Medical

2018 Medicare Part D Notice

The above 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.

Medical Plans

The District is self-insured for the medical insurance and uses Aetna Insurance Company as a Third Party Administrator (TPA) to utilize their network of providers, to administer the benefits, and to process claims. The District offers four Plans (Plan 3769, Plan 5773, Plan 7419 and High Deductible Health Plan - HDHP) to choose from that best meet the needs of the employee and/or their dependents. All regular employees working at least 30 hours per week are entitled to employee only medical insurance. The District gives every eligible employee flex credits to apply towards their medical insurance. The amount is $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 with an HSA, PLEASE read the information below regarding the HSA eligibility rules.

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 (Core Health Benefits). (Keep in mind....subtract $306.70 from each premium below for the actual premium employees will pay per period.)

**For the High Deductible Health Plan, 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 (dental, vision, cancer, accident and critical illness) or dependent premiums. The excess will be placed in a HSA. The amount is $77.50 per pay / $1,860.00 annually. Therefore, $229.20 of the $306.70 Board Contribution is applied to HDHP premiums and the remaining $77.50 is applied to the HSA.

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

Medical Plan Premiums per paycheck for the four (4) medical plans

Tiers PPO Plan 3769 PPO Plan 5773 PPO Plan 7419 High Deductible Health Plan (HDHP)
Employee Only $324.20* $306.70* $291.70* $229.20**
Employee / Spouse $777.15 $732.80 $696.95 $611.60
Employee / Child $484.25 $457.25 $434.90 $364.30
Employee / Children $676.90 $638.40 $607.20 $526.95
Employee / Family $978.25 $921.90 $876.80 $781.35

*The Board Paid Flex of $306.70 per paycheck pays in full the premiums of the 7419 Plan, the 5773 Plan and the High Deductible Health Plan at the employee only tier. The 3769 Plan is a buy-up plan, costing an additional $17.50 per paycheck above the Board paid contribution amount of $306.70 at the employee only tier.

**Since the High Deductible Health Plan is tied to the Health Savings Account (HSA) to help offset the plan year deductible, the Board still contributes $306.70 to the employee, but splits it into two parts: $229.20 of the $306.70 Board contribution is applied to HDHP premium and the remaining $77.50 is applied to the HSA.

***** ATTENTION 20 PAY EMPLOYEES *****

PLEASE NOTE: The premiums listed above are based on 24-pay periods. Employee who receive 20 paychecks (i.e. 186-day work schedule), will pay the rates listed above with an additional 20% pre-pay which will be applied toward summer coverage. The Flex Credit amount also includes an extra 20% summer contribution.

Medical Plan Details

Teladoc

  • 24/7/365 access to U.S. Board Certified doctors available through phone or video consults
  • $25 copay for the 3769 Plan
  • $35 copay for the 5773 Plan

Full price (currently $40) for the High Deductible Health Plan and Plan 7419 until deductible is met, then 20% of the full price until out of pocket maximum is met.

Quest Diagnostics

Quest Diagnostics and LabCorp are Aetna’s in-network lab service providers. Please click the link below for Quest and LabCorp locations and office hours.

Frequently Asked Questions About Medical Insurance

What is an Health Savings Account (HSA)?

An HSA is like an 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 HRA; AND your spouse MUST NOT have a full purpose FSA.

HSA funds are on a calendar year basis per the 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.

The maximum contribution allowed for Year 2019 is: Individual- $3,500.00; Family- $7,000.00. The Board contributes $1,860.00 annually from the Board Paid Flex credit. You may contribute an additional amount up to the maximum allowed. 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 (ie. copy of ID card). The District will then provide $25 per paycheck towards the purchase of certain voluntary benefits (dental, vision, cancer, accident and critical illness insurance) only. It cannot be received as additional compensation. This option is only allowed: 1) as a New Hire - within 30 days of hire date; 2) during the District's annual Open Enrollment Period; OR 3) 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?

  • New employees and their dependents - medical insurance will be effective the first of the month following a 45-day waiting period. Open Enrollment - elections / changes made in February are not effective until April 1st.
  • Qualifying Events (outside Open Enrollment) - 1st 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. The Aetna Choice POS II (open access) Network of providers is the same for all Four (4) plans.

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 web link. However, when making your appointments, you should always verify with the providers that they are on the Aetna Choice POS II Network.

Please click the above web link Aetna web link and follow the instructions below:

  • Fill in the box "Who or What are you looking for" by indicating the name or specialty of the Provider you are looking for. You can also select from one of the Provider Types, Conditions or Procedures listed below the two (2) search boxes by clicking on the appropriate selection;
  • Fill in the "where" box (you can search by Zip Code, City or State;
  • You will then need to select your plan AETNA CHOICE POS II (open access) and hit continue; your search results should then appear.

How do I add my newborn?

Coverage for newborns is NOT automatic. You must physically enroll your newborn by completing two (2) forms and providing proof of birth. Please contact the Insurance and Benefits Department, (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, by phone or email, Wanda Vega at (239) 337-8153 in Staffing and Talent Management to inquire about 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 will need to 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, Alma Jones at (239) 337-8317 in Insurance & Benefits Management.

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 Aetna RX Mail Order Program 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. For more information on Aetna RX please view the Aetna RX brochure.

View the Aetna RX Order Form