The School Board of Polk County GuÃa de Beneficios

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SCHEDULE OF BENEFITS Medical Benefit PCSB Health Plan Preventive or Diagnostic Mammogram $0 $0 Colonoscopy (Routine) $0 CYD + 40% Coinsurance Colonoscopy (Diagnostic) Ambulatory Surgical Center $0 CYD + 40% Coinsurance Outpatient Hospital Mental Health & Substance Abuse Inpatient/Outpatient Provider Services at Hospital and ER Skilled Nursing Facility Option 1 – 20% Coinsurance (CYD Waived) Option 2 – 25% Coinsurance (CYD Waived) CYD + 20% Coinsurance CYD + 20% Coinsurance CYD + 20% Coinsurance Limited to 60 days per Benefit Period CYD + 40% Coinsurance CYD + 20% Coinsurance CYD + 40% Coinsurance Limited to 60 days per Benefit Period * Diabetic Supplies are not covered as the Rx benefit is carved out. Diabetic Equipment (insulin pumps, tubing) are covered under the medical benefit. This is not an insurance contract or Benefit Booklet. The above Benefit Summary is only a partial description of the many benefits and services covered by your Health Plan. For a complete description of benefits and exclusions, please refer to the Summary Plan Description (SPD). The written terms of the SPD prevail. Health Dialog 24-hour Nurse Line Toll Free at 1-877-789-2583 Did you know that if your child gets sick in the middle of the night, you have access to a nurse for advice? Did you know that if you are newly diagnosed with a condition, you have access to a Health Coach 24 hours a day, 7 days a week to provide you with information you need to make informed decisions about your treatment? As a BCBSF member, you can call Health Dialog at 1-877-789-2583 anytime and speak privately and confidentially with a trained Health Coach about your immediate or everyday health concerns. Health Coaches are specially trained health care professionals, including registered nurses, dietitians, and respiratory therapists with valuable clinical experience. They can answer your questions about health conditions, diet, exercise and understanding your medications. You can even arrange to have one particular Health Coach as your personal contact for ongoing calls.
HEALTH REIMBURSEMENT ARRANGEMENT Customer Service 1-800-422-4661 Website www.benefitspaymentsystem.com There will not be any 2012 employer contributions into the Health Reimbursement Arrangement (HRA) accounts for employees who were enrolled in the HRA designated 3160/3161 Health Plans for plan year 2011. Any funds currently in the HRA accounts will be available for eligible expenses incurred and submitted for payment until December 31, 2013. FAQ’s Q. What will happen to the money currently in an employee’s HRA Account? A. Any funds remaining from plan year 2011 will be available through the 2013 plan year. Therefore, active employees may use funds remaining in the HRA account for any eligible expense incurred and submitted for payment by December 31, 2013. After December 31, 2013, any remaining balance will be forfeited and not available to you. Q. Is there a cash-out option? A. No. There is no cash-out option available to active or terminated employees. Any balance in the HRA account is forfeited after December 31, 2013. Q. What happens to HRA funds if an employee resigns or is terminated? A. Employees whose employment terminates are entitled to submit eligible claims incurred between the beginning of the plan year and the termination date. These claims must be submitted by the end of the run-out period. An employee that elects COBRA is entitled to use their remaining balance in their HRA account for claims until the end of the plan year or until they terminate COBRA. Claims may be submitted until the end of the run-out period up to December 31, 2013. Q. Can I submit payment requests for eligible claims incurred during the 2013 plan year after December 31, 2013? A. No. Any balance in the HRA account is forfeited after December 31, 2013. *Examples of qualified and non-qualified expenses: How to use the HRA funds: Use the HRA DirectPay claim card to pay for qualified medical expenses, or, you may submit a paper claim for reimbursement. To order your personalized reimbursement form, please contact TASC at 1-800-422-4661, or use the “contact us” on the website at www.tasconline.com. Qualified Medical Expenses Deductibles Copayments Coinsurance Out of pocket expenses for prescription drugs Non-Qualified Expenses Dental Routine Vision Nutritional supplements Health club dues Cosmetic procedures Hair transplants Teeth whitening * Not intended to be a complete listing
Page 1 and 2: El Plan para el año 2012 será des
Page 3 and 4: Información Importante CUENTA DE G
Page 5 and 6: Conceptos básicos de Inscripción
Page 7 and 8: COBERTURA DE SEGURO DE SALUD Servic
Page 9: Medical Benefit Lifetime Maximum Ca
Page 13 and 14: BlueCross BlueShield of Florida - E
Page 15 and 16: BENEFICIO DE FARMACIA Servicio de c
Page 17 and 18: COPAGOS DE MIEMBRO: Compras al por
Page 19 and 20: Ir genérico! ¿Sabías que la Admi
Page 21 and 22: Servicio al Cliente: 800-325-5757 e
Page 23 and 24: Seguro por Incapacidad Periodo de e
Page 25 and 26: DENTAL INSURANCE DEDUCCION MENSUAL
Page 27 and 28: SEGURO de VISION Servicio al Client
Page 29 and 30: FAQ’s Q. ¿Como se debe de utiliz
Page 31 and 32: Preguntas frecuentes acerca del Pro
Page 33 and 34: 2011-2012 PCSB Programas para detec
Page 35 and 36: Con el constante aumento de el cost
Page 37 and 38: Aviso encomiable de la cobertura de
Page 39 and 40: Usted es participante del plan, o l
Page 41 and 42: Al ejercer su beneficios de permiso

The School Board of Polk County GuÃ­a de Beneficios

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The School Board of Polk County GuÃa de Beneficios