DeSoto County

Supervisor of Election

Benefits at a Glance Booklet

Plan Year:

October 1, 2016—September 30, 2017

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Introduction

The DeSoto County Board of County Commissioners is committed to providing its employees with a

comprehensive benefits program to help you stay healthy and feel secure. This booklet will describe

those benefits which include medical, dental, vision, life and AD&D insurance.

Full time employees are eligible for benefits on the 1st day of the month following 30 days of full time

employment. The County pays 100% of the employee premium and 50% of the dependent premium for

medical coverage. The County also pays 100% of the premium for basic life and AD&D insurance. Em-

ployees may purchase dental, vision, and voluntary life insurance for themselves and their dependents

through payroll deduction.

In order to get the most out of your plans you should seek care at an in network provider. These

providers have agreed to discount their prices, so you will pay less out of pocket. You can locate an in

network provider by accessing the carrier’s website listed in the back of this booklet.

The Benefit at a Glance Booklet is a high level overview of the County’s employee benefits pro-

gram. For a detailed description of benefits, exclusions, and limitations please refer to the applica-

ble Certificates of Coverage.

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Dependent Eligibility Overage dependents will automatically terminate on the plan, and no further action is required on

the employee’s part. If your overage dependents meets the extended eligibility requirements,

please provide supporting documentation to Human Resources. If you have an overage dependent

that is disabled, and you would like to continue coverage with the plan, please contact Human

Resources for the additional information. Medical

To age 26 with no eligibility requirements

26 to the end of the calendar year in which they turn 30 if they are:

Unmarried with no dependents

Not enrolled in any other health plan

Florida resident or a full time student

Dental

Through the end of the calendar year in which they turn 25

Vision

Through the end of the calendar year in which they turn 26

Life

From live birth through age 20 (through age 24 if a registered student in full time attendance

at an accredited educational institution).

Qualifying Events

The premiums you pay toward yours and your dependents’ coverage may be deducted from your pay

check pre-tax through an IRS Section 125 Plan. Pre-tax coverage elections made at Open Enrollment

cannot be changed until the next annual Open Enrollment period. The only exception to this IRS Section

125 Rule is if you experience a “Qualifying Event.” A Qualifying Event allows you to make a change to

your benefit elections within 30 days of the Event.

Examples of Qualifying Events include:

Marriage

Birth, adoption, or legal custody of a dependent child

Divorce or legal separation

Involuntary loss of other group coverage

Death

***If you experience a Qualifying Event, you must contact Human Resources within 30 days to

change your benefit elections.

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Important Tax Information

Starting in January 2016 you will receive 2 additional employee state-

ments along with your W-2 form:

The first statement is a 1095-B and will be provided by the insur-

ance carrier. This statement will be used by you when preparing

your own individual tax return to confirm you are enrolled in mini-

mum essential coverage and therefore, will not be subject to the in-

dividual mandate penalty under the Affordable Care Act.

The second statement is a 1095-C and will be provided by the em-

ployer. This statement will advise whether you were offered group

health coverage that was affordable (generally costing not more

than 9.5% of your pay for single employee medical coverage) and

of minimum value (covering at least 60% of your benefits), and

whether you enrolled in coverage. The second statement is used to

determine if you are eligible for a premium tax credit for coverage

on the exchange (the Marketplace) in the event you would choose

to get coverage there rather than through your employer.

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Medical Insurance

Healthcare Service Choice Plus Legacy Plan AHL1

In Network Out of Network

Deductible $500 / $1,500 Family $750 / $2,250 Family

Coinsurance (Member Responsibility) 20% 40%

Out of Pocket Max $2,500 / $5,000 Family $3,000 / $9,000 Family

Primary Care Visit $15 40% after Ded.

Specialist Visit $15 40% after Ded.

Wellness Visits $0

Certain services are covered

when using a non-network

provider. Please see certifi-

cate of coverage for more

information.

Lab work (LABCORP) $0 40% after Ded.

X-Ray $0 40% after Ded.

MRI, CAT, PET Scan (at Diagnostic

Testing Facility) $50 40% after Ded.

Urgent Care $35 40% after Ded.

Emergency Room $100 $100

Inpatient Hospital 20% after Ded. 40% after Ded.

Outpatient Surgery 20% after Ded. 40% after Ded.

Durable Medical Equipment 20% after Ded. 40% after Ded.

Prescription—30 day Retail $10 / $30 / $50 $10 / $30 / $50

Prescription—90 day Mail Order $25 / $75 / $125 Not Covered

Medical

Monthly Cost Employer Cost Per Month Employee Cost Per Month

Employee Only $735.46 $735.46 $0.00

Employee + Spouse $1363.53 $1049.50 $314.03

Employee + Child(ren) $1303.82 $1019.72 $284.25

Family $1487.82 $1111.64 $376.18

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HEY!

Did you know…

Feel good about $4 generics*!!! Hundreds are available. Walmart offers a wide range of generics to help treat a variety of health related con-

cerns. They are just as effective as their brand-name equivalents, but are available at a

much lower cost—just $4 for a 30-day supply, or $10 for 90 days. To view the list of pre-

scriptions, visit your local Walmart pharmacy or website www.walmart.com/pharmacy

Free Prescriptions! Bring any of the prescriptions listed below to your neighborhood Publix Pharmacy to

receive the medication for FREE!

14-day supply of:

Amoxicillin *Ciprofloxacin Ampicillin

Penicillin VK Sulfamethoxazole/Trimethoprim (SMZ-TMP)

90 day supply of:

*Amlodipine (up to 180 2.5-mg or 5-mg tablets, or 90 10-mg tablets) *Lisinopril

*Metformin (360 tablets of 500-mg, 270 tablets of 850-mg or 225 tablets of 1000-

mg) *Some restrictions and/or exclusions may apply

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Dental Insurance

Dental—Low Plan

Employee Cost Per Pay Period

Employee Only $24.44

Employee + Spouse $50.52

Employee + Child(ren) $65.72

Family $91.68

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Dental Insurance

Dental—High Plan

Employee Cost Per Pay Period

Employee Only $30.00

Employee + Spouse $62.00

Employee + Child(ren) $83.28

Family $115.24

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Dental Insurance

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Vision Plan

Employee Cost Per Pay Period

Employee Only $4.70

Employee + Spouse $8.92

Employee + Child(ren) $9.39

Family $13.80

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Life and AD&D

Basic Life and AD&D

The DeSoto County Board of County Commissioners pays 100% of the premium for your Basic Life and

Accident Death and Dismemberment coverage. Your Basic Life coverage amount is 1 times your annual

earnings to a maximum of $200,000. For a covered accidental loss of life, your Basic AD&D coverage

amount is equal to your Basic Life coverage amount (1 times your annual salary). For other covered

losses a percentage of this benefit will be payable. Please see your certificate of coverage for more infor-

mation.

Age Reductions: Basic Life and AD&D insurance coverage amounts reduce by 35% at age 65, by

50% at age 70, and by 65% at age 75.

You can update your beneficiary information in PlanSource @ benefits.plansource.com

Voluntary Additional Life Insurance

Employee Life Coverage: You may elect Additional Life insurance units of $10,000 up to a maxi-

mum of $300,000. If you wish to become insured for an amount of Additional Life in excess of

$100,000, the excess will be subject to medical underwriting approval.

Spouse Life Coverage: This coverage is available in units of $5,000 to a maximum of $150,000, but

not to exceed 100% of your additional life coverage. If you elect an amount for your spouse that is great-

er than $50,000, the excess will be subject to medical underwriting approval.

Age Reductions For Employee/Spouse: Voluntary Life insurance coverage amounts reduce by

35% at age 65, by 60% at age 70, and by 75% at age 75.

Child Life Coverage: You may elect $10,000 of Dependents Life insurance for your eligible chil-

dren.

**If you waive voluntary life during the initial enrollment period or decide to increase coverage in

the future, you will need to provide evidence of good health to The Standard so that they can de-

termine if you will be approved or denied for this coverage.

Employee’s Age (as of October 1)

Employee / Spouse Rate (per $1,000)

Under 29 $0.05

Age 30 - 34 $0.08

Age 35 - 39 $0.12

Age 40 - 44 $0.15

Age 45 - 49 $0.26

Age 50 - 54 $0.45

Age 55 - 59 $0.81

Age 60 - 64 $1.08

Age 65 - 69 $1.97

Age 70 - 74 $3.27

Age 75 + $12.85

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Extension of Dependent Coverage to Age 26

Individual whose coverage ended, or who were denied coverage (or were not eligible for coverage) be-cause the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the group medical plan. Individuals may request enrollment during the annual enrollment period for an effective date of December 1, 2010.

Genetic Information Non-Discrimination Act - GINA

GINA (Title II) contains requirements related to genetic nondiscrimination in health plan coverage. These requirements regulate group health plans, health insurance issuers offering health insurance coverage in the group and individual markets, non-federal governmental plans and issuers of Medicare supplemental policies.

In general, GINA prohibits group health plans and insurance issuers from:

Adjusting group premium or contribution amounts on the basis of genetic information;

Requesting or requiring individuals (or their family members) to undergo a genetic test (with limited exceptions such as for determinations regarding payment based on medical appropri-ateness); and

Collecting genetic information prior to or in connection with enrollment, or at any time for un-derwriting purposes.

Employers that want to obtain genetic information of employees in order to monitor the biological effects of exposure to toxic substances in the workplace must provide written notice to each affected employee of the genetic monitoring. The employee must authorize the monitoring, unless it is required by law. Addi-tional requirements apply to genetic monitoring.

Employers generally may not disclose an employee’s genetic information. Certain exceptions apply to this rule, including disclosure of genetic information in response to a court order or to public health agencies regarding contagious, life-threatening illness. Notice to the employee is required if the employer discloses genetic information for these purposes.

Health Insurance Marketplace Coverage

The Health Insurance Marketplace is available to assist you as you evaluate health insurance options for you and your family. The notice provides some basic information about the new Marketplace and employ-ment based health coverage offered by your employer.

The Marketplace is designed to help you find health insurance and compare private health insurance op-tions. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

Notice of Lifetime Limit

Effective, December 1, 2010, the lifetime limit on the dollar value of benefits under the group medical

plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the

plan are eligible to enroll in the plan. Individuals may request enrollment during the annual enrollment

period for an effective date of December 1, 2010.

Important Notices for Plan Participants

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Mental Health Parity and Addiction Equity Act 2008 (MHPAEA)

Under the MHPAEA, the financial requirements and treatment limits that group health plans and health insurance issuers apply to mental health or substance use disorder benefits generally cannot be more re-strictive than those applicable to medical and surgical benefits. If a plan covers mental health and sub-stance use disorder, MHPAEA provides medical and surgical benefits and mental health and substance use disorder benefits. MHPAEA it must comply with the federal parity requirements.

The MHPAEA contains the following parity requirements:

The financial requirements (such as deductibles, copayments, coinsurance and out-of-pocket limits) applicable to mental health and substance use disorder benefits cannot be more restric-tive than the predominant financial requirements applied to substantially all medical and sur-gical benefits.

Treatment limitations (such as frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of coverage) must also comply with the MHPAEA’s parity requirements. Non-quantitative treatment limitations (such as medical man-agement standards, formulary design and determinations of usual, customary or reasonable amounts) are subject to a separate parity requirement.

If medical and surgical benefits are offered on an out-of-network basis, a plan or issuer must also offer mental health and substance use disorder benefits on an out-of-network basis

Newborn’s Act

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Fed-eral law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applica-ble). In any case, plans and issuers may not, under Federal law, require that a provider obtain authoriza-tion from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Qualified Medical Child Support Order (QMCSO)

QMCSO is a judgment, decree, or order (including an approval of a property settlement) that is made pursuant to State domestic relations law (including a community property law) and/or certain other State laws relating to medical child support that provides for child support or health benefit coverage for a child of a participant under a group health plan and relates to benefits under the plan. Upon receipt of medical child support order, plan administrator must promptly issue notice, including plan’s procedures for determining its qualified status. Within a reasonable time after its receipt, plan administrator must also issue separate notice as to whether the medical child support order is qualified.

QMCSO is a medical child support order that:

Creates or recognizes the right of an alternate recipient to receive benefits for which a partici-pant or beneficiary is eligible under a group health plan or assigns to an alternate recipient the right of a participant or beneficiary to receive benefits under a group health plan; and

Is recognized by the group health plan as “qualified” because it includes information and meets other requirements of the QMCSO provisions..

Important Notices for Plan Participants

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Key Contact Information

Please refer to this list when you need to contact one of your benefits vendors. For general

information, contact your Human Resources Department.

Company Name Customer Service Website Address

Francene Marra

(386) 239-5769

Robin Riley

(386) 239-4051

www.bbpria.com

Medical

1-866-633-2446 www.myuhc.com

Dental

1-800-547-9515

Life

1-800-628-8600

www.standard.com

EyeMed Vision

888-203-7437

eyemedvisioncare.com

This Benefits at a Glance handbook is designed to provide basic information to employees on employee benefit

plans and programs available October 1, 2016—September 30, 2017 for the employees of DeSoto County Board

of County Commissioners. It does not detail all of the provisions, restrictions and exclusions of the various benefit

programs documented in the carrier contract or the Summary Plan Description (SPD). This booklet does not con-

stitute a SPD or Plan Document as defined by the Employee Retirement Income Security Act.