Helping you make informed benefit choices. . .
2014
Publication Date: August 2013
The Consolidated Benefits
Office (CBO) and Wellness &
Prevention (W&P) strive to
provide you with helpful
benefit and wellness
information, and the necessary
tools and resources to assist
you with understanding your
benefit options and what it
takes to maintain or improve
your health.
Keeping you informed . . .
As
an
employee
of
the
City
of
Virginia
Beach/Virginia
Beach
City
Public
Schools,
you
are
o
ff
ered
a
comprehensive
bene
fi
ts
package
and
an
award
winning
wellness
program.
To
help
you
make
informed
bene
fi
ts
choices,
the
CBO
gives
you
several
tools,
including
this
handbook,
the
CBO
and
W&P
Intranet
sites,
monthly
e
‐
Bulle ns
and
new
hire
orienta ons.
Please
review
the
informa on
carefully
and
contact
the
CBO
if
you
have
any
ques ons.
TABLE OF CONTENTS
LIFE INSURANCE
38
Minnesota
Life
‐
Basic
Life
Insurance
39
Minnesota
Life
‐
Op onal
Life
Insurance
SAVINGS PLANS
40
457
Deferred
Compensa on
41
403(b)
Tax
Sheltered
Accounts
VIRGINIA RETIREMENT SYSTEM (VRS)
42
VRS
EMPLOYEE ASSISTANCE PROGRAM (EAP)
45
Bon
Secours
EAP
WELLNESS & PREVENTION (W&P)
46
W&P
Programs
47
VB
Wellness
for
Life
RATES
50
Bene
fi
t
Plan
Premiums
NOTICES
55
Legal
No ces
66
Glossary
of
Health
Coverage
and
Medical
Terms
70
Individual
Coverage/Community
Resources
CONTACT
INFORMATION
73
Bene
fi
ts
Resources
‐
Who
to
Call/Contact
CBO
‐
Who
to
Call/Contact
IMPORTANT GUIDELINES
5
Enrollment
‐
New
Hire
6
Qualifying
Life
Events
7
Open
Enrollment
8
Eligibility
‐
Employee,
Spouse,
Dependent
9
Eligibility
&
Enrollment
‐
Re ree
10
Your
Bene
fi
ts
while
on
Leave
of
Absence
BENEFIT OPTIONS
12
Bene
fi
ts
Choices
At
‐
A
‐
Glance
HEALTH PLANS
13
Op ma
Health
‐
POS,
Equity
HDHP
w/HSA
18
Op ma
Health
Plan
Summary
of
Bene
fi
ts
DENTAL PLANS
31
MetLife
Dental
‐
Gold,
Silver
32
MetLife
Dental
‐
Choices
At
‐
A
‐
Glance
FLEXIBLE SPENDING ACCOUNTS (FSA)
33
WageWorks
FSA
Accounts
LEGAL SERVICES PLAN
35
Legal
Resources
LONG TERM DISABILITY (LTD)
36
Pruden al
Financial
LTD
37
UNUM
‐
Long
Term
Care
LONG TERM CARE (LTC)
Back Cover
ENROLLMENT - New Hire
As a newly hired benefits‐eligible1 employee, you are offered an ini al enrollment period to elect benefits. Certain benefits can only be elected within 30 calendar
days following your date of hire. Other benefits may be
elected at any me; however, medical underwri ng2 may be required.
Complete Required Forms
Enrollment Forms -
There are separate enrollment forms for each benefit. Forms are provided in your new hire packet (loose or within the specific vendorguide). All enrollment forms can also be printed from the “FORMS” sec on on the CBO Intranet site.
Dependent Requirements
Dependent Cer fica on Form ‐ required for
health/dental plan enrollments with the excep on of employee only coverage.
Dependent SSN ‐ required with health plan
enrollment.
Proof of dependent status ‐ (e.g. birth cer ficate/
marriage cer ficate), is required if the dependent’s last name differs from yours.
HSA Election Form -
required annually with enrollment in the Op ma Equity HDHP.
VBWellness
for
Life Health Screening Form -
To earn the annual $500 health care premium credit
(prorated semi‐monthly) you must par cipate in a health screening, complete the appropriate VB
WellnessforLife screening form, and comply with the requirements of the program. Forms are
provided in your new hire packet or on the “FORMS” sec on on the W&P Intranet site.
Submit Forms
Forms MUST be received in the CBO within 30 calendar
days following your date of hire. Late forms will not be
accepted.
Enrollment Confirma ons ‐ You may view pending
enrollment/changes and benefit plan deduc ons online through Employee Self Service (ESS).
Need More Information or Enrollment
Assistance . . . C
ontact the CBO at 757.263.1060.
Please refer to the back cover of this handbook for our
office and Drop Box loca on and how to contact the CBO.
Must Elect
within 30 days:
May Elect
any
me:
Health
Long
Term
Care
2
VB
Wellness
for
Life
3
Long
Term
Disability
2
Dental
Op onal
Life
Insurance
2
Flexible
Spending
Accounts
4
Compensa on
Deferred
(457)
Legal
Resources
Tax
Sheltered
Accounts
403(b)
1
See page 8 for eligibility informa on.
2Evidence of Insurability (EOI) is required for enrollment a er new hire
eligibility period.
3You must par cipate in a VBWellnessforLife health screening each plan
year to receive the annual health credit towards your health insurance
premium.
4
Flexible Spending Accounts must be re‐elected each plan year.
Effective Date of Coverage
First (1st) day of the month following your hire date. If hired on the 1st working day of the month, coverage is effec ve on the 1st day of the month hired. Elec ons made as a new hire will stay in effect for the en re plan year and cannot be changed un l the next plan year during Open Enrollment, unless you experience a qualifying event.
How to
Get Started . . .
Review your Resources
This Employee Benefits Handbook contains important informa on for all the benefit plans, eligibility guidelines, legal no ces and informa on regarding changes in coverage due to qualifying life events. Detailed plan informa on is provided in your new hire packet and on
the CBO Intranet site.
DEADLINE TO ENROLL
STEP 1 STEP 2 STEP 3The CBO Drop Box is available 24/7.
QUALIFYING LIFE EVENTS -
Making Benefit Changes During the Year
Examples of Qualifying Life Events
(rela ng to theemployee, spouse and/or dependents). The following
events may permit changes in coverage according to
Sec on 125 of IRS Regula ons:
Marriage1, Divorce, Separa on
Birth of a Child1, Adop on1, Legal Custody1, Legal
Guardianship1
Death of Spouse or Dependent
Loss of Eligibility (e.g. age)
Change in Employment Status which results in a gain or
loss of plan coverage (e.g. termina on/re rement, new hire,
change in hours that affect eligibility)
Leave of Absence (LOA) (e.g. unpaid LOA, return from unpaid
LOA, Military LOA. Please refer to the leave of absence guidelines on pages 10 ‐ 11 or contact the CBO for more informa on)
Change in Residence to an area not covered by the
network
Open Enrollment
En tlement or loss of Medicare/Medicaid
Court Ordered Health Care
Note: The list above may not include every possible
qualifying life event. Please contact the CBO within 30
calendar days following the qualifying life event for more
informa on.
1.HIPAA Special Enrollment allows eligible, but not‐enrolled employee,
spouse and/or dependents to enroll in the plan within 30 calendar days
following marriage, birth, adop on or placement for adop on.
Certain
events
in
your
life
may
require
that
you
make
changes
to
your
bene
fi
t
plan(s).
There
are
only
two
opportuni es
to
make
changes
to
your
bene
fi
ts:
1) During annual Open Enrollment
(
fall of each plan year)2) When you experience a Qualifying Life Event
Making Benefit Changes - IRS
regula ons
require
you
to
maintain
your
bene
fi
t
elec ons
for
the
full
plan
year
(January
1
through
December
31).
However,
there
are
certain
“Qualifying
Life
Events”
that
may
permit
limited
mid
‐
year
plan
changes.
Important Requirements - A
request
to
change
your
plan
coverage
mid
year
will
ONLY
be
considered
if
the
following
requirements
are
met:
Enrollment,
cancella on
or
change
form(s)
pertaining
to
your
change
request
are
received
in
the
CBO
within 30 calendar days following the
qualifying life event date
.
If the form(s) is/are not
received within this
meframe, the next
opportunity you will have to enroll or make
changes to your bene
fi
ts will be the next plan year
during open enrollment.
The
enrollment,
cancella on
or
change
request
is
consistent
with,
and
on
account
of,
the
qualifying
life
event
and
is
for
individuals
directly
a
ff
ected
by
the
qualifying
life
event,
except
as
permi ed
by
HIPAA
Special
Enrollment
1
Documenta on
is
provided
to
the
CBO
to
substan ate
the
qualifying
life
event.
How to Request a Change in Coverage?
STEP 1
SUBMIT FORMS
The
following
forms
MUST be received in the CBO
within 30 calendar days following the qualifying life
event date:
Enrollment Form*
(there
are
separate
enrollment
forms
for
each
bene
fi
t;
include
all
individuals
to
remain
on
plan;
omit
those
being
removed)
Dependent Cer
fi
ca on Form*
(required
for
all
health/dental
enrollments,
except
with
employee
only
coverage)
VBWellnessforLife Health Screening Form*
‐
(if
you
are
newly
enrolling
in
the
health
plan
you
MUST
par cipate
in
a
health
screening,
and
comply
with
the
requirements
of
the
program
to
earn
the
annual
$500
health
care
premium
credit
(prorated
semi
‐
monthly).
Please
refer
to
pages
47
‐
49
for
more
informa on.
Bene
fi
t Cancella on Request Form
(if
canceling
a
plan
bene
fi
t)
FSA Change Form
(if
canceling/changing
your
FSA)
Note:
Proof
of
dependent
status
is
required
if
a
spouse
or
dependent’s
last
name
di
ff
ers
from
the
employee
(e.g.,
marriage
cer
fi
cate,
birth
cer
fi
cate/proof
of
birth
Suppor ng
documenta on
may
include
but
is
NOT
limited
to:
Marriage
cer
fi
cate,
birth
cer
fi
cate
or
proof
of
birth
le er,
divorce
decree,
court
order,
company
le er,
COBRA
le er.
Date
of
qualifying
life
event
(e.g.
termina on
date,
hire
date);
E
ff
ec ve
date
of
gain
or
loss
of
coverage;
Plan
name
(e.g.
health,
dental);
Name
of
the
individuals
a
ff
ected
by
the
qualifying
life
event.
QUALIFYING LIFE EVENTS
Effective Date of Change Request
Enrollment
‐
Any
changes
in
coverage
due
to
a
qualifying
life
event
will
be
e
ff
ec ve
on
the
fi
rst
of
the
month
following
the
event
date
or
loss/gain
of
coverage
date
as
determined
and
consistent
with
the
event.
When
adding
a
child
due
to
birth,
adop on,
legal
guardianship
or
custody,
the
e
ff
ec ve
date
is
the
date
of
the
event.
Termina on of Coverage
‐
Coverage
will
end
on
the
last
day
of
the
month
following
the
event
date.
Please
refer
to
the
bene
fi
t
termina on
guidelines
provided
in
this
handbook
for
speci
fi
c
plan
termina on
guidelines
and
requirements.
REMEMBER . . . It is IMPORTANT that
all
required
forms
are
received
in
the
CBO
within
30
calendar
days
following
the
qualifying
life
event
date,
even
if
the
suppor ng
documenta on
is
not
yet
available.
Are you close to the 30 day
deadline . . . Is it the last eligible
day following the qualifying life
event? No need to worry! A
Drop Box is available 24/7 so
that you can drop off your forms and meet this
important deadline. The Drop Box is located at
the entrance to Plaza Annex. See back cover for
location information.
Need More Information - If
you
have
any
ques ons,
require
assistance
or
would
like
more
informa on
of
the
rights
and
rules
of
qualifying
life
Open Enrollment is offered annually
to
give
you
the
opportunity
to
enroll,
change
or
cancel
your
bene
fi
t
plans,
add
or
remove
dependents
from
coverage,
and
enroll
in
a
Flexible
Spending
Account.
The
only
other
opportunity
you
have
to
make
changes
to
plan
coverage
is
when
you
experience
a
qualifying
life
event.
Dates
Open
Enrollment
is
conducted
the
fall
of
each
plan
year
(usually
October).
Informa on
about
Open
Enrollment
dates
will
be
communicated
prior
to
open
enrollment.
Watch
for
your
monthly
Bene
fi
t
e
‐
Bulle ns,
sent
via
your
work
address,
visit
the
CBO
Intranet
and
look
for
posters
displayed
at
your
work
site
for
the
date
announcement.
Open Enrollment Materials
Informa on
regarding
open
enrollment
will
be
available
on
the
CBO
Intranet
site
and
at
your
department
or
school
work
site
prior
to
Open
Enrollment.
Deadline to Enroll/Request a Change
The
last
day
of
open
enrollment.
Please
refer
to
your
Open Enrollment Guide
distributed
in
the
fall
for
more
details.
Effective Date of Coverage
Elec ons
made
during
Open
Enrollment
will
become
e
ff
ec ve
January
1
st
of
the
new
plan
year.
More Information
Open
Enrollment
Guide
CBO:
757.263.1060,
CBO
Intranet
site
OPEN ENROLLMENT
STEP 2
SUBMIT SUPPORTING DOCUMENTATION
Dependent Eligibility Veri
fi
ca on
Dependent Cer fica on Form is required
with any health and/or dental enrollment
request except if enrolling in employee
only coverage.
Proof of dependent status is required
with enrollment for dependents with a
different last name than the employee.
May be required for others, if requested,
due to ongoing audi ng efforts.
Examples of acceptable forms of proof may
include:
Copy of marriage cer ficate
Court Order
Divorce decree
Birth cer ficate
Proof of birth le er
Employee
All benefits are available to:
City Employees working full‐ me*
School Employees working in a full‐ me equivalent
posi on: bus drivers/bus assistants, and food service
employees working a minimum of 25 hours;
percentage employees excluding: bus drivers/bus
assistants and food service employees; and temporary employees filling an allocated posi on.
Please refer to School Board Policy 4‐1 for more informa on.
Employees who meet the eligibility requirements shown
above are eligible for all plans listed in this Benefits
Handbook, except for Tax Sheltered Accounts (403(b)
plans), which are only available to School employees.
Employees who do not meet the eligibility requirements
shown above are only eligible for the following:
Deferred Compensa on (457) ‐ City and School
employees
Tax Sheltered Accounts (403 (b) plans) ‐ School
employees only
Employee Assistance Program ‐ City and school
employees (automa cally enrolled)
*Part‐ me City employees should contact the Human
Resources Department (385.8427) for informa on on
obtaining health coverage.
Eligible Dependents ‐ You may enroll your eligible
dependents in medical, dental, legal, and op onal life
insurance coverage.
Spouse
Lawful Spouse (same sex domes c partners are
ineligible for coverage)
Dependents
Biological children
Stepchildren
Legally adopted children
Any child for whom you are a legal guardian
Dependent children are eligible for health and/or dental
coverage un l the end of the month in which the
dependent turns age 26.
ELIGIBILITY
Disabled Dependents
Disabled dependents reaching age 26 may be eligible to
con nue health/dental coverage or newly enroll (if not
previously eligible). The disabled dependent must meet the
following criteria by providing medical documenta on
annually from a physician cer fying the disability:
Incapable of self‐sustaining support due to a mental/
physical disability
Dependent upon the employee for support and
maintenance due to a mental/physical disability
If for any reason, voluntary or involuntary, the employee or
disabled dependent is disenrolled from health/dental
coverage, and the disabled dependent reaches the limi ng
age during the me of disenrollment, the disabled
dependent is no longer eligible for coverage upon
re‐enrollment of the employee.
The plan uses Social Security’s defini on for “disability” in
determining eligibility.
IMPORTANT: You may only add/remove dependents from your health/dental plan(s) during open
enrollment (conducted the fall of each plan year) or within 30 calendar days following a qualifying life
ELIGIBILITY & ENROLLMENT -
Retiree
The following criteria MUST be met to receive benefits at retirement:
Retiree Benefits Eligibility
Benefits eligibility for re ree benefits coverage is based upon your re rement status. In order to con nue certain coverage as a re ree you MUST:
Be enrolled in coverage as an ac ve employee at the me of re rement
Not be eligible for Medicare (those with End Stage Renal Disease are eligible for coverage during the
first 30 months of dialysis regardless of Medicare eligibility)
Elect coverage within 30 calendar days following the last day of employment
Must be re red under VRS guidelines
Employer Contribution Eligibility
Eligibility for the Employer Contribu on is based on your years of service:
1. Employees that re re under VRS guidelines with 25
years or more of cumula ve service with the City
and/or Schools, or City employees with 5 years or more of service with a work‐related disability ARE eligible to receive the employer contribu on towards re ree health premiums.
2. City/School employees that re re with less than 25
years of service are NOT eligible to receive the
employer contribu on and would pay the full cost of coverage.
3. Employees that defer re rement or do not re re under VRS guidelines are NOT eligible for re ree benefits coverage.
VRS Health Credit
(available to School employees only)Re rees from certain posi ons with at least 15 years of service are eligible for a monthly health insurance credit through VRS. This monthly credit is added into your monthly re rement benefit and intended to assist with the cost of your health and dental insurance premiums. The credit is a dollar amount set by the General
Assembly for each year of service.
Continuation of Benefits Coverage
Certain benefit plans may con nue to be available to you as you transi on from an ac ve employee to a re ree. Each plan has specific con nua on guidelines which will be explained in your Re ree Benefits Packet.
VB
WellnessforLife
You will con nue to receive the VBWellnessforLife health care premium credit a er enrolling in re ree health care coverage, if you received the health care premium credit as an ac ve employee, and remained compliant in the
Termination of Active Employee Benefits
Coverage.
All Benefits will terminate at the end of the month following your termina on/re rement.
Please refer to the benefit termina on informa on provided in this handbook for specific plan termina on guidelines and requirements.
Note: Health and dental coverage will terminate on
August 31st for school employees termina ng/re ring during the months of June, July or August.
Retiree Benefit Plan Enrollment
Upon re rement, you will receive a Re ree Benefits Packet that contains detailed informa on about the enrollment process, including a Re ree Benefits Handbook and enrollment applica ons.
IMPORTANT: Re ree
benefit elec on forms must bereceived in the CBO within 30 calendar days following your re rement date.
More Information
VRS: 888.827.3847, www.vare re.org CBO: 757.263.1060
RETIREMENT SEMINARS
Are you planning on re ring within the next 5 years? If so, you will benefit from a ending a Re rement Seminar.Seminar Registra on Informa on:
City Employees: Contact your Department Training Representa ve. School Employees: Login to VBCPS.com Professional Learning Program Training & Informa on System.
Note: If you delayed Medicare Part B as an ac ve employee, you
should elect it as soon as you re re. This is in your best financial interest, even though Medicare gives you up to eight months to enroll without a Medicare premium penalty.
Your Benefits Upon a Leave of Absence -
City Employees
Con nua on
of
bene
fi
ts
for
City
employees
on
an
approved
leave
of
absence.
Con nua on of Coverage
Leave Status
Health
Dental
Legal
Long
Term
Disability
Long
Term
Care
Paid Leave ‐ Coverage will con nue while in a paid status.
Unpaid Leave* ‐ You may elect to con nue coverage while in an unpaid status by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from start of unpaid leave status, coverage will terminate
effec ve the end of the month in which unpaid leave began or last premium was paid. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
*Specific guidelines pertain to employees on long term illness or Military leave of absence. Please contact the CBO for detailed informa on.
Health
Care
FSA
Private
Insurance
FSA
Paid Leave ‐ Coverage will con nue while in a paid status.
Unpaid Leave ‐ You may elect to con nue coverage while in an unpaid status by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from start of unpaid leave status, coverage will terminate effec ve the end of the month from the date unpaid leave began or last premium was received. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
FSA Claims ‐ Claims must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.
Dependent
Care
FSA
Par cipa on in the plan will terminate (you must be ac vely working for par cipa on in the plan) at the end of the month in which leave begins. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date. Dependent Care FSA Claims ‐ Claims must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.Dependent Care FSA (Ac ve Military Leave)
You may elect to con nue coverage while on ac ve Military leave by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from the start of leave, coverage will terminate effec ve the end of the month from the date ac ve Military leave began or last premiums was received. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
Dependent Care FSA Claims ‐ Claims must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.
Wellness & Preven on Certain benefits require enrollment in our health plan. Please refer to your Wellness Guide for details. The Wellness Guide is also available on the Wellness & Preven on Intranet site.
Basic
Life
Insurance
Op onal
Life
Insurance
VRS
Please contact City Payroll at 757.385.4301 for informa on on con nua on of coverage while on a leave of absence.
Deferred Compensa on
Paid Leave ‐ Deduc ons will automa cally con nue while in a paid status.
Unpaid Leave ‐ Deduc ons will stop once you are in an unpaid status and will automa cally resume upon return to paid a status.
Your Benefits Upon a Leave of Absence -
School Employees
Con nua on
of
bene
fi
ts
for
School
employees
on
an
approved
leave
of
absence.
Con nua on of Coverage
Leave Status
Health Dental
Long Term Disability Long Term Care Op onal Life
Paid Leave ‐ Coverage will con nue while in a paid status.
Unpaid Leave* ‐ You may elect to con nue coverage while in an unpaid status by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from start of unpaid leave status, coverage will terminate effec ve the end of the month in which unpaid leave began or last premium was paid. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
*Employees on Long Term Illness or Ac ve Military leave of absence, should contact the CBO for detailed informa on.
Health
Care
FSA
Private
Insurance
FSA
Paid Leave ‐ Coverage will con nue while in a paid status.
Unpaid Leave ‐ You may elect to con nue coverage while in an unpaid status by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from start of unpaid leave status, coverage will terminate effec ve the end of the month in which unpaid leave began or last premium was paid. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
FSA Claims ‐ must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.
Dependent
Care
FSA
Par cipa on in the plan will terminate (you must be ac vely working for par cipa on in the plan) at the end of the month in which leave begins. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.FSA Claims ‐ Claims must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.
Dependent Care FSA (Ac ve Military Leave)
You may elect to con nue coverage while in ac ve Military leave by direct payment to the CBO. If con nua on of coverage is not elected or premiums are not submi ed within 90 days from the start of leave, coverage will terminate effec ve the end of the month from the date ac ve Military leave began or last premium was paid. You may re‐elect coverage by submi ng an enrollment form within 30 calendar days following return to work date.
FSA Claims ‐ Claims must be received by WageWorks by the end of the month following 90 calendar days a er your coverage end date.
Wellness & Preven on Certain benefits require enrollment in our health plan. Please refer to your Wellness Guide for details. The Wellness Guide is also available on the Wellness & Preven on Intranet site.
Basic
Life
Insurance
Op onal
Life
Insurance
Coverage will con nue while on an approved leave of absence for a maximum of 24 months.
Tax Sheltered Accounts
Deferred Compensa on
Paid Leave ‐ Deduc ons will automa cally con nue while in a paid status. Unpaid Leave ‐ Deduc ons will stop once you are in an unpaid status and will automa cally resume upon return to a paid status.
VRS
VRS service credit will not accrue during unpaid leave status. However, if your unpaid status begins on the 18th of the month or a er you will receive credit for the first month of
Healthy Living Protec ng your loved ones…
and your income
Take Control of your Future Balancing Life
BENEFITS
AT
‐
A
‐
GLANCE
Health, Preventive Vision, Prescription Point of Service (POS) High Deduc ble Health Plan (HDHP) with Health Savings Account (HSA) Preven ve Vision ‐ EyeMed Vision Care Prescrip on Drug Coverage and Mail Oder Prescrip on Services Sentara MDLIVE Dental Plans MetLife Gold MetLife Silver
Health Care Flexible Spending Account (FSA)
VBWellnessforLife Wellness & Prevention
Disease Management Paren ng Preparedness Fitness & Weight Management Screenings & Health Services Tobacco Cessa on Health Coaching (Healthyroads®)
Long Term Disability (LTD) Long Term Care (LTC) Life Insurance Basic Life Insurance Op onal Life Insurance Savings Plans 457 Deferred Compensa on 403(b) Tax Sheltered Accounts Retirement Virginia Re rement System (VRS)
Dependent Care Flexible Spending Account (FSA) Private Insurance Flexible Spending Account (FSA) Employee Assistance Program (EAP)
Legal Services
The City of Virginia Beach and Virginia Beach City Public Schools is committed to assisting employees in maintaining a healthy, productive lifestyle for themselves and their families. We are proud to offer employees a wide array of benefits so that employees can take advantage of a variety of benefits and opportunities that will add value and quality to their work life balance. The following are the Benefits At-A-Glance for services available during 2014. Detailed information on each benefit can be found in this Employee Benefits Handbook or by visiting the CBO Intranet site.
HEALTH PLANS
Health Plan Choices
The Op ma Health Point of Service (POS) Plan provides characteris cs of both an HMO plan and a PPO plan
with the op on to seek services within the Op ma network, Private Healthcare System (PHCS) Network, or
out‐of‐network. Most services require a copayment.
POS
The Equity High Deduc ble Health Plan (HDHP) allows you to use physician services
in‐network and out‐of‐network. You pay lower premiums than other health plans;
however, there is a higher deduc ble that you must meet before the plan begins to pay.
Most services require a coinsurance payment. A Health Savings Account (HSA) is a tax‐advantaged savings
and spending account that can be used for building health savings or pay for qualified out‐of‐pocket health
care expenses, now, or in the future. The HSA can be funded by pre‐tax employee contribu ons from you
and your employer. With Equity HDHP enrollment you will receive a $500 annual employer contribu on
(prorated semi‐monthly).
Equity HDHP
w/HSA
Networks
- you have the option to receive services from any of the following networks:
Op ma Network
‐
The Op ma Network benefit op on provides the lowest out‐of‐pocket costs by seeing a Planprimary care physician, specialist, therapist, and other healthcare professionals who have met all of Op ma Health’s creden aling requirements, and are part of the Op ma Health Plan Provider Network.
PHCS Network
‐
The Private Healthcare System (PHCS) Network gives you the op on to receive your health care fromthe extended out‐of‐area PHCS Provider Network. By using a PHCS network provider, your out‐of‐pocket costs will be slightly higher. This network is only available while you are outside of the Op ma Network area.
Out‐of‐Network
‐
If you choose to use your Out‐of‐Network benefit op on, it means you and your covered familymembers can select the doctor or medical facility you want for most covered services, regardless of whether or not they are Plan providers. Remember your out‐of‐pocket costs will be higher
when
you
use
out
‐
of
‐
network
bene
fi
ts.
Annual Deductible
Op ma Network: $300 individual, $600 family
PHCS Network: $600 individual, $1,000 family
Out‐of‐Network: $1,000 individual, $2,000 family
The annual network deduc ble must be met before the plan begins to pay, with the excep on of:
Op ma network and PHCS network Preven ve Care as outlined in the summary of benefits on page 18.
Primary Care Physician (PCP) Visits
Specialist Office Visits
Urgent Care Services
Sentara MDLIVE
Note: There are separate deduc bles for Op ma network, PHCS
network and out‐of‐network coverage. The plan will begin to pay a er an individual meets their deduc ble or once the family deduc ble is met.
Plan Advantages
Networks ‐ More choices and freedom to choose. You
have the op on to seek services from any provider, in‐network, PHCS network and/or out‐of‐network.
Preven ve Care is covered at 100% with the excep on of
out‐of‐network coverage. No copayment/coinsurance. . . no deduc ble.
Removal of Deduc ble for Office Visits ‐ An enhanced
feature for 2014 allows you to receive services for primary care physician (PCP) visits, specialist office visits, urgent care services and Sentara MDLIVE without having to meet a deduc ble. You will only be responsible for the applicable copayment/coinsurance.
Plan Requirements
The POS plan recommends you choose an Op ma network primary care physician (PCP) to coordinate your
The following pages summarize the Point of Service (POS) and the Equity HDHP w/HSA. Please review the informa on carefully before making your health plan selec on.
Health Plan
Networks
- you have the option to receive services from any of the following networks:
In‐Network
‐
The Op ma Network benefit op on means you can lower your out‐of‐pocket costs by seeing a Planprimary care physician, specialist, therapist, and other healthcare professionals who have met all of Op ma Health’s creden aling requirements, and are part of the Op ma Provider Network. The in‐network level of coverage includes providers in the Private Healthcare System (PHCS) Network
.
The PHCS Network gives you the op on to receive your health care from the extended out‐of‐area PHCS Provider Network. By using a PHCS network provider, your
out‐of‐pocket costs will be the same level as in‐network coverage. This network is available while you are outside the Op ma network.
Out‐of‐Network
‐
If you choose to use your Out‐of‐Network benefit op on, it means you and your covered familymembers can select the doctor or medical facility you want for most covered services, regardless of whether or not they are Plan providers. Remember your out‐of‐pocket costs will be higher
when
you
use
out
‐
of
‐
network
bene
fi
ts.
Annual Deductible
In‐Network/PHCS Network: $1,250 individual,
$2,500 family
Out‐of‐Network: $1,250 individual, $2,500 family
The annual network deduc ble must be met before the plan begins to pay, with the excep on of
in‐network/PHCS network Preven ve Care as outlined in the summary of benefits on page 18.
Note: There are separate deduc bles for in‐network/PHCS
network and out‐of‐network coverage. If you are enrolled in individual coverage you must sa sfy the individual member coverage deduc ble before the plan begins to pay. For any other level of coverage you must meet the family coverage deduc ble before the plan begins to pay.
Plan Advantages
Affordability ‐ Lower health care premiums
Networks ‐ You have the op on to seek services from
any provider you choose, both in‐network, and out‐of‐network.
Preven ve Care is covered at 100% with the excep on
of out‐of‐network coverage.
Savings Opportuni es ‐ You have the op on to take
the money you once spent on higher premiums and put it into a Health Savings Account (HSA) where you can grow your money without taxa on.
Plan Requirements
To be eligible to enroll in the Op ma Equity HDHP plan, the following eligibility criteria MUST be met:
Employee/re ree: Must be enrolled in the Op ma
Equity HDHP to be eligible for an HSA.
Employee/re ree and any enrolled members:
Cannot be covered by any other health plan
coverage including: Group health coverage,
individual health coverage, including coverage through spouse’s plan or eligible for Tricare, Medicare or Medicaid in order to be eligible for the HSA and the Op ma Equity HDHP.
Cannot be claimed as a dependent on another
individuals’ tax return (other than married
couples filing a joint tax return).
Cannot be enrolled in a Flexible Spending
Account (FSA), even if the enrolled member’s
spouse or dependent is receiving coverage under another employer’s plan.
Cannot be enrolled in a Health
Reimbursement Arrangement (HRA), even if
the enrolled member’s spouse or dependent is receiving coverage under another employer’s plan.
Cannot have received Veterans
Administra on (VA) medical benefits at any
me over the past three months prior to enrollment in the Equity HDHP to be eligible for an HSA.
Health Plan
Option 2
Equity High Deductible Health Plan w/HSA
What is a Health Savings Account (HSA)?
An HSA is a tax‐free savings account that works with a qualified health plan (Equity HDHP) to help you pay your insurance deduc ble and qualified out‐of‐pocket health care expenses.
You might consider taking the money you would have paid for higher health insurance premiums and use it to pay qualified health care expenses or save it and let it grow from year to year.
Plan Advantages
Savings
Receive an annual $500 HSA pre‐tax employer
contribu on (prorated semi‐monthly)
Contribute your own tax‐free dollars to your HSA
with pre‐tax employee contribu ons
Save money in your HSA for future qualified medical
expenses
Grow your money through op onal investment
accounts (a er balance exceeds $2,000)
Ownership
The HSA account belongs to you, not your employer
Funds remain in your account from year to year, no
“use it or lose it” penalty, and the account is portable . . . meaning it stays with you, even if you change employment or re re, change health plans, become unemployed, or move to another state.
Triple Tax Savings
Contribu ons from your employer, plus the amount
you elect, are tax free
Withdrawals for qualified medical expenses are tax
free
Earnings from investments are tax free
Note: A er age 65 there is no penalty for any distribu on, and
distribu ons for medical expenses (including Medicare premiums) are s ll tax free!
What are the Tax-Deductible Contribution Limits?
HealthEquity® is the financial custodian for the HSA
HSA Account Benefits include:
Account set‐up, with unlimited transac ons
HealthEquity® Visa® Health Account Card
24/7/365 Support
Investment op ons with no transac on fees
PayChoice™ online bill pay tool
Mobile AppNote: A er enrollment you will receive a welcome kit and a
HealthEquity® Visa® Health Account Card within 7‐10 business days a er the CBO receives and process your enrollment.
HSA Enrollment Tips
The plan requirements listed on the previous page
MUST be met to be eligible to enroll in the Equity
HDHP w/HSA.
The HSA elec on form is required annually and upon ini al enrollment in the Equity HDHP.
More Information
HealthEquity Customer Service: 266.346.5800 www.Healthequity.com
CBO Intranet site CBO 757.263.1060 Level of Coverage 2014 IRS Contribu on Limit1 55+ Age Catch‐up Contribu on2
Single Subscriber (employee/re ree only
coverage)
$3,3001 $1,000
Family Coverage (two person or family) $6,5501 $1,000
The Health Savings Account (HSA)
To locate a par cipa ng EyeMed provider visit:
www.op mahealth.com or EyeMed Customer Services at:
866.939.3633.
You can manage your account, check claims and more by
visi ng: www.eyemedvisioncare.com.
Other Discounts and Programs - “Saving More”
Op ma Health plan members receive special discounts of the
following: hearing care, massage therapy, acupuncture,
chiroprac c care, laser vision correc on, health and fitness.
For more informa on visit:
ASHN Member Services: 877.327.2746 or op mahealth.com
Disease Management Programs
provide members
diagnosed with a chronic condi on such as diabetes,
respiratory, and cardiovascular disease, the educa on,
support and resources required to maintain a healthy
lifestyle.
Members mee ng the program’s criteria may be eligible to
receive Financial incen ves through the W&P Program*.
*See page 46 for more informa on on the W&P Program.
AccordantCare™ Program
offers disease managementand case management services for people with rare chronic
condi ons. Members eligible for the program are offered
services at no cost to them. This is a specialized program to
help people manage their rare chronic illness. These
condi ons and their associated complica ons are managed
by registered nurses. The program is designed to improve the
quality of life for those who are ill, their families and
caregivers, while reducing overall health care costs.
For more informa on visit www.accordant.com.
EyeMed Vision Care
Op ma Health members receive preven ve vision care
services (i.e. eye examina on, refrac on, lenses, frames,
or contact lenses) from a par cipa ng EyeMed provider.
POS Equity HDHP $10 copay
(one exam every 12 months) $15 copay (one exam every 24 months)
Lenses covered in full Frames covered in full up to $100 retail Discount on eyeglasses & frames Covered in full up to $95 retail (in lieu of
glasses) Discount on contacts Service Spectacle Exam Eyeglasses Contact Lenses Contact Exam $40 copay
(one exam every 12 months) $40 copay (one exam every 24 months)
Healthyroads
®Wellness & Preven on has partnered with Healthyroads®
to offer confiden al, professional health coaching services.
Healthyroads® provides a comprehensive telephone‐based
health coaching program with award winning online tools.
Your health coach will help you set and meet your goals.
You will be able to design personal meal and exercise
programs, measure your progress with online trackers, and
have 24/7 access to health informa on. Health coaching is
not a punishment. It is a way for you to become a healthier
you!
Visit page 47 for more informa on about Healthyroads®.
Catamaran Home Delivery for prescription
medications
Catamaran Home Delivery service is a
convenient and cost‐effec ve way for you to
order up to a 90‐day supply of maintenance or
long‐term medica on for delivery to your
home, office or loca on of your choosing. You
will minimize trips to the pharmacy and save money on
your prescrip ons.
For more informa on visit: www.mycatamaranrx.com or
contact Catamaran Member Services at 866.244.9113.
BriovaRX™ Specialty Pharmacy Services
Managing a chronic condi on or serious illness is
challenging, and o en requires complex medica on and
careful coordina on of therapies. BriovaRX takes a
hands‐on approach to managing your condi on and
treatment, so you can expect:
Convenient Home delivery for specialty medica ons,
such as injectables. BriovaRX will ship them directly to
your home or office (temperature controlled, if
necessary).
Comprehensive and consistent pa ent management
tailored to your specific requirements.
24/7 Support ‐ You will have access to speak with a
clinician 24 hours a day 7 days a week.
Access to specialty medica on supplies at no addi onal
cost. These are medica ons that are not rou nely in
stock at retail pharmacies and frequently must be
ordered so there will be minimal disrup on, if any.
If you require specialty medica on or supplies, your doctor
will help you get started with BriovaRX.
If you have any ques ons, please contact Op ma Health
Member Services at: 757.687.6141 or 866.509.7567.
Included with your Optima Plan:
View and compare Op ma Health Plan Summaries on
the following pages for detailed plan informa on,
covered services, copays, deduc bles, limita ons and
other very important informa on. The Plan documents
governing these health plans are available on the CBO
Intranet site.
Plan Member Cards
You
will
receive
your
Op ma
Health
member
card
within
7
‐
10
business
days
a er
the
CBO
receives
and
processes
your
enrollment
and
on
an
annual
basis
at
the
beginning
of
each
plan
year.
Equity
HDHP
members
will
receive
a
Welcome
Kit
and
their
HSA
Visa®
card
within
7
‐
10
business
days
a er
the
CBO
receives
and
processes
the
enrollment.
Health Plan Termination and Changes in
Coverage
May elect to terminate/change coverage during open enrollment or within 30 calendar days following a qualifying life event
Coverage will end at the end of the month in which the termina on/re rement occurs or December 31st if canceled during open enrollment
Coverage will end on August 31st for School employees with a termina on/re rement date of June, July or August.
VB
Wellness
for
Life
‐ See page 47 to learn how you can save $500 annually on your health care premiums.
More Information
Detailed plan informa on for POS and Equity HDHP are provided in your new hire packet and on the CBO Intranet site.
POS and Equity HDHP Benefit Informa on Guides
(provided in your new hire packet and on CBO Intranet site)
www.Op maHealth.com ‐ Locate an Op ma network or PHCS network provider, view/print claims, deduc bles and out‐of‐pocket expenses, pharmacy tools and benefits resources and more.
Op ma Health Member Services: 757.687.6141 or 866.509.7567
Locate an Op ma Network or PHCS Network
NEW FOR 2014 . . . Sentara MDLIVE
The Doctor is Always In™
Get 24/7/365 Access to Board‐Cer fied doctors any me,
anywhere.
Online Video ‐ See a doctor using your computerover the Internet.
Phone Call ‐ No webcam? No problem! Talk to adoctor over the phone!
Secure E‐mail Advice ‐ Ask ques ons and get adviceprivately using secure e‐mail.
What can be treated by Sentara MDLIVE?
Pediatric Care Acne Allergies Asthma Bronchi s Celluli s Cold & Flu Cons pa on Diarrhea Ear Infec on Fever Gout Headache Infec ons Insect Bites Joint Aches Nausea & Vomi ng Pink EyePoison Ivy
Rashes
Respiratory Infec ons Sinus
Infec ons Skin Inflamma on Smoking Addic on Sports Injuries
Cold & Flu Cons pa on Ear Infec on Fever Mood Swings Nausea & Vomi ng And more . . . General Health
When to use Sentara MDLIVE
If you’re considering the emergency room or urgent care center for a non‐emergency medical issue When your primary care physician (PCP) is not
available
Need to request prescrip ons or get refills*
Traveling and in need of medical care
During or a er normal business hours, nights, weekends, and even holidays
*prescrip ons are issued only when clinically appropriate. No controlled
substances may be prescribed, and the availability may be restricted by
law.
How to get Started?
Go to www.mdlive.com/op ma or call 866.648.3638
Have your Op ma Health member ID number available to register. Please note that you’ll need to create an account for each covered member of your family over the age of two.
When you want to see a doctor, you can go online to request immediate access to a provider on‐call via phone or schedule a me at your convenience. You can also get conne