Medical

Medicare Part D Notification 

The Medicare Part D notice is required to be sent out by October 15th of each year. This notice has information about your current prescription drug coverage with the District and your options under Medicare's prescription drug coverage.

To learn more information about Medicare prescription drug coverage, visit the Medicare website.

Medical Plan (Aetna)

The District is self-insured for medical insurance and uses Aetna Insurance Company as a Third-Party Administrator, to utilize their network of providers, to administer benefits and to process claims. The District offers three Plans, Plan 9520, Plan 7419, and a High Deductible Health Plan (HDHP) to choose from, to best meet the needs of its employees and/ or their dependents. All regular employees working at least 30 hours per week are eligible to employee only medical insurance. The District gives every eligible employee flex credit to apply towards their medical insurance. That amount is $306.70 per paycheck or $7,360.80 annually.

PLEASE NOTE: If you are also enrolled/ covered in any other medical coverage including Medicare in addition to one of the District's medical plans, the District will be your PRIMARY carrier while you are an active employee. It is a Federal Law that the employer's coverage is the Primary coverage.

Also, if you are enrolled/ covered in any other medical coverage and are thinking about enrolling in the High Deductible Health Plan (HDHP) with a Health Savings Account, (HSA), PLEASE read the HSA eligibility rules listed below.

For more information, please watch the video below.

Dependent Eligibility

Spouse: Legally married;

Children: Employee's natural, newborn, adopted, foster, step child(ren), or a child for whom the Covered Employee has been court-appointed as legal guardian or legal custodian, may be covered until the end of the calendar year in which he/ she turns 26 years of age with NO Criteria, such as dependent marital status, student status, financial dependency on the Covered Employee, etc.

Employees receive $306.70 in Flex Credits each pay period to apply toward the purchase of Medical, Dental, Vision, Cancer, Accident, and Critical Illness Insurance Benefits, the Core Health Benefits. Keep in mind, to subtract $306.70 from the premium for Plans 9520 and 7419; $229.20 from High Deductible Health Plan (HDHP) for the actual premium employees will pay per paycheck.

For the High Deductible Health Plan (HDHP), a Health Savings Account (HSA) is tied to this plan to help offset the plan year deductible. The Board still contributes $306.70 to the employee, however, the excess remaining after deducting the cost of the medical insurance does not go towards voluntary benefits like dental, vision, cancer, accident and critical illness, or dependent premiums. The excess amount of $77.50 will be placed in a Health Savings Account (HSA), or a total amount of $1,860.00 annually. Therefore, $229.20 of the $306.70 Board Contribution is applied to High Deductible Health Plan (HDHP) premiums and the remaining $77.50 is applied to the Health Savings Account (HSA).

The Board Paid Flex of $306.70 per paycheck pays in full the premium of the 7419 and High Deductible Health Plan at the employee only tier. The 9520 Plan is a buy-up plan, costing an additional $13.00 per paycheck above the Board Contribution amount of $306.70 at the employee only tier.

To Learn more about a Health Savings Account, review this website: https://www.connectyourcare.com/m/leeschools/hsa-education/

Additional information can be found here: Your Complete 2020 Guide to the Health Savings Account.

The premiums are per paycheck and are deducted twice a month, the 15th and the last day of the month.

Aetna Medical Plan Premiums (April 1, 2020 through March 31, 2021) (rates are per paycheck):

You will receive $306.70 in Flex Credits each pay period to apply toward the purchase of the following Medical. All premiums are per paycheck and are deducted twice a month, the 15th and the last day of the month.

Plan 9520 (Tiers and Premiums) (Insurance Premiums listed are per paycheck)

Employee Only Full Rate: $319.70; Employee Share $13.00
Employee/ Spouse Full Rate: $765.30; Employee Share $458.60
Employee/ Child Full Rate: $477.15; Employee Share $170.45
Employee/ Children Full Rate: $666.60; Employee Share $359.90
Employee/ Family Full Rate: $963.10; Employee Share $656.40

Plan 7419 (Tiers and Premiums) (Insurance Premiums listed are per paycheck)


Employee Only Full Rate: $306.70; Employee Share $0.00
Employee/ Spouse Full Rate: $732.80; Employee Share $426.10
Employee/ Child Full Rate: $457.25; Employee Share $150.55
Employee/ Children Full Rate: $638.40; Employee Share $331.70
Employee/ Family Full Rate: $921.90; Employee Share $615.20

High Deductible Health Plan (HDHP) with Health Savings Account (HSA)* (Insurance Premiums listed are per paycheck)

Employee Only Full Rate: $229.20; Employee Share $0.00
Employee/ Spouse Full Rate: $611.40; Employee Share $382.40
Employee/ Child Full Rate: $364.30; Employee Share $135.10
Employee/ Children Full Rate: $526.95; Employee Share $297.75
Employee/ Family Full Rate: $781.35; Employee Share $552.15

ATTENTION 20 PAY EMPLOYEES

PLEASE NOTE: The premiums listed above are based on 24 pay periods. Employee who receive 20 paychecks, 186-day work schedule, will pay the rates listed above with an additional 20% Employee Pre-Pay which will be applied toward summer coverage.

Medical Plan Details

Teladoc and CVS MinuteClinics

Teledoc:

24/7/365 access to United States Board Certified doctors available through phone or video consults. 

$10 copay for the Plan 9520 and Plan 7419;

$40 copay for High Deductible Health Plan until deductible is met, then 20% of the full price until out-of-pocket maximum is met.

Behavioral Health Teledoc will also be offered to adults 18 and older for anxiety, depression, grief, family issues, and more. Make your selection to choose a psychiatrist, psychologist, social worker, or therapist via web, phone, or app. School District of Lee County will absorb visit costs so there is a $0 copay for all three Medical Plans for employees.

To Learn more, log into the Teledoc Health Web Page.

CVS MinuteClinic:

Hours: Monday through Friday 8:30 am - 1:30 pm; 2:30 pm - 7:30 pm
Saturday 9 am - 1:30 pm; 2 pm - 5:30 pm
Sunday 9 am - 1:30 pm; 2 pm - 4:30 pm

$0 copay for 7419 and 9520 Plans;

Full Price for High Deductible Health Plan until deductible is met, then 20% of the full price until out-of-pocket maximum is met.

Important information:

Clinic closing times may vary due to the number of patients waiting to be seen. Additional patients may not be able to sign in when the wait time extends past the posted clinic closing time. In addition to diagnosing and treating illnesses, injuries and skin conditions, they provide wellness services including vaccinations, physicals, screenings and monitoring for chronic conditions. Services are for both adults and children 18 months and over.

To Learn more about the CVS MinuteClinic locations and hours of operation, please log into their website.

Quest Diagnostics and LabCorp

Quest Diagnostics and LabCorp are Aetna’s in-network lab service providers. To learn more and to find locations and office hours, review the websites for Quest Diagnostics and LabCorp.

Frequently Asked Questions About Medical Insurance

What is an Health Savings Account (HSA)?

A Health Savings Account (HSA) is like an Flexible Spending Account (FSA) as far as eligible expenses. The same eligible expenses for FSA apply to an HSA.

There are a few differences, however:

  • Unlike an FSA, the money in your HSA account is yours. It can increase every year as there is no "USE IT or LOSE IT" rule. You can take the funds with you when you retire or terminate employment. Your money keeps accruing.
  • You must be under the age of 64 to enroll as you cannot contribute to an HSA if you are 65 years old. Once you turn 65 years old, you can use the money in your account to pay for insurance premiums.

To be eligible for an HSA, you:

  • MUST be covered under a high deductible health plan;
  • MUST have no other health coverage;
  • MUST be 63 or younger to enroll;
  • MUST NOT be enrolled in Medicare, employee or dependents;
  • MUST NOT be claimed as a dependent on someone else's tax return;
  • MUST NOT have a standard, or full purpose Flexible Spending Account (FSA) or Health Reimbursement Account (HRA); AND your spouse MUST NOT have a full purpose Flexible Spending Account.

HSA funds are on a calendar year basis per the Internal Revenue Service (IRS), however, our plan is on a benefit year (4/1 to 3/31). It is important that your contributions do not exceed the maximum allowed per calendar year. With an HSA, you are able to adjust your contributions throughout the year.

Health Savings Account (HSA) (Connect Your Care):

2020 Maximum contribution, increased by Internal Revenue Service (IRS):

Individual: Employee only: $3550 per CALENDAR YEAR $3,550 max minus the $1,860 Board Contribution equals up to $1,690 Employee Contribution;

Family: Employee & dependents: $7100 per CALENDAR YEAR $7,100 max minus $1,860 Board Contribution equals up to $5,240 Employee Contribution.

The Board contributes $1,860.00 annually from the Board Paid Flex credit. Please review your contributions on a regular basis so that you do not exceed the calendar year maximum allowed.

How can I waive Medical Insurance?

An employee may elect to waive the medical insurance provided that proof of other group coverage is given, for example with a copy of Insurance Identification card. The District will then provide $25 per paycheck towards the purchase of certain voluntary benefits. Only dental, vision, cancer, accident and critical illness insurance are eligible to be purchased. It cannot be received as additional compensation. This option is only allowed:

  • As a New Hire, within 30 days of hire date;
  • During the District's Annual Open Enrollment Period; OR
  • As a Qualifying Event, within 60 days of obtaining new coverage to drop or waive the District's plan.

What are the coverage Effective Dates?

For new employees and their dependents: medical insurance will be effective the first of the month following a 45-day waiting period. Open Enrollment elections and changes made in February are not effective until April 1.

Qualifying Events, outside Open Enrollment: medical insurance will be effective the first of the month following the event date, except for birth/ adoption which is the date of birth or adoption/ placement. See Adding Newborn information below.

Will I need a referral?

With these plans, no referrals are required from a Primary Care Physician (PCP) to see a Specialist. However, it is the responsibility of the employee/ patient to make sure the provider is in network. For the 9520 Plan, we utilize the Aetna Select Open Access Network; for the 7419 Plan and the High Deductible Health Plan (HDHP), we utilize the Choice POS II Open Access Plan.

How do I locate a Provider?

The most up-to-date way to find out if a provider is in the network, is to use the Aetna Website. However, when making your appointments, you should always verify with the providers that they are on either the Aetna Select Open Access Network for Plan 9520 or the Aetna Choice POS II Network for Plan 7419 and the High Deductible Health Plan (HDHP).

After logging into the Aetna Website, follow these instructions:

At the top of page click on “Find a Doctor”;

In the “Guests” box, click on ”Plan from an employer”;

In the “Continue as a Guest’” box, enter City or Zip Code of area wanted. Click on City to select and then click “Search”;

The most important part is to select the correct plan. Scroll down to the “Aetna Open Access Plans”;

You will want to either select:

Aetna Choice POS II Open Access for the 7419 & HDHP Plan

OR

Aetna Select Open Access for the 9520 Plan.

Click “Continue” at the top of that box;

Here you will either type in a providers specific name or click on one of the boxes to find a list of “Providers per category”.

A list will be produced for you to choose from.

How do I add my newborn?

Coverage for newborns is NOT automatic. You must physically enroll your newborn by completing two forms and providing proof of birth. Please contact the Insurance and Benefits Management Department at 239.337.8321, to obtain the forms required.

You have 60 days from the date of birth to physically add your newborn to your medical plan. If you complete the required paperwork within 30 days after the birth, no premium will be charged for the first 30 days of life. If the required paperwork is completed between the 31st and the 60th day after birth, you will be charged the applicable premium for your child from the date of birth. In the event you do not complete the required paperwork to add your newborn within 60 days of the birth of your newborn child, you will not be able to add your newborn until the District's annual Open Enrollment Period. The effective date then would be April 1st of that year.

The Effective Date of coverage for a newborn child shall be the date of birth.

Maternity Leave / Workers' Comp Leave / FMLA Questions

When going on a leave of absence, we would suggest that you contact 239.337.8153 in the Staffing and Talent Management Department to inquire about the FMLA (Family Medical Leave Act). FMLA can assist you with your medical premiums for a limited amount of time, if you are eligible. There is paperwork that you must complete in a timely manner.

Visit our Leave of Absence page for information on Leave of absence. For Insurance billing questions while on FMLA please contact the Insurance & Benefits Management Department, Alma Jones, Employee Benefits Billing, at 239.337.8317 or email almajo@leeschools.net.

How does my prescription coverage work?

The District's prescription drug plan includes Mandatory Generics when available and a Mandatory Mail Order for maintenance drugs. Maintenance drugs are prescribed to be taken on a long term basis to treat an existing medical condition. There are two ways to access maintenance medication; through the CVS Caremark Mail Order Pharmacy or retail at your local CVS Pharmacy. For your non-maintenance medication you may utilize the other in-network pharmacies such as Publix, Walgreens, Walmart and Target.