.20
PPO Low Retiree + Child(ren) $69.30
(NO Orthodontia) Retiree + Spouse/DP* $61.74
Retiree + Full Family $93.25
20Dental Benefits
Commonly Covered Procedures:
Sample procedure codes, see full schedule for complete listing: www.myhumana.com
BENEFIT OPTION 1 - DHMO ENHANCED OPTION 2 - DHMO BASIC
DEDUCTIBLE
Annual Deductible None None
Calendar Year Maximum None None
Claim Forms None None
Primary Dentist Required None None
PREVENTIVE & DIAGNOSTIC YOU PAY YOU PAY
Office visit No charge No charge
Routine exams (2 per 12 Months) No charge No charge
Prophylaxis (cleaning) - basic (3 per 12 months) No charge No charge
Emergency treatment (palliative) No charge No charge
X-ray - complete series including bitewings
No charge No charge
(1 per 24 months)
Fluoride application (1 per 12 months) $10 $15
BASIC/RESTORATIVE PROCEDURES
Simple extractions $10 $20
Amalgam fillings - 1 surface permanent No charge No charge
Anterior Root canals (1 canal) $100 $110
Endodontic Therapy, Premolar Tooth $185 $185
Endodontic Therapy, Molar Tooth $225 $245
Composite resin fillings - 1 surface, anterior $0 $0
Sealants (up to age 15) No charge No charge
MAJOR SERVICES
Crowns - porcelain, high noble metal $495 $500
Dentures - upper/lower $460 each $525 each
Bridges - porcelain, base metal $420 $425
PERIODONTICS
Periodontal Maintenance (limit 4 per year) $0 $0
ORTHODONTICS
Pre-orthodontic treatment visit $0 $35
Comprehensive treatment of transitional
$1,600 $2,200
dentition
Comprehensive treatment of adolescent
$1,600 $2,250
transitional dentition
Comprehensive treatment of adult dentition $1,950 $2,350
Network: Palm Beach Schools DHMO
21Dental Benefits
PPO Plans
Sample procedure codes, see full schedule for complete listing: www.myhumana.com
OPTION 3 - PPO HIGH OPTION 4 - PPO LOW
BENEFIT
IN-NETWORK OUT-OF-NETWORK* IN-NETWORK OUT-OF-NETWORK*
DEDUCTIBLE (MAXIMUM 3 PER FAMILY) - CALENDAR YEAR IS JANUARY 1 - DECEMBER 31
Class I None None None None
Class II, III, IV $50 per year, individual $50 per year, individual
Calendar Year Maximum $1,000 + Extended Annual Maximum $1,000 + Extended Annual Maximum
Lifetime Orthodontic Maximum $1,000 Adults / $2,000 Children Not covered
CLASS I - PREVENTIVE & DIAGNOSTIC
Routine Oral Exam 100% 90% 100% 80%
X-rays (diagnostic) 100% 90% 100% 80%
Routine Cleanings 100% 90% 100% 80%
Periodontal cleanings 100% 90% 100% 80%
Fluoride treatment 100% 90% 100% 80%
Sealants 100% 90% 100% 80%
Space maintainers 100% 90% 100% 80%
Oral Cancer Screening (ages 40+) 100% 90% 100% 80%
Panoramic x-rays 100% 90% 100% 80%
CLASS II - BASIC SERVICES
Emergency care for pain relief 80% 70% 50% 40%
Amalgam / Composite fillings 80% 70% 50% 40%
Oral Surgery (includes extractions) 80% 70% 50% 40%
Harmful habit appliances 80% 70% 50% 40%
Periodontics 80% 70% 50% 40%
Endodontics 80% 70% 50% 40%
CLASS III - MAJOR SERVICES
Inlays/onlays/crowns & bridges 50% 40% 50% 40%
Dentures and other removable
50% 40% 50% 40%
prosthetics
Implants 50% 40% 50% 40%
CLASS IV - ORTHODONTIC SERVICES
Orthodontia (Adult & child up to age 18) 50% 50% Not covered Not covered
Network: Palm Beach Schools PPO
22Vision Benefits
Provider: EyeMed Vision Care • Anti-reflective (AR) coating - This coating reduces the
amount of light that reflects off the lenses. These lenses
eyemed.com can be particularly helpful for driving at night, when
An eye examination means more than getting a prescription reflections on your lenses may be greater than daylight
– it evaluates your eye health and is critical in the early driving conditions. AR coating also enables people to
detection of several vision and health-related conditions, see your eyes more clearly as opposed to seeing the
including: reflection off your lenses.
• glaucoma • Scratch-resistant coating - When scratches are present
• cataract on your lenses, they may distort or interfere with your
• diabetes vision. This protective coating is added to the lens
• hypertension surface to protect it from normal scratches as a result of
everyday mishaps. It’s a great way to extend the life of
Plan Features your eyewear.
You may choose independent ophthalmologists,
optometrists, opticians or the convenience of a retail facility Claim Forms
including LensCrafters®, most Pearle Vision locations, and You do not need to obtain a claim form for the in-network
Target Optical locations in your area or throughout the services. Simply inform your provider that you are an
country for: EyeMed member when you make your appointment or
• eye examinations visit a participating provider location.
• contact lenses
• glasses To Locate An EyeMed Provider Near You
• Rx sunglasses
• lens options and accessories Visit the EyeMed website at www.eyemed.com and choose
“Select” network and enter your ZIP code to find a provider or
• LASIK and PRK laser vision correction procedures
simply use the newly featured EyeMed member App.
Know Before you Go- a tool now available to all members
Lens Options on their portal which will give members estimates of their
You can choose from many different lenses and lens options purchase total before visiting their provider.
for your frames at participating eye provider locations.
Here are just a few of the lens options you may find at Call EyeMed customer call center at 1-866-723-0514 and
participating provider locations: choose the “provider locator” automated option, or speak to
• Ultra Violet (UV) protection - UV ray exposure can be a customer service representative during normal operating
generated from the sun or other light sources. With hours (Monday-Friday, 7:30 a.m. - 11 p.m. ET; Sunday, 11 a.m.
enough exposure to these light rays, there could be an - 8 p.m. ET).
increased risk of cataracts and macular degeneration.
23You can also read
