R et iree Benefits 2020 Plan Year - foresight is 2020 - The School District of Palm Beach County
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foresight is 2020
R
et
iree
Benefits
2020 Plan Year
Welcome
Dear District Retirees,
UnitedHealthcare Coordination of Benefits
We welcome you to view the benefits information
(COB) with Medicare Plans
included in this reference guide. We’ve compiled all the
information about benefits available to you as a retiree This coverage plan reduces its benefits as described
of The School District of Palm Beach County. below for covered persons who are eligible for
Medicare when Medicare would be the primary
MEDICAL coverage plan. Medicare benefits are determined as
We offer several options for retirees and are confident if the full amount that would have been payable under
you will find a plan that meets your needs and budget. Medicare was actually paid under Medicare, even if:
DENTAL AND VISION COVERAGE • The person is entitled but not enrolled for
Dental and Vision Insurance are important optional Medicare. Medicare benefits are determined as if
benefits that are not part of most medical plans. the person were covered under Medicare Parts A
and B.
OPTIONAL LIFE
Optional Retiree Life Insurance of $1,000 is available • The person is enrolled in a Medicare+Choice
only to those who continue enrollment in a medical (Medicare Part C) plan and receives non-covered
plan at the time of retirement. services because the person did not follow
all rules of that plan. Medicare benefits are
MEDICARE PART D determined as if the services were covered under
Your existing prescription coverage with the School Medicare Parts A and B.
District of Palm Beach County is on average as good
as standard Medicare prescription drug coverage. • The person receives services from a provider
You can keep this coverage and not pay extra if you who has elected to opt-out of Medicare. Medicare
later decide to enroll in Medicare prescription drug benefits are determined as if the services were
coverage. You should also know that if you drop or lose covered under Medicare Parts A and B and the
your coverage with the School District of Palm Beach provider had agreed to limit charges to the amount
County and don’t enroll in Medicare prescription drug of charges allowed under Medicare rules.
coverage when your current coverage ends, you may
pay more (a penalty) to enroll in Medicare prescription • The services are provided in any facility that is not
drug coverage later. eligible for Medicare reimbursements, including
a Veterans Administration facility, facility of the
Uniformed Services, or other facility of the federal
Sincerely, government. Medicare benefits are determined as
Dr. Donald E. Fennoy II if the services were provided by a facility that is
eligible for reimbursement under Medicare.
• The person is enrolled under a plan with a
Medicare Medical Savings Account. Medicare
benefits are determined as if the person were
covered under Medicare Parts A and B.
2
Table of
Welcome 2
Benefits Directory 4
Contents Important Enrollment Information
2020 Monthly Rates
5
4
New Retirees 7
UnitedHealthcare Medical Plans 9
Medical Benefits At-A-Glance 11
Health Savings Account (HSA) 14
When & Where to Get Care 16
Dental Benefits 17
Vision Benefits 22
Medicare Part D 24
Important Notices 25
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 24 for more details.
Benefits Directory
Risk & Benefits Management Medical Plans
https://www.palmbeachschools.org/careers/benefits/ UnitedHealthcare®
retiree_health_benefits Group Number All Plans: 704471
Retiree Benefits Desk: www.myuhc.com
1-561-434-8673 Member Service Numbers:
3370 Forest Hill Blvd, Suite A-103 Low Option HMO (EPO):
West Palm Beach, FL 33406-5870 1-888-380-0389
Fax Number for Retiree Benefits: High Option HMO:
1-561-434-8103 1-888-380-0389
CDHP (High Deductible):
Dental Insurance (Effective 01/01/2020) 1-888-380-0389
Humana Dental®
Group #: 830206 Term Life and Accident
800-233-4013 DHMO & PPO Plans Metropolitan Life Insurance Company
myhumana.com (as of 01/01/2020) (MetLife)
Dental Provider Search Group Number: 106456
- DHMO - http://l.sdpbc.net/me0w5 www.MetLife.com/MyBenefits.com
- PPO - http://l.sdpbc.net/rcb7o 800-638-6420
Open Enrollment Humana Support Line
1-855-811-0409 Special Retirement Plan Administrator
Hours: 8:00 a.m. - 8:00 p.m. Eastern BENCOR Administrative Services
humana.com (prior to 01/01/20) Group Number: 100260
www.bencorplans.com
866-296-9712
Florida Retirement System (FRS)
Email: questions@bencorplans.com
www.myfrs.com
Payroll (pension checks):
1-850-488-4742 or 1-844-377-1888
U.S. Social Security Administration
www.ssa.gov
Disability:
1-850-488-2968 1-800-772-1213
Calculations:
1-850-488-6491 or 1-888-738-2252 Vision Plan
Survivor Benefits: Group Number: 9705435
1-850-488-5207 www.eyemed.com
EyeMed Vision Care:
Medicare 1-866-723-0514
www.medicare.gov
1-800-MEDICARE (1-800-633-2273)
4
Important Enrollment Information
New Retirees Special Rules for Those Retirees
As a new retiree, you have the opportunity to continue your Eligible for Medicare
current plan coverage for medical, dental and vision. Each All plans reduce benefits for covered persons who are
year following your retirement, you will have the opportunity eligible for Medicare when Medicare would be the primary
to make plan changes. Life insurance choices are limited to coverage plan. Medicare benefits are determined as if the
a maximum of $1,000 as a retiree. full amount that would have been payable under Medicare
was actually paid under Medicare, even if the person is
Current Retirees entitled to, but not enrolled in Medicare.
All retirees have a choice of any of the District’s medical
plans as offered to active employees: Other Plan Options for Retirees
1. Low Option HMO
2. High Option HMO or
Eligible for Medicare
3. Consumer Driven Health Plan (CDHP) You may be able to find Medicare Supplement Plans
or Medicare Advantage Plans at better premiums than
Retirees who are enrolled in Medicare will still be continuing under the District’s plan. We encourage you to
responsible for all UnitedHealthcare’s copayments and review your options by looking at the Medicare website:
deductibles. www.medicare.gov.
Tobacco Use Surcharge You may also want to take advantage of discussing your
options with one of the insurance agents listed in the
The School District of Palm Beach County will add a tobacco
advertisement section of this book. All of the agents are well
surcharge to medical plan premiums for retirees who
versed in Medicare plans and have a good understanding of
use any tobacco products and elect medical coverage.
the District’s plans.
The same surcharge will apply if a tobacco status was
not declared. The School District of Palm Beach County
encourages you to take steps to quit the use of all tobacco
products. This tobacco premium surcharge will be strictly
enforced for all retirees covered under the group
medical plan.
5
2020 Monthly Rates
2020 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
CDHP Medical Plan Retiree + Child(ren) $786 $836
(High Deductible Plan) Retiree + Spouse/DP* $868 $918
Retiree + Full Family $1,142 $1,192
* DP = domestic partner
2020 DENTAL PLANS - HUMANA 2020 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 2020 BASIC LIFE INSURANCE - METLIFE
(Florida Dentist) Retiree + Spouse/DP* $19.03 RETIREE ONLY COST
Retiree + Full Family $29.96
Optional Life ($1,000) $0.22
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 In order to be eligible to continue health insurance benefits,
employees (with the exception of 12-month employees) who you have to be retired and receiving monthly payments
retire at the end of a school year and work through their from FRS. Enrollment in the FRS investment plan may limit
contract period — coverage will end on July 31 of your eligibility to continue health benefits upon retirement.
that year. Please refer to School Board Policy 6Gx50-3.79 for more
information.
As a retiree of the School District of Palm Beach County,
you are eligible to continue your health, dental and vision
coverage if you pay the monthly premium in full. For more Term Life Plans
information regarding benefits, policies and premiums, MetLife is the district’s provider for Term Life Insurance. You
please refer to the school district’s website at: may continue the Term Life insurance as follows:
http://l.sdpbc.net/t72rt Optional Life - Face Amount: $1,000. You must continue
Note: Your retirement date must be in a month in which your health insurance in order to continue this Basic Life
you are covered under the district’s benefits plan in order Insurance. You must be enrolled in a medical plan to
to continue benefits as a retiree. For less than 12-month continue the Basic Life Insurance.
employees, the same rules apply except that at the end of In order to continue your current life insurance coverage
the school year, if you complete your contract, most benefits with MetLife upon retirement, you must convert your
will remain in place through the end of July. If you do not coverages to individual plans within 31 days of the date your
physically return to work in August, your benefits ended in coverage terminated. Proof of insurability is not required in
July, so your retirement date must be in July. Continuing order to convert. Premiums are paid directly to the carrier.
with this example, if you choose an August retirement date,
The carrier must receive the completed application and
you will not be eligible to continue benefits as a retiree.
payment within 31 days after your life insurance ends.
IMPORTANT
For example, for 12-month employees, benefits are
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.
9UnitedHealthcare
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
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
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
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
Prescription Drugs Pharmacy Provider - Optum Rx
• 30-day supply per prescription at participating
pharmacists. Prescription benefits provided by Optum Rx 30% of contracted fee after deductible 40% of eligible expenses after deductible
• Mail order for a 90-day supply of formulary maintenance
medication per prescription 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.
13Health Savings Account (HSA)
Introduction to Health Savings Accounts
Introduction to Health Savings Accounts
A health savings account (HSA) allows you to save money for qualified
A health savings account (HSA) allows you to save money for qualified
medical expenses that you’re expecting, such as contact lenses or monthly
medical expenses that you’re expecting, such as contact lenses or monthly Contribution
Contribution limits
limits
prescriptions, as well as unexpected ones — for this year and the future.
prescriptions, as well as unexpected ones — for this year and the future.
There
There areare contribution
contribution limits,
limits, set set
Why have an HSA?
Why have an HSA? byby the
the Internal
Internal Revenue
Revenue Service
Service
(IRS)
(IRS) and and adjusted
adjusted annually.
annually.
You own
Youitown it
The money is yours until spend
you spend it, even deposits madebybyothers,
others, such
such as
These
These limits
limits are:are:
The money is yours until you it, even deposits made as
an employer
an employer or family
or family member.
member. YouYou
keep keep it, even
it, even if youchange
if you changejobs,
jobs, health
health • $3,450 for individual coverage
• $3,500 for individual coverage
plans orplans or retire.
retire. in 2018; $3,500 in 2019
in 2019; $3,550 in 2020
• $6,900 for family coverage in
Tax savings $7,000 forinfamily
Tax savings • 2018; $7,000 2019 coverage in
HSAs help you plan, save and pay for health care, all while saving on taxes. 2019; $7,100 in 2020
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. $1,000
• older, extra ifas
also known you’re 55 or
catch-up
• The money you deposit is federal income tax-free. older, also
contributions known as catch-up
• Savings grow income tax-free.
• Savings grow income tax-free.medical expenses are also income tax-free. contributions
• Withdrawals for qualified
• Withdrawals for qualified medical expenses are also income tax-free.
It’s not just for doctor visits
It’s notOnce
justyou’ve
for doctor visitsto your account, you can use the funds in your HSA
contributed
to pay for qualified medical expenses such as:
Once you’ve contributed to your account, you can use the funds in your HSA
• Dental
to pay for care,medical
qualified including extractions
expenses andas:
such braces
• Vision
• Dental care, care, including
including contact lenses,
extractions prescription sunglasses and LASIK surgery
and braces
• Prescription medications
• Vision care, including contact lenses, prescription sunglasses and LASIK surgery
• Chiropractic services
• Prescription medications
• Acupuncture
• Chiropractic services
Save for the future
• Acupuncture
Your HSA rolls over from year to year, so you can continue to grow your
savings
Save for and use it in the future - even into retirement.
the future
Your HSA rolls over from year to year, so you can continue to grow your
14 savings and use it in the future - even into retirement.Intro to HSAs
Health Savings Account (HSA)
Who can open an HSA?
To be an eligible individual and qualify for an HSA, you must have a high- Contributions add up
deductible health plan (HDHP) that meets IRS guidelines for the annual quickly.
deductible and out-of-pocket maximum.
When Marcus started his new
In addition, you must: job, he decided to open an HSA
and contribute $100 per month.
• Be covered under a qualifying HDHP on the first day of a given month.
Because he hasn’t had many
• Not be covered by any other health coverage except what is permitted medical expenses, he decided
(dental, vision, disability and some other types of additional coverage not to touch the balance during
are permissible). his first year. Here’s how his
• Not be enrolled in Medicare, TRICARE or TRICARE for Life. contributions added up:
• Have not received Department of Veterans Affairs (VA) benefits within the Monthly contribution: $100
past three months, except for preventive care. If you are a veteran with a Annual contribution: $1,200
disability rating from the VA, this exclusion does not apply.
Annual income tax savings1: $452
• Not be claimed as a dependent on someone else’s tax return. 1
25% federal | 5% state | 7.65% FICA
• Not have a health care flexible spending account (FSA) or health Use the HSA Calculator on
reimbursement account (HRA). Alternative plan designs, such as a limited- optumbank.com to help
purpose FSA or HRA, might be permitted. determine your contributions
Other restrictions and exceptions also apply. Consult a tax, legal or financial and see how much you can save
advisor to discuss your personal circumstances. on taxes.
Open your HSA today.
Open your account
Check with your employer or benefits specialist to learn about your company’s
application process. You may be able to sign up through your employer or
enroll at optumbank.com or through myuhc.com®. You cannot use your The Optum Bank App
HSA to pay for medical expenses you had before you opened your account — is here!
so be sure to open your HSA as soon as you are eligible.
Enjoy an easier way to manage your
And be sure to save your receipts! For a full list of qualified medical expenses, health savings account. You can
visit optumbank.com/qualifiedexpenses. pay bills, view transactions, upload
receipts and more! Download today
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15When & 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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or family doctorit’sfirst.
important to know your quick care options to find the
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helptoprimary
access avoid care physician
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your records, theor
surprises.
knows familypicture
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bigger doctor
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choices at uhc.com/checkchoosego.
today and
your health may even offer same-day appointments
Your physician
to meet has easy
your needs. Whenaccess
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your physician
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it’syour health to
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to meet your
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Options
for you seeing your physician
and help avoid financialNeedsis not possible,
or Symptoms
surprises. however, it’s important to know your quick
Compare your choices today at uhc.com/checkchoosego. care options to find the
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
• or where
Choosing Symptoms
to get • Health and wellness help Average Cost*
Quick
24/7 Care
NurseOptions
Line Needs or Symptoms Average Cost*
Call the number on your health
medical care
• Finding
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• Answers to questions
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0
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plan ID card for expert advice. • Choosing where to get •
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planthe number
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medical
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a doctor
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or hospital
Virtual Visits • Cold • Pinkeye
Anywhere, anytime online • Flu • Sinus problems $
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doctor visits. • Fever
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doctor visits.
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Treatment that’s nearby. • Low back pain • Infections
Urgent Care Center • Respiratory
(cough, pneumonia, asthma)
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genital-urinary) $50-75
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• Infections
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Urgent Care Center • Low back pain
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(skin,
(burns,eye, ear/nose/throat,
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(burns, stitches, sprains,
• Stomach
(pain, vomiting, diarrhea)
(burns, stitches, sprains,
small fractures)
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Emergency Room (ER) • Chest pain
small fractures)
• 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
$1,700
Emergency Room
needs. (ER)
•
• Chest painof breath •
• Major
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1,700
For serious immediate Shortness injuries
For serious immediate needs. •
• Shortness of breath
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• Severe
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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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peopleconditions
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patients. • Is this facility a
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
benefit
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facility names, addresses, phone numbers and network statuses are subject to change without notice.
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17-5438are not intended to address or life-threatening
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16
Administrative
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coverage provided
provided bythrough
by or United HealthCare Services,
UnitedHealthcare Inc. or their
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Company or its affiliates.
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.
17Dental 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
• No claims to file How to refer a dentist
• A large panel of providers to choose from You can help us get your dentist on our participation list.
• Same copayment to participating general dentist or Simply complete the form at https://www.humana.com/
specialist provider/dentist-resources/refer-a-dentist. We’ll invite your
• No referrals required to see a participating specialist dentist to participate in the Humana Dental network.
• Pediatric specialist care for age 16 and under Transition of care
Orthodontic transition allows patients who are under an
Orthodontics orthodontist’s care through the prior carrier to continue
Both the DHMO Enhanced and DHMO Basic cover seeing the same orthodontist that was treating their case
orthodontia services for both adults and children. prior to becoming a member of Humana.
Copayments under the DHMO Enhanced are set at $1,600
for children and adolescents; $1,950 for adults. Copayments PPO*
under the DHMO Basic are set at $2,200 for children, For members enrolling in the PPO High, if your dependent is
$2,250 for adolescents and $2,350 for adults. in active orthodontia treatment without having experienced
a lapse in coverage, Humana will subtract the amount the
PPO Plans prior carrier covered from the orthodontic total case fee
Option 3 (PPO High) allows you and each covered family and orthodontic lifetime maximum. Humana will prorate the
member to use the dentist of your choice; however, you’ll remaining charges over the remaining treatment period and
receive a higher level of coverage when you choose a systematically issue monthly payments, which are applied
participating dentist. There is a deductible of $50 per toward the lifetime orthodontic maximum.
person ($150 per family). There is no deductible for Humana will work with your prior dental carrier to obtain
preventive and diagnostic services. This plan has an annual information regarding the orthodontia treatment in progress.
maximum benefit of $1,000, plus an extended annual *Prior DHMO plan moving to a PPO plan with orthodontic coverage: Humana will not apply
maximum benefit. This plan covers orthodontia for adults the payment information that was rendered while under the DHMO plan to the participant’s
PPO plan. Humana will prorate the charges prior to the Humana effective date and issue
and children up to the age of 18. The lifetime orthodontic benefits from the effective date forward under the Humana PPO plan.
maximum benefit is $1,000 for adults and $2,000 for
DHMO
children.
For members enrolling in the DHMO plan, Humana works
Option 4 (PPO Low) allows you and each covered family with the prior carrier and member to obtain reports of
member to use the dentist of your choice; however, you’ll the orthodontia treatment in progress covered under the
receive a higher level of coverage when you choose a contract holder’s prior plan. To be eligible and covered
participating dentist. There is a deductible of $50 per under the Humana plan, the treatment must be shown on
person ($150 per family). There is no deductible for the member’s schedule of benefits and they must have the
preventive and diagnostic services. This plan has an annual subsequent treatment performed by a participating provider.
maximum benefit of $1,000, plus an extended annual
maximum benefit. This plan does not cover orthodontic
services.
18Dental Benefits
Extended Annual Maximum*
2020 DENTAL PLANS - HUMANA
As part of Humana’s dental PPO Plans, the Extended Annual
Maximum helps you save money by ensuring you have Retiree Only $14.40
access to network discounts and 30% coinsurance, even Retiree + Child(ren) $30.60
after you have reached your annual maximum. You can DHMO Enhanced
achieve and maintain your best health by getting dental (Florida Dentist) Retiree + Spouse/DP* $25.20
care when it’s needed, before oral health issues may affect
Retiree + Full Family $39.60
your overall health and well-being.
With Humana’s extended annual maximum, you won’t have Retiree Only $10.94
to put off important dental care procedures for yourself or Retiree + Child(ren) $23.40
your covered dependents. DHMO Basic
*Excludes orthodontia (Florida Dentist) Retiree + Spouse/DP* $19.03
Increased Preventive Coverage Retiree + Full Family $29.96
Early detection is the key to preventing more serious health
Retiree Only $31.96
conditions including diabetes, heart disease and stroke.
Humana’s enhanced preventive care benefits cover many Retiree + Child(ren) $87.89
PPO High
services to help you achieve and maintain your best oral
(Orthodontia) Retiree + Spouse/DP* $78.31
health and save on out-of-pocket expenses.
Our enhanced preventive care benefit covers four Retiree + Full Family $118.27
periodontal maintenance cleanings, as well as three
Retiree Only $25.20
routine cleanings every year, whichever is needed,
helping you prevent oral health issues from becoming PPO Low Retiree + Child(ren) $69.30
chronic conditions. Under enhanced preventive coverage,
(NO Orthodontia) Retiree + Spouse/DP* $61.74
periodontal maintenance cleanings are covered under
preventive services. Retiree + Full Family $93.25
• Three routine cleanings per year
• Four periodontal maintenance cleaning procedures per * DP = domestic partner
year—covered as a preventive service
• Oral cancer screenings for members aged 40 plus
Humana Cost Comparison
There are copayment differences between the prior Solstice DHMO benefits and the new Humana DHMO benefits.
Exclusions and limitations applied to certain Solstice benefits and the listed copayments did not include the cost of
material and laboratory fees. Unexpected additional costs were applied to those benefits at the time of service.
Humana’s DHMO plans have set copayments that include the cost of material and laboratory fees so there are no
hidden additional charges. Below is an example:
CURRENT PLAN PREVIOUS PLAN
HUMANA - DHMO ENHANCED SOLSTICE - DHMO S500PB
MAJOR
PROCEDURES Material & Member Total Material & Member Total
Copayment Laboratory Copayment Copayment Laboratory Copayment
Fees Fees
Crowns – $130 high noble
porcelain, metal fee
high $495 $0 $495 $240 + $495
noble $125 crown
metal laboratory fee
19Dental 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
20Dental 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
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