Employee
Benefit
Highlights
2024-2025
Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Contact Information
Risk Management
Jennifer Bullistron,
Risk/Benefits Coordinator
Phone: (941) 743-1244
Jennifer.Bullistron@charlottecountyfl.gov
Myra Trowsdale,
Onsite Cigna Representative
Phone: (941) 743-1388
myra.tr[email protected]
Stephanee Phillips,
Wellness Coordinator
Phone: (941) 764-4927
https://wellness.charlottecountyfl.gov
Stephanee.Phillips@charlottecountyfl.gov
Online Benefit Enrollment Bentek Support
(888) 5-Bentek (523-6835)
www.mybentek.com/charlottecounty
Medical Insurance Cigna Healthcare
Customer Service: (800) 244-6224
Onsite Cigna Representative: (941) 743-1388
www.mycigna.com
Mail-Order Pharmacy Program Elixir Pharmacies
Customer Service: (866) 909-5170
www.elixirsolutions.com
Telehealth MDLIVE through Cigna
Customer Service: (888) 726-3171
www.mycigna.com
Health Reimbursement Account P&A Group
Customer Service: (716) 852-2611
www.padmin.com
Dental Insurance Cigna Healthcare
Customer Service: (800) 244-6224
www.mycigna.com
Vision Benefit EyeMed
Customer Service: (866) 939-3633
www.eyemed.com
Flexible Spending Accounts P&A Group
Customer Service: (716) 852-2611
www.padmin.com
Employee Assistance Program Cigna Behavioral Health
Customer Service: (877) 622-4327
www.mycigna.com
Basic Life and AD&D Insurance New York Life Group Benefit Solutions
Customer Service: (800) 362-4462
www.mynylgbs.com
Voluntary Life Insurance New York Life Group Benefit Solutions
Customer Service: (800) 362-4462
www.mynylgbs.com
Voluntary Short & Long Term Disability
Insurance
New York Life Group Benefit Solutions
Customer Service: (800) 362-4462
www.mynylgbs.com
Supplemental Insurance Aflac
Customer Service: (800) 992-3522
www.aflacgroupinsurance.com
Medicare Supplemental Insurance Valery Insurance Agency Customer Service: (800) 330-8445
COBRA Benefits P&A Group
Customer Service: (716) 852-2611
www.padmin.com
Legal Insurance Legal Shield
Agent: Jim and Andrea Carroll
Phone: (941) 235-1770
Employee Health Centers My Health Onsite
Customer Service: (941) 800-2005
Customer Service: (941) 764-0301
www.MyHealthOnsite.com/patient-access
Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Table of Contents
Introduction 1
Online Benefit Enrollment 1
Core Benefits 2
Group Insurance Eligibility 3
Annual Over-Age Dependent Audits 3
Qualifying Events and Section 125 4
Medical Insurance 5
Premium Deductions 5
Tobacco User Premiums 5
Telehealth 5
Cigna OAPIN Plan At-A-Glance 6
Dental Insurance 7
Cigna Dental PPO Plan At-A-Glance 8
Vision Insurance 9
EyeMed Vision Care Plan At-A-Glance 10
Health Reimbursement Account 11-12
Flexible Spending Accounts 13-14
Employee Assistance Program 15
Basic Life and AD&D Insurance 15
Voluntary Life Insurance 16
Voluntary Short Term Disability 17
Voluntary Long Term Disability 17
Supplemental Insurance - Aflac 18
Retiree Benefits 19
COBRA Benefits 20
Medicare Supplemental Insurance 20
LegalShield & IDShield Insurance 20
My Health Onsite Registration 21
Employee Health Centers 21-22
Employee Health Centers Services 23
Notes 24
This booklet is merely a summary of employee benefits. For a full description, refer to the plan document. Where conflict exists between this summary and the plan document, the plan document controls.
The County reserves the right to amend, modify or terminate the plan at any time. This booklet should not be construed as a guarantee of employment.
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Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Introduction
The County is pleased to offer a comprehensive array of benefits including
group insurance coverage, retirement savings plans, Employee Health Centers
and wellness programs. Please refer to the County Personnel Policies and/or
Certificates of Coverage for detailed descriptions of all available employee
benefit programs and stipulations therein. For further explanation or
assistance answering specific questions, please refer to the customer service
phone number under each benefit description heading. General inquiries may
be directed to Risk Management.
IMPORTANT NOTE
New Hires have two weeks from date of hire to complete the benefit
election process.
Online Benefit Enrollment
The County provides employees with an online benefits enrollment
platform through Bentek’s Employee Benefits Center (EBC). The EBC
provides benefit-eligible employees the ability to select or change
insurance benefits online during the annual Open Enrollment Period,
New Hire Orientation, or for Qualifying Life Events.
Accessible 24 hours a day, throughout the year, employee may log
in and review comprehensive information regarding benefit plans,
and view and print an outline of benefit elections for employee and
dependent(s). Employee also has access to important forms and carrier
links, can report qualifying life events and review and make changes to
Life insurance beneficiary designations.
To Access the Employee Benefits Center:
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Log on to www.mybentek.com/charlottecounty
Please Note: Link must be addressed exactly as written. Due to
security reasons, the website cannot be accessed by Google or
other search engines.
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Sign in using a previously created username and password or
click "Create an Account" to set up a username and password.
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If employee has forgotten username and/or password, click
on the link “Forgot Username/Password” and follow the
instructions.
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Once logged on, navigate using the Launchpad to review
current enrollment, learn about benefit options, and make
any benefit changes or update beneficiary designations.
For technical issues directly related to using the EBC, please
call (888) 5-Bentek (523-6835) or email Bentek Support at
support@mybentek.com, Monday through Friday during regular
business hours 8:30am - 5:00pm.
To access Bentek using a mobile
device, scan code.
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Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Core Benefits
Plan Coverages at Time of Hire
The County’s health insurance plan consists of the following core benefits:
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Medical Insurance (including prescription drug coverage)
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Dental Insurance
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Vision Insurance
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Basic Term Life Insurance
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Accidental Death and Dismemberment Insurance
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Employee Assistance Program
Medical, dental and vision coverage is offered to all benefit-eligible employees
as a package, however, employee can elect to opt-out of dental and/or vision
and remain on the medical plan only (please note that this will not affect
employee's deductions). Electing dependent coverage also entitles employee's
dependent(s) to receive benefits with the exception of the Basic Life and
Accidental Death and Dismemberment Insurance. The employee costs for these
Core Benefits are payroll deducted under a pre-payment plan. Deductions are
taken out the month before the effective date of coverage. For example, if the
effective date is December 1, payroll deductions would be taken in November.
There are 24 payroll deductions per year.
Employee will also be offered the following optional benefits that can be
elected on a voluntary basis and payroll deducted:
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Short Term Disability Insurance
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Long Term Disability Insurance
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Flexible Spending Accounts (Medical & Dependent Care)
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Voluntary Term Life Insurance
Open Enrollment
The County's annual Open Enrollment period is the time of year employees may
make changes to their benefit elections. These elections will be effective when
the new plan year begins on October 1. During Open Enrollment, employees may:
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Change your Section 125 Tax Election
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Add Dependent(s)
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Remove Dependent(s)
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Apply for Short Term Disability
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Apply for Long Term Disability
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Apply for Voluntary Life Insurance
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Apply for Aflac Products
A special Open Enrollment for Flexible Spending Accounts will be conducted
each December for the following year. Employees must re-enroll in Flexible
Spending Accounts each year.
Other Coverage
If employee is covered by another medical insurance plan (example: an
individual policy, as a dependent under a spouse’s policy, military insurance,
etc.) and employee wishes to decline the County’s medical insurance plan,
the County will reimburse employee $200 per month (considered taxable
income). However, employee will still be enrolled in the Basic Life insurance
and Accidental Death and Dismemberment insurance at no cost. To be eligible
to receive this coverage rebate, employee must be under the age of 65 and
not Medicare eligible. Employee must also provide proof of other medical
insurance (example; certificate of insurance, copy of identification card or copy
of current policy). Employee will be required to verify this information on an
annual basis.
Coordination of Benefits
When both employee and spouse work for the County, each person may be
covered by their employer’s health plan, as well as the spouse’s health plan.
Coordination of benefits determines which group health care plan pays
benefits first. The secondary health plan may then pay additional benefits.
Health insurers follow a common set of guidelines to determine which plan
pays first and which plan pays second for family members. The employee's
group health care plan is always primary. If the employee is married, and both
the employee and spouse cover dependent child(ren), the plan that covers the
parent whose birthdate is first in the calendar year is usually primary for any
dependent child(ren).
Other factors that may affect which plan pays first includes eligibility for
Medicare, court decrees or custody arrangements, the length of time an
employee is covered, and whether employee is active or a retiree. If both the
employee and employee's spouse are both County employees, they may not be
covered as both an employee and a dependent. Additionally employees may
not cover child(ren) as dependent(s) of both employees.
Example: If the employee's birthdate is January 14, and the spouse’s birthdate
is April 10, the employee's group health plan is primary for the employee and
child(ren), but is secondary for the spouse.
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Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Group Insurance Eligibility
The County’s group insurance plan year is
October 1 through September 30.
Employee Eligibility
Employees are eligible to participate in the County’s health insurance plans
if they are full-time employees or average 130 working hours a month,
under the accepted measurement method elected under the Affordable
Care Act. Coverage will be effective the first of the month following 30 days
of employment. For example, if employee is hired on February 11, then the
effective date of coverage will be April 1.
Separation of Employment
If employee separates employment from the County, insurance will continue
through the end of the month in which separation occurred. COBRA
continuation of coverage may be available as applicable by law.
Dependent Eligibility
A dependent is defined as the legal spouse and/or dependent child(ren) of the
participant or the spouse. The term “child” includes any of the following:
• A natural child
• A stepchild
• A legally adopted child
• A newborn (up to age 18 months) of a covered dependent (Florida)
• A child for whom legal guardianship has been awarded to the
participant or the participant’s spouse
Dependent Age Requirements
Medical Coverage: A dependent child may be covered through the
end of the calendar year in which the child turns age 26. An over-
age dependent may continue to be covered on the medical plan to
the end of the calendar year in which the child reaches age 30, if the
dependent meets the following requirements:
• Unmarried with no dependents; and
• A Florida resident, or full-time or part-time student; and
• Otherwise uninsured; and
• Not entitled to Medicare benefits under Title XVIII of the
Social Security Act, unless the child is disabled.
Please see Taxable Dependents if covering eligible dependents over age 26.
Dental Coverage: A dependent child may be covered through the
end of the calendar year in which the child turns age 26.
Vision Coverage: A dependent child may be covered through the end
of the calendar year in which the child turns age 26.
Disabled Dependents
Coverage for an unmarried dependent child may be continued beyond age 26 if:
• The dependent is physically or mentally disabled and incapable of
self-sustaining employment (prior to age 26); and
• Primarily dependent upon the employee for support; and
• The dependent is otherwise eligible for coverage under the group
medical plan; and
• The dependent has been continuously insured
Proof of disability will be required upon request. Please contact Risk
Management if further clarification is needed.
Taxable Dependents
Employee covering adult child(ren) under employee's medical insurance plan
may continue to have the related coverage premiums payroll deducted on a
pre-tax basis through the end of the calendar year in which dependent child
reaches age 26. Contact Risk Management for further details if covering an
adult dependent child who will turn age 27 any time during the upcoming
calendar year or for more information.
Annual Over-Age Dependent Audits
At the end of each year Risk Management will conduct an over-age dependent
audit of all dependent children over the age of 26 that are on the plan. An
employee who meets the criteria to keep an over-age dependent on the
medical plan must complete an Over-Age Dependent Verification Form,
and pay the appropriate post-tax premium. The form includes an affidavit
whereby employees must sign verifying they understand; that any person who
knowingly and with the intent to defraud or deceive any insurer by providing
false or misleading information may result in denial of benefits, termination of
coverage and/or disciplinary action (Fl Statute Ch 817.234(1)(b)(200).
OCTOBER
01
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Charlotte County
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Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Qualifying Events and Section 125
Section 125 of the Internal Revenue Code
Premiums for medical, dental, vision insurance, and/or certain supplemental
policies are deducted through a Cafeteria Plan established under Section
125 of the Internal Revenue Code and are pre-taxed to the extent permitted.
Under Section 125, changes to an employee's pre-tax benefits can be made
ONLY during the Open Enrollment period unless the employee or qualified
dependent(s) experience(s) a Qualifying Event and the request to make a
change is made within 30 days of the Qualifying Event.
Under certain circumstances, employee may be allowed to make changes
to benefit elections during the plan year, if the event affects the employee,
spouse or dependent’s coverage eligibility. An “eligible” Qualifying Event is
determined by Section 125 of the Internal Revenue Code. Any requested
changes must be consistent with and due to the Qualifying Event.
Examples of Qualifying Events:
• Employee gets married or divorced
• Birth of a child
• Employee gains legal custody or adopts a child
• Employee's spouse and/or other dependent(s) die(s)
• Loss or gain of coverage due to employee, employee's spouse and/
or dependent(s) termination or start of employment.
• An increase or decrease in employee's work hours causes eligibility
or ineligibility
• A covered dependent no longer meets eligibility criteria for coverage
• A child gains or loses coverage with other parent or legal guardian
• Change of coverage under an employer’s plan
• Gain or loss of Medicare coverage
• Losing or becoming eligible for coverage under a State Medicaid
or CHIP (including Florida Kid Care) program (60 day notification
period)
IMPORTANT NOTES
If employee experiences a Qualifying Event, Risk Management must
be contacted within 30 days of the Qualifying Event to make
the appropriate changes to employee’s coverage. Employee may be
required to furnish valid documentation supporting a change in status
or “Qualifying Event”. If approved, changes may be effective the date of
the Qualifying Event or the first of the month following the Qualifying
Event. Newborns are effective on the date of birth. Qualifying Events
will be processed in accordance with employer and carrier eligibility
policy. Beyond 30 days, requests will be denied and employee may be
responsible, both legally and financially, for any claim and/or expense
incurred as a result of employee or dependent who continues to be
enrolled but no longer meets eligibility requirements.
Summary of Benefits and Coverage
A Summary of Benefits & Coverage (SBC) for the Medical Plan is provided
as a supplement to this booklet being distributed to new hires and existing
employees during the Open Enrollment period. The summary is an important
item in understanding employee's benefit options. A free paper copy of the
SBC document may be requested or is also available as follows:
From: Benefits Coordinator
Address: Charlotte County Risk Management
18500 Murdock Circle #B-201, Port Charlotte, FL 33948
Phone: (941) 743-1244
Email: Jennifer.Bullistron@charlottecountyfl.gov
Enrollment Software – Bentek: www.mybentek.com/charlottecounty
The SBC is only a summary of the plan’s coverage. A copy of the plan
document, policy, or certificate of coverage should be consulted to determine
the governing contractual provisions of the coverage. A copy of the group
certificate of coverage can be reviewed and obtained by contacting the
Benefits Coordinator.
If there are any questions about the plan offerings or coverage options, please
contact the Benefits Coordinator at (941) 743-1244.
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Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Medical Insurance
The County offers medical insurance through Cigna Healthcare to benefit-
eligible employees. The monthly costs for coverage are listed in the premium
tables below. For more detailed information about the medical plans, please
refer to the carrier's Summary of Benefits and Coverage (SBC) or contact
Cigna's customer service.
An Open Access Plan (OAP) is a plan that allows members to access any in-
network provider (physician, lab, hospital, etc.) anywhere in the United States
of America. Unlike an HMO, members do not need to name a Primary Care
Physician, or have referrals to see a specialist. Members who stay within the
OAP network, are covered according to the plan benefits.
Medical Insurance – Cigna OAPIN Plan - Premiums
Monthly Cost - Includes Medical, Dental and Vision Coverage
Tier of Coverage
Employee
Contribution
County
Contribution
Total Monthly
Rate
Employee Only $26.00 $1,133.00 $1,159.00
Employee + Spouse $286.00 $2,153.00 $2,439.00
Employee + Child(ren) $249.00 $1,870.00 $2,119.00
Employee + Family $315.00 $2,364.00 $2,679.00
Medical Insurance – Cigna OAPIN Plan -
With Tobacco Premiums
Monthly Cost - Includes Medical, Dental and Vision Coverage
Tier of Coverage
Employee
Contribution
County
Contribution
Total Monthly
Rate
Employee Only $76.00 $1,133.00 $1,209.00
Employee + Spouse $336.00 $2,153.00 $2,489.00
Employee + Child(ren) $299.00 $1,870.00 $2,169.00
Employee + Family $365.00 $2,364.00 $2,729.00
Premium Deductions
Medical, dental and vision coverage is offered to all benefit-eligible employees
as a package, however, employee may elect to opt-out of dental and/or vision
and remain on the medical plan only (please note that this will not affect
the payroll deductions. Electing dependent medical coverage also entitles
employee's dependent(s) to receive dental and vision benefits unless they
opt-out of dental or vision coverage. Employee costs for benefits are payroll
deducted under a pre-payment plan. Deductions are taken the month before
the effective date of coverage. For example, if employee's effective date is
December 1, payroll deductions would be taken in November. There are 24
deductions per year.
Tobacco User Premiums
Employees must request and complete a nicotine test at one of the Employee
Health Centers during the Wellness Initiative Program period. Employees that
do not complete the test will receive the “With Tobacco Premium". Employees
who test negative for nicotine will qualify for a "With Tobacco Premium"
waiver for the plan year. Additionally, employee that tests positive for nicotine
but also completes a Tobacco Cessation Program will qualify for a waiver for
the plan year. Any employee that DOES NOT complete the test or program by
the required deadlines will receive the "With Tobacco Premium".
Other Available Plan Resources
Cigna offers all enrolled employees and dependents additional services and
discounts through value added programs. For more details regarding other
available plan resources, please contact Cigna’s customer service at (800) 244-
6224, or visit www.mycigna.com.
Cigna Healthcare | Customer Service: (800) 244-6224 | www.mycigna.com
Telehealth
Cigna provides access to telehealth services as part of the medical plan.
MDLIVE is a convenient phone and video consultation company that provides
immediate medical assistance for many conditions.
This benefit is provided to all enrolled members. Registration is suggested and
should be completed prior to using services. This program allows members 24
hours a day, seven (7) days a week on-demand access to affordable medical
care via phone and online video consultations when needing immediate care
for non-emergency medical issues. Telehealth should be considered when
employee's primary care doctor is unavailable, after-hours or on holidays
for non-emergency needs. Many urgent care ailments can be treated with
Telehealth, such as:
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Sore Throat
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Headache
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Stomachache
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Fever
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Cold And Flu
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Allergies
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Rash
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Acne
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UTIs And More
Telehealth doctors do not replace employee's primary care physician but
may be a convenient alternative for Urgent Care and ER visits. For further
information please contact MDLIVE through Cigna.
Telehealth - MDLIVE Services Cost Per Visit
Urgent Virtual Care No Charge
Primary Care $25.00 Copay
Specialty Care $35.00 Copay
Cigna Healthcare
MDLIVE | Customer Service: (888) 726-3171 | www.mycigna.com
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Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Locate a Provider
To search for a participating provider,
contact Cigna's customer service or visit
www.mycigna.com. When completing
the necessary search criteria, select
Open Access Plus network.
Plan References
*Although the plan renews according
to the fiscal year (Oct 1 - Sept 30) the
deductibles and out-of-pocket limit
accrue and reset on a calendar year
basis.
**Quest Diagnostics and LabCorp are
the preferred labs for bloodwork through
Cigna. When using a lab other than
LabCorp or Quest, please confirm they
are contracted with Cigna’s Open Access
Plus network prior to receiving services.
Important Notes
Services recieved by providers or facilities
not in the Open Access Plus network,
will not be covered.
Cigna OAPIN Plan At-A-Glance
Network Open Access Plus
Calendar Year Deductible (CYD)* In-Network
Single $500
Family $1,000
Coinsurance
Member Responsibility 0%
Calendar Year Out-of-Pocket Limit*
Single $1,500
Family $3,000
What Applies to the Out-of-Pocket Limit? Deductible and Copays (Includes Rx)
Physician Services
Primary Care Physician (PCP) Office Visit (No PCP Election Required) $25 Copay
Specialist Office Visit (No Referral Required) $35 Copay
Maternity Visit (Initial Visit Only) $35 Copay
Non-Hospital Services; Freestanding Facility
Clinical Lab (Bloodwork)** No Charge
X-rays No Charge
Advanced Imaging (MRI, PET, CT) 0% After CYD
Outpatient Surgery in a Surgical Center 0% After CYD
Physician Services at Surgical Center 0% After CYD
Urgent Care (Per Visit) $50 Copay
Hospital Services
Inpatient Hospital (Per Admission) 0% After CYD
Outpatient Hospital 0% After CYD
Physician Services at Hospital 0% After CYD
Emergency Room (Per Visit: Waived if Admitted) $150 Copay
Mental Health/Alcohol & Substance Abuse
Inpatient Hospital Services (Per Admission) 0% After CYD
Outpatient Services (Per Visit) No Charge
Outpatient Office Visit $35 Copay
Prescription Drugs (Rx)
Generic $15 Copay
Preferred Brand Name $30 Copay
Non-Preferred Brand Name $60 Copay
Mail Order Drug (90-Day Supply) 2x Retail Copay
7
Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Dental Insurance
Cigna Dental PPO Plan
The County offers dental insurance through Cigna Healthcare to benefit-
eligible employees. A brief summary of benefits is provided on the following
page. For more detailed information about the dental plan, please refer to the
carrier's summary plan document or contact Cigna’s customer service.
In-Network Benefits
The Dental PPO plan provides benefits for services received from in-network
and out-of-network providers. It is also an open-access plan which allows for
services to be received from any dental provider without having to select a
Primary Dental Provider (PDP) or obtain a referral to a specialist. The network
of participating dental providers the plan utilizes is the Cigna Total DPPO
Network. These participating dental providers have contractually agreed to
accept Cigna’s contracted fee or “allowed amount.” This fee is the maximum
amount a Cigna dental provider can charge a member for a service. The
member is responsible for a Plan Year Deductible (PYD) and then coinsurance
based on the plan’s charge limitations.
Please Note: Total DPPO dental members have the option to utilize a dentist that
participates in either Cigna’s Advantage Network or DPPO Network. However, members
that use the Cigna Advantage Network will see additional cost savings from the added
discount that is allowed using an Advantage Network provider. Members are responsible
for verifying whether the treating dentist is an Advantage Dentist or a DPPO Dentist.
Out-of-Network Benefits
Out-of-network benefits are used when member receives services by a non-
participating Cigna Total DPPO provider. Cigna reimburses out-of-network
services based on what it determines as the Maximum Reimbursable Charge
(MRC). The MRC is defined as the most common charge for a particular dental
procedure performed in a specific geographic area. If services are received from
an out-of-network dentist, the member may be responsible for balance billing.
Balance billing is the difference between the Cigna's MRC and the amount
charged by the out-of-network dental providers. Balance billing is in addition
to any applicable plan deductible or coinsurance responsibility.
Plan Year Deductible
The Dental PPO plan benefits begin once each covered member satisfies a $50
deductible (waived for Class I services). The deductible is applied collectively
for either in-network or out-of-network services or any combination of both.
Once any three (3) covered members in a family each satisfy the $50 deductible,
the deductible will be considered met for all covered members in the family.
IMPORTANT NOTE
The plan year deductible for the dental plan is October 1st through
September 30th.
Plan Year Benefit Maximum
The maximum benefit (coinsurance) the Dental PPO plan will pay for each
covered member is $1,500 for in-network and out-of-network services or
combined. Diagnostic and preventive services will accumulate towards the
benefit maximum. Once the plan's benefit maximum is met, the member will
be responsible for future charges until next plan year.
Cigna Healthcare | Customer Service: (800) 244-6224 | www.mycigna.com
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Cigna Dental PPO Plan At-A-Glance
Network Total Cigna DPPO
Plan Year Deductible (PYD) In-Network Out-of-Network*
Per Member $50
Per Family $150
Waived for Class I Services? Yes
Plan Year Benefit Maximum
Per Member $1,500
Class I Services: Diagnostic & Preventive Care
Oral Exam
Plan Pays: 100%
Deductible Waived
Plan Pays: 100%
Deductible Waived
(Subject to Balance Billing)
Cleanings
X-rays (Bitewing / Full Mouth)
Fluoride Treatments (Restrictions Apply)
Sealants (Restrictions Apply)
Space Maintainers
Class II Services: Basic Restorative Care
Fillings
Plan Pays: 80%
After PYD
Plan Pays: 80% After PYD
(Subject to Balance Billing)
Simple Extractions
Endodontics (Root Canal Therapy)
Periodontal Services
Oral Surgery
Anesthetics
Class III Services: Major Restorative Care
Crowns
Plan Pays: 50%
After PYD
Plan Pays: 50% After PYD
(Subject to Balance Billing)
Bridges
Dentures
Class IV Services: Orthodontia
Lifetime Maximum $1,500
Benefit (Dependent Children Up To Age 19)
Play Pays: 50%
Deductible Waived
Locate a Provider
To search for a participating provider,
contact Cigna's customer service or visit
www.mycigna.com. When completing
the necessary search criteria, select
Cigna Total DPPO network.
Plan References
*Out of Network Balance Billing: For
information regarding out-of-network
balance billing that may be charged by
an out-of-network provider, please refer
to the Out-Of-Network Benefits section
on the previous page.
Important Notes
• Each covered family member
may receive up to two (2) routine
cleanings per plan year covered
under the preventive benefit.
• For any dental work expected to cost
$200 or more, the plan will provide a
"Pre-Determination of Benefits" upon
the request of the dental provider.
This will assist with determining
approximate out-of-pocket costs
should employee have the dental
work performed.
• Waiting periods and age limitations
may apply
• Benefit frequency limitations may
apply to certain services.
9
Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Vision Insurance
EyeMed Vision Care Plan
The County offers vision insurance through EyeMed to benefit-eligible
employees. A brief summary of benefits is provided on the following page.
For more detailed information about the vision plan, please refer to EyeMed's
summary plan document or contact EyeMed’s customer service.
Please Note: Vision coverage is included as part of the medical contribution.
In-Network Benefits
The vision plan offers employees and covered dependent(s) coverage for
routine eye care, including eye exams, eyeglasses (lenses and frames) or contact
lenses. To schedule an appointment, covered employee and dependent(s) can
select any network provider who participates in the EyeMed Insight network.
At the time of service, routine vision examinations and basic optical needs will
be covered as shown on the plan’s schedule of benefits. Cosmetic services and
upgrades will be additional if chosen at the time of the appointment.
Out-of-Network Benefits
Employee and covered dependent(s) may choose to receive services from
vision providers who do not participate in the EyeMed Insight network.
When going out of network, the provider will require payment at the time of
appointment. EyeMed will then reimburse based on the plan’s out-of-network
reimbursement schedule upon receipt of proof of services rendered.
Plan Year Deductible
There is no plan year deductible.
Plan Year Out-of-Pocket Maximum
There is no out-of-pocket maximum. However, there are benefit reimbursement
maximums for certain services.
EyeMed | Customer Service: (866) 939-3633 | www.eyemed.com
Other Available Plan Resources
EyeMed.com
• Find an eye doctor.
• Get directions to the provider of choice.
• Schedule appointments.
• View or print member ID card.
• See current benefits eligibility and in-network benefit details.
• Get answers to commonly asked questions.
EyeMed Member App
The EyeMed app is like a personal assistant. Download and get the same
helpful features that are found on eyemed.com – but with upgrades like
the ability to save vision prescriptions, or schedule an exam and contact lens
change reminders. Visit the Apple Store or Android Play Store and download
the EyeMed app today.
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Charlotte County
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Employee Benefit Highlights
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© 2016, Gehring Group, Inc., All Rights Reserved
EyeMed Vision Care Plan At-A-Glance
Network Insight
Services In-Network Out-of-Network
Eye Exam $10 copay Up to $35 Reimbursement
Contact Lens Fit & Follow-Up
Standard Lens Up to $40 Allowance Not Covered
Premium Lens 10% Off Retail Price Not Covered
Frequency of Services
Examination 12 Months
Lenses 12 Months
Frames 24 Months
Contact Lenses 12 Months
Lenses
Single Covered at 100% Up to $25 Reimbursement
Bifocal Covered at 100% Up to $40 Reimbursement
Trifocal Covered at 100% Up to $60 Reimbursement
Frames
Allowance
Up to $200 Retail Allowance; Then
20% Off Balance Over $200
Up to $45 Reimbursement
Contact Lenses*
Non-Elective (Medically Necessary) Covered at 100% Up to $210 Reimbursement
Elective (Lenses)
Conventional
Up to $200 Allowance; Then 15%
Off Balance Over $200
Up to $200 Reimbursement
Disposable
Up to $200 Allowance; Plus Balance
Over $200
Up to $200 Reimbursement
Locate a Provider
To search for a participating provider,
contact EyeMed's customer service
or visit www.eyemed.com. When
completing the necessary search
criteria, select Insight network.
Plan References
*Contact lenses are in lieu of spectacle
lenses.
Important Notes
Member options, such as LASIK, UV
coating, progressive lenses, etc. are not
covered in full, but may be available at
a discount.
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Health Reimbursement Account
The County is providing employees who participate in the Wellness Initiative Program a Health Reimbursement Account (HRA) administered through P&A Group. HRA
monies are not taxable, funded by the County and can be used for any qualified medical expense incurred, such as deductibles and coinsurance for physician services
and hospital services.
HRA IRS Guidelines
HRA’s must be funded solely by an employer. The contribution cannot be paid
through a voluntary salary reduction agreement on the part of an employee.
Employee is reimbursed tax free for qualified medical expenses up to a
maximum dollar amount per coverage period. An HRA may be offered with
other health plans, including Flexible Spending Accounts.
Employee may enjoy several benefits from having an HRA.
9
Contributions made by the employer can be excluded from
gross income.
9
Reimbursements may be tax free if employee pays qualified
medical expenses.
9
Any unused amounts in the HRA can be carried forward for
reimbursements in later years.
Distributions From an HRA
Generally, distributions from an HRA are paid to reimburse employee for
qualified medical, dental or vision expenses incurred. The expense must have
been incurred on or after the date employee enrolled in the HRA.
*Debit cards, credit cards, and stored value cards given to employee by the County can
be used to reimburse participants in an HRA. If the use of these cards meets certain
substantiation methods, employee may not have to provide additional information to the
HRA administrator.
Health Reimbursement Account (HRA) Flexible Spending Accounts (FSA)
9
Employer funded account
9
Enrollment is automatic if enrolled in medical plan
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Funds are used for eligible medical expenses for employee and
employee's dependent(s) who are enrolled in medical plan
9
Unused funds accumulate and roll over each year
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Employee funded account
9
Employee must enroll annually
9
Funds are used for eligible medical, dental, vision & dependent
care for employee and employee's qualified dependent(s)
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Employees may carry over unused FSA funds into the next plan
year.
If an employee has the HRA and also elects an FSA, FSA monies will be used first since they may be forfeited.
What are some examples of qualified expenses eligible for reimbursement?
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Prescription/Over-the-Counter Medications
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Physician Fees and Office Visits
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LASIK Surgery
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Menstrual Products
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Drug Addiction/Alcoholism Treatment
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Mental Health Care
9
Ambulance Service
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Experimental Medical Treatment
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Nursing Services
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Chiropractic Care
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Corrective Eyeglasses and Contact Lenses
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Optometrist Fees
9
Dental and Orthodontic Fees
9
Hearing Aids and Exams
9
Sunscreen SPF 15 or Greater
9
Diagnostic Tests/Health Screenings
9
Injections and Vaccinations
9
Wheelchairs
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Health Reimbursement Account (Continued)
The County will fund each employee’s Health Reimbursement Account (HRA) if the employee (and dependent spouse covered on the plan) participate in the Wellness
Initiative Program. This money is not taxable to employee and can be used to offset the cost of expenses incurred under the medical insurance plan. Examples of these
expenses include deductible and copays for items such as doctor visits, inpatient hospital stays and prescription drugs that generate out-of-pocket cost to the employee.
If both employee and eligible spouse participate in the program, each could earn the $500 incentive up to a maximum of $1,000 (single parent with children can earn
a maximum of $750).
HRA Funding Allotment
• If both employee and eligible spouse participate in the program,
each are eligible to earn the $500 incentive up to a maximum of
$1,000 (single parent with children can earn a maximum of $750).
• Funds remain in account designated for employee until claimed for
reimbursement.
• Employee will receive a debit card to pay for medical plan expenses.
If provider does not accept debit card, the user will pay the cost
for the incurred expense at the time of service and then claim
reimbursement from the plan administrator.
• Reimbursement is not subject to income tax.
• Claims must be filed within 90 days after the end of the plan year in
order to claim reimbursement.
• Unused funds roll forward for use in future years. When employee
retires from the County, employee will be able to use remaining
funds for qualified medical expenses. Employee must meet the FRS
guidelines for retirement to be considered a retiree. If employee
leaves County employment not due to retirement, any unused
funds will remain with the County.
Distributions From an HRA
Generally, distributions from an HRA must be paid to reimburse employee
for qualified medical, dental or vision expenses employee has incurred. The
expense must have been incurred on or after the date employee is enrolled
in the HRA. Keep all receipts in the event employee is asked to provide them.
Mobile App
Managing your benefit plans is easier than ever before with P&A Group’s
mobile app. Time-saving tools are quickly accessible with the tap of an icon,
providing you with everything you need to manage your account(s) wherever,
whenever. View account information, file claims and upload receipts using a
smartphone camera. Visit the App Store (on Apple devices) or Google Play (on
Android devices) and search “P&A Group” to get the app.
How to Login to My HRA Account?
1. Go to www.padmin.com and in the Login box make sure “Participant”
is selected under User Type. Choose your Account Type and click “Go to
Login".
2. Under My Benefits Account Login, enter your username and password
and click “Submit”. If you are a first time user, click the “First Time
Logging In” link. You will be prompted to create a username and
password for your account.
3. After you successfully logged into your account, your My Benefits
Summary will be displayed. This shows a summary of every plan made
available to you through your employer.
Rollover Guidelines
The 2024 plan year will end on December 31, 2024, however, employee will
have an additional 90 days after the plan ends to submit claims to P&A Group
for service dates from January 1, 2024 to December 31, 2024. Employee will
not be able to use the debit card for these services; however employee may
submit a claim manually through the online portal, toll free fax, email or mail.
All rollover funds occur in April of the following year.
Please Note: Employees should not use the card for services dated in old plan year as the
services will be denied and a repayment request will be generated.
P&A Group | Phone: (716) 852-2611 | www.padmin.com
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Flexible Spending Accounts
The County offers Flexible Spending Accounts (FSA) administered through P&A Group. The FSA Plan Year is from January through December annually. FSA open
enrollment period, will be held in December. Employee may elect to participate in either or both FSAs.
If employee or family member(s) has predictable health care or work-related day care expenses, then employee may benefit from participating in an FSA. An FSA allows
employee to set aside money from employee's paycheck for reimbursement of health care and day care expenses they regularly pay. The amount set aside is not taxed
and is automatically deducted from employee’s paycheck and deposited into the FSA. During the year, employee has access to this account for reimbursement of some
expenses not covered by insurance. Participation in an FSA allows for substantial tax savings and an increase in spending power. Participating employee must re-elect
the dollar amount to be deducted each plan year. There are two types of FSAs:
Health Care FSA Dependent Care FSA
This account allows participant to set aside up to an
annual maximum of $3,200. This money will not be
taxable income to the participant and can be used to
offset the cost of a wide variety of eligible medical care
expenses that generate out-of-pocket costs. Participating
employee can also receive reimbursement for expenses
related to dental and vision care (that are not classified
as cosmetic).
Examples of common expenses that qualify for
reimbursement are listed below.
This account allows participant to set aside up to an annual maximum of $5,000 if
single or married and file a joint tax return ($2,500 if married and file a separate tax
return) for work-related day care expenses. Qualified expenses include adult and child
day care centers, preschool, and before/after school care for eligible children and
dependent adults.
Please note, if family annual income is over $20,000, this reimbursement option will
likely save participant more money than the dependent day care tax credit taken on a
tax return. To qualify, dependents must be:
• A child under the age of 13, or
• A child, spouse or other dependent who is physically or mentally
incapable of self-care and spends at least eight (8) hours a day in the
participant's household.
Please Note: The entire Health Care FSA election is available for use on
the first day coverage is effective.
Please Note: Unlike the Health Care FSA, participant will only be reimbursed up to the amount that has
been deducted from participant's paycheck for the Dependent Care FSA.
A sample list of qualified expenses eligible for reimbursement include, but not limited to, the following:
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Prescription/Over-the-Counter Medications
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Physician Fees and Office Visits
9
LASIK Surgery
9
Menstrual Products
9
Drug Addiction/Alcoholism Treatment
9
Mental Health Care
9
Ambulance Service
9
Experimental Medical Treatment
9
Nursing Services
9
Chiropractic Care
9
Corrective Eyeglasses and Contact Lenses
9
Optometrist Fees
9
Dental and Orthodontic Fees
9
Hearing Aids and Exams
9
Sunscreen SPF 15 or Greater
9
Diagnostic Tests/Health Screenings
9
Injections and Vaccinations
9
Wheelchairs
Log on to http://www.irs.gov/publications/p502/index.html for additional details regarding qualified and non-qualified expenses.
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Flexible Spending Accounts (Continued)
FSA Guidelines
• Employee may carry over up to $640 of unused Health Care FSA
funds into the next plan year after plan year ends and all claims
have been filed. Dependent Care funds cannot be carried over.
• When a plan year ends and all claims have been filed with the
exception of the $640 rollover for the Health Care FSA, all unused
funds will be forfeited and not returned.
• Employee can enroll in an FSA only during the Open Enrollment
Period, a Qualifying Event, or a New Hire Eligibility Period.
• Money cannot be transferred between FSAs.
• Reimbursed expenses cannot be deducted for income tax purposes.
• Employee and dependent(s) cannot be reimbursed for services not
received.
• Employee and dependent(s) cannot receive insurance benefits or
any other compensation for expenses reimbursed through an FSA.
• Domestic Partners are not eligible as Federal law does not recognize
them as a qualified dependent.
HERE’S HOW IT WORKS!
An employee earning $50,000 elects to place $1,000 into a Health
Care FSA. The payroll deduction is $41.66 based on a 24 pay period
schedule. As a result, health care expenses are paid with tax-free
dollars, giving the employee a tax savings of $197.
With a Health
Care FSA
Without a Health
Care FSA
Salary $50,000 $50,000
FSA Contribution - $1,000 - $0
Taxable Pay $49,000 $50,000
Estimated Tax
19.65% = 12% + 7.65% FICA
- $9,628 - $9,825
After Tax Expenses - $0 - $1,000
Spendable Income $39,372 $39,175
Tax Savings
$197
Filing a Claim
Claim Form
A completed claim form along with a copy of the receipt as proof of the
expense can be submitted via web, mobile app, mail or fax. The IRS requires
FSA participants to maintain complete documentation, including copies of
receipts for reimbursed expenses, for a minimum of one (1) year.
Debit Card
FSA participants can request a debit card for payment of eligible expenses. With
the card, most qualified services and products can be paid at the point of sale
versus paying out-of-pocket and requesting reimbursement. The debit card is
accepted at a number of medical providers and facilities, and most pharmacy
retail outlets. P&A Group may request supporting documentations for
expenses paid with a debit card. Failure to provide supporting documentation
when requested, may result in suspension of the card and account until funds
are substantiated or refunded back to the P&A Group. If employee has a health
care FSA, funds will be deducted first from the FSA until depleted and then
from the HRA, when using the debit card.
• The amount employee has available is the balance on the P&A
Card. Employee may use the P&A Card up to this amount, but never
over. Employee may check available balance at www.padmin.com.
Please keep P&A Card as it will be used again next plan year, or up
to the expiration date on the card. When the expiration nears, a new
card will automatically be ordered.
• If employee is close to reaching the balance on P&A Card, it will
only allow employee to spend the funds remaining in the account.
If the purchase exceeds the account balance, employee will need
to pay the difference using another means of payment (i.e., out-
of-pocket).
• If employee decides not to use the P&A Card, employee may submit
a manual claim for reimbursement either by fax, email, mail, or
online through the secure web form at www.padmin.com (while
logged in) or through the P&A Group mobile app for iPhone or
Android at any time during the plan year.
Rollover Guidelines
The 2024 plan year will end on December 31, 2024, however, employee will
have an additional 90 days after the plan ends to submit claims to P&A Group
for service dates from January 1, 2024 to December 31, 2024. Employee will
not be able to use the debit card for these services; however employee may
submit a claim manually through the online portal, toll free fax, email or mail.
Please Note: Employees should not use the card for services dated in old plan year as the
services will be denied and a repayment request will be generated.
P&A Group | Phone: (716) 852-2611 | www.padmin.com
15
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Employee Assistance Program
The County cares about the well-being of all employees on and off the job
and provides, at no cost, a comprehensive Employee Assistance Program
(EAP) through Cigna. EAP offers employee and each family member access to
licensed mental health professionals through a confidential program protected
by State and Federal laws. EAP is available to help employee gain a better
understanding of problems that affect them, locate the best professional help
for a particular problem, and decide upon a plan of action. EAP counselors are
professionally trained and certified in their fields and available 24 hours a day,
seven (7) days a week.
What is an Employee Assistance Program (EAP)?
An Employee Assistance Program offers covered employees and family
members free and convenient access to a range of confidential and
professional services to help address a variety of problems that may negatively
affect employee or family member’s well-being. Coverage includes three (3)
face-to-face visits with a specialist, per person, per issue, per year, telephonic
consultation, online material/tools and webinars. EAP offers counseling
services on issues such as:
9
Child Care Resources
9
Legal Resources
9
Grief and Bereavement
9
Stress Management
9
Depression and Anxiety
9
Work Related Issues
9
Adult & Elder Care Assistance
9
Financial Resources
9
Family and/or Marriage Issues
9
Substance Abuse
Are Services Confidential?
Yes. Receipt of EAP services are completely confidential. If, however,
participation in the EAP is the direct result of a Management Referral (a referral
initiated by a supervisor/manager), we will ask permission to communicate
certain aspects of the employee’s care (attendance at sessions, adherence
to treatment plans, etc.) to the referring supervisor/manager. The referring
supervisor/manager will not receive specific information regarding the referred
employee’s case. The supervisor/manager will only receive reports on whether
the referred employee is complying with the prescribed treatment plan.
To Access Services
Employee and family member(s) must register and create a user ID on
www.mycigna.com to access EAP services.
Cigna Behavioral Health
Customer Service: (877) 622-4327 | www.mycigna.com | ID: CCBOCC
Basic Life and AD&D Insurance
Basic Term Life Insurance
The County provides Basic Term Life insurance for all eligible employees at no
cost through New York Life. All full-time general employees are covered for a
benefit amount of two (2) times base annual salary rounded to the next higher
$1,000 to a maximum of $50,000.
Accidental Death & Dismemberment Insurance
The County also provides Accidental Death & Dismemberment (AD&D)
insurance which pays in addition to the Basic Term Life benefit when death
occurs as a result of an accident. The AD&D benefit amount equals the Basic
Term Life benefit and a partial benefit is also payable based on the schedule of
benefits. For detailed coverages, exclusions and stipulations, please refer to the
carrier’s benefit summary or contact New York Life’s customer service.
Age Reduction Schedule
Benefit amounts are subject to the following age reduction schedule:
• Reduces to 65% of the benefit amount at age 65;
• Reduces to 40% of the benefit amount at age 70;
• Reduces to 25% of the benefit amount at age 75;
• Reduces to 15% of the benefit amount at age 80.
• Age based reductions are subject to a minimum benefit of $10,000.
Beneficiary Designations
Events such as death, marriage, birth of a child, and divorce can drastically
change a life. For these reasons, it is important to review Life insurance
beneficiaries to make sure beneficiary designations are up to date. Employee
may update beneficiary information at any time through Bentek, or may
download the form on Connect at Work under "County Forms".
Always remember to keep beneficiary forms updated.
Beneficiary forms may be updated at anytime through Bentek.
New York Life Group Benefit Solutions
Customer Service: (800) 362-4462 | www.mynylgbs.com
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Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Voluntary Life Insurance
Voluntary Employee Life Insurance
Eligible employee may elect to purchase additional Life insurance on a
voluntary basis through New York Life. This coverage may be purchased in
addition to the Basic Term Life and AD&D coverages. Voluntary Life insurance
offers coverage for employee, spouse or child(ren) at different benefit levels.
New Hires may purchase Voluntary Employee Life insurance without
being subject to Medical Underwriting, also known as Evidence of
Insurability (EOI), up to the Guaranteed Issue amount of $200,000.
• Units can be purchased in increments of $10,000, with a benefit
maximum of $500,000, or not to exceed five (5) times annual
salary.
• Benefit amounts are subject to the following age reduction
schedule:
› Reduces to 65% of benefit amount at age 65
› Reduces to 50% of benefit amount at age 70
2024-2025 Open Enrollment: Eligible employees have the opportunity
during Open Enrollment to purchase or increase Voluntary Employee Life
insurance up the Guaranteed Issue amount of $200,000 without Evidence of
Insurability (EOI)
Voluntary Spouse Life Insurance
New Hires may purchase Voluntary Spouse Life insurance without being
subject to Medical Underwriting, also known as Evidence of Insurability
(EOI), up to the Guaranteed Issue amount of $50,000.
• Employee must participate in Voluntary Employee Life plan for
spouse to participate.
• Units can be purchased in increments of $5,000 to a maximum
of $250,000, however, coverage cannot exceed 100% of the
employee’s approved Life insurance coverage amount.
• Spouse Life insurance coverage is subject to the same age reduction
schedule as employee with coverage terminating at age 70.
2024-2025 Open Enrollment: Eligible employees have the opportunity
during Open Enrollment to purchase or increase Voluntary Spouse Life
insurance up the Guaranteed Issue amount of $50,000 without Evidence of
Insurability (EOI)
Voluntary Life Insurance Rate Table
Monthly Premium
Age Bracket
(Based On Employee Age)
Employee/ Spouse
(Rate Per $1,000 of Benefit)
Under 35 $0.128
35-39 $0.156
40-44 $0.224
45-49 $0.337
50-54 $0.536
55-59 $0.862
60-64 $1.321
65-69 $2.240
70-74 $4.250
75+ $8.026
Child(ren) $0.248
Please Note: Spouse coverage terminates when the spouse reaches age 70
Voluntary Dependent Child(ren) Life Insurance
• Employee must participate in the Voluntary Employee Life plan for
dependent child(ren) to participate.
• Children from six (6) months to age 26 may be covered for a $10,000
benefit.
• Children from birth to six (6) months may be covered for a $500
benefit.
New York Life Group Benefit Solutions
Customer Service: (800) 362-4462 | www.mynylgbs.com
17
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Voluntary Short Term Disability
The County offers Voluntary Short Term Disability (STD) insurance to all
benefit-eligible employees through New York Life. The STD benefit pays a
percentage of weekly earnings if employee becomes disabled due to a non-
work related injury or illness. The premium is calculated based on weekly
earnings; examples are illustrated in the Voluntary STD Premium Rate Table
below. Employee's STD rate and benefit will be adjusted if salary fluctuates
throughout the plan year.
Voluntary Short Term Disability (STD) Benefits
• STD provides 60% of weekly earnings, up to a maximum benefit of
$1,000 per week.
• Employee must be disabled 29 consecutive days prior to becoming
eligible for benefits (known as the elimination period).
• Benefit begins on the 30th day after the employee is disabled due to non-
work related injury or illness.
• The maximum benefit period is 22 weeks.
• Employee unable to return to work after 22 weeks will be automatically
transitioned to Long Term Disability, if elected.
• The benefit amount will be offset by any other income received.
Employee may not receive more than 60% total of all income combined.
Please Note: If employee does not elect this coverage when initially eligible, employee will have to
complete an Evidence of Insurability form if electing in the future. This form will ask basic medical
history questions and must be approved by carrier prior to employee's coverage becoming effective.
2024-2025 - Open Enrollment will not require EOI for enrollment
Voluntary STD Premium Rate Table
Annual Salary Weekly Salary
Benefit
Per Week
Monthly
Premium
$15,000 $288.46 $173.08 $4.85
$20,000 $384.62 $230.77 $6.46
$25,000 $480.77 $288.46 $8.08
$30,000 $576.92 $346.15 $9.69
$35,000 $673.08 $403.85 $11.31
$40,000 $769.23 $461.54 $12.92
$45,000 $865.38 $519.23 $14.54
$50,000 $961.54 $576.92 $16.15
$55,000 $1,057.69 $634.62 $17.77
$60,000 $1,153.85 $692.31 $19.38
$65,000 $1,250.00 $750.00 $21.00
$70,000 $1,346.15 $807.69 $22.62
$75,000 $1,442.31 $865.38 $24.23
$80,000 $1,538.46 $923.08 $25.85
$86,667 $1,666.67 $1,000.00 $28.00
Voluntary Long Term Disability
The County offers Voluntary Long Term Disability (LTD) insurance to all benefit-
eligible employees through New York Life. The LTD benefit pays a percentage
of monthly earnings if employee becomes disabled due to a illness or injury. The
premium is calculated based on monthly earnings; examples are illustrated in the
Voluntary LTD Premium Rate Table below. Employee's LTD rate and benefit will be
adjusted if salary fluctuates throughout the plan year.
Voluntary Long Term Disability (LTD) Benefits
• LTD provides 60% of monthly earnings up to a maximum benefit of
$3,500 per month.
• Benefit payments will commence on the 181st day of disability.
• Benefits are payable to age 65 or are based on a reduced benefit
duration if the employee is disabled on or after the age of 62.
• Benefits are payable for the first 24 months if employee is unable to
perform own occupation. After 24 months employee is considered
disabled if, solely due to injury or sickness, employee is unable to
perform the material duties of any occupation for which employee is
(or may reasonably become) qualified to perform.
• If employee returns to work part-time, a partial LTD benefit may be
payable.
• The benefit amount will be offset by any other income received.
Employee may not receive more than 60% total of all income combined.
Please Note: If employee does not elect this coverage when initially eligible, employee will have to
complete an Evidence of Insurability form if electing in the future. This form will ask basic medical
history questions and must be approved by carrier prior to employee's coverage becoming effective.
2024-2025 - Open Enrollment will not require EOI for enrollment
Voluntary LTD Premium Rate Table
Annual Salary
Monthly
Salary
Benefit
Per Month
Monthly
Premium
$15,000 $1,250.00 $750.00 $7.88
$20,000 $1,666.67 $1,000.00 $10.50
$25,000 $2,083.33 $1,250.00 $13.13
$30,000 $2,500.00 $1,500.00 $15.75
$35,000 $2,916.67 $1,750.00 $18.38
$40,000 $3,333.33 $2,000.00 $21.00
$45,000 $3,750.00 $2,250.00 $23.63
$50,000 $4,166.67 $2,500.00 $26.25
$55,000 $4,583.33 $2,750.00 $28.88
$60,000 $5,000.00 $3,000.00 $31.50
$65,000 $5,416.67 $3,250.00 $34.13
$70,000 $5,833.33 $3,500.00 $36.75
New York Life Group Benefit Solutions | Customer Service: (800) 362-4462 | www.mynylgbs.com
18
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Supplemental Insurance - Aflac
The County is now offering a variety of supplemental medical insurance
products sponsored by Aflac. These benefits can help off-set copays,
deductibles and out of pocket expenses incurred in the event of an accident
or illness. Aflac pays cash benefits directly to the policyholder. These coverages
may be purchased separately on a voluntary basis and premiums are paid through
semimonthly payroll deductions. To learn more about these new plans, please meet
with an enrollment counselor during Open Enrollment for a personal one-on-one
presentation. Details regarding available plans and services are also available on
Bentek.
Aflac Plan Features:
• All coverages for benefit-eligible and new hires employees are
guaranteed-issue, meaning medical underwriting is waived.
• Employee may cover a spouse and/or dependent child(ren)
regardless of participation level and coverage with other insurance
carriers.
• Several plans qualify for pre-tax premium payroll deductions.
• Benefits are paid directly to policyholder.
• Coverage is portable (with certain stipulations). Employee can take
it with them if employee changes jobs or retires.
• No age limit to enroll.
Aflac Core Benefits:
Group Accident Advantage Plus - 24-Hour High Plan
(Pre-tax Payroll Deduction)
• Pays cash benefits for expenses resulting from injuries on or off the
job and pays in addition to any other insurance in force.
• Pays cash benefits fast for expenses that major medical may
not cover, including: doctor visits, ambulance rides, ER visits,
hospitalization, surgery, stitches, casts, medical appliances, and
other medical expenses not covered by major medical insurance.
• Covers accidental fractures dislocations, lacerations burns,
concussions, coma and much more.
• Accidental Death & Dismemberment benefit included.
• Annual Wellness benefit per covered policyholder, included.
Group Hospital Indemnity Plan 2 (Pre-tax Payroll Deduction)
• Cash benefits for injuries and illness resulting in hospital admission,
daily confinement and ICU confinement.
• Covers treatment services including, outpatient services, physician
office visits, Telemedicine, major diagnostic exams, out of hospital
Rx, ER visits and rehabilitation facility stays.
• Annual wellness benefit per policyholder annually, included.
Group Critical Illness with Cancer Plan (After-tax Payroll Deduction)
• Guaranteed Issue lump sum benefit payable up to $30,000 for
employee and $15,000 for spouse coverage.
• Provides cash when needed most that will help with treatment
costs for covered critical illnesses and cancer.
• Cash flow to help pay bills so policyholder(s) can focus on
recuperation instead of stressing over out of pocket expenses.
• Dependent child(ren) coverage at no additional cost.
• Annual wellness benefit per policyholder, included.
• Payable for the following covered illnesses:
› Cancer (Internal and
Invasive)*
› Heart Attack (Myocardial
infraction)
› Kidney Failure
› Coronary Artery Bypass
Surgery
› Stroke
› End Stage Renal Failure
› Stem Cell Transplant
› Major Organ Transplant
› Bone Marrow Transplant
To get more information about individualized cost, please contact the Aflac agent.
*Refer to online brochure for full limitation and exclusions.
Aflac Group Plans
Customer Service: (800) 433-3036 | www.aflacgroupinsurance.com
Aflac | Agent: Margaret Pearson
Phone: (561) 881-1964 | Fax: (561) 881-8872
Email: margar[email protected]flac.com
19
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Retiree Benefits
Group Retiree Health Plan
The County’s Group Retiree Health Plan will be provided by the insurance
carrier(s) in force at the time of retirement and is subject to change if the
County changes carriers, benefits or rates. All of the following requirements
must be met in order for a County employee to be eligible for retiree insurance
benefits (medical, dental & vision insurance).
• Employees must have a minimum of eight (8) years of service
vested with the County in conjunction with the Florida Retirement
System (FRS).
• The employee must be eligible to receive and/or be receiving
benefits from the FRS.
• Retirement age of 55 or above must be attained (unless the
employee has 30 consecutive years of service with the FRS/25 Years
for High Risk employees).
• Having a job elsewhere is not a factor.
Health Insurance - Retiree Rates
Includes Medical, Dental and Vision Coverage
Tier of Coverage Total Monthly Rate
Employee Only $1,159.00
Employee + Spouse $2,439.00
Employee + Child(ren) $2,119.00
Employee + Family $2,679.00
Supplemental Retiree Program
Supplemental Retiree Program is a subsidized program for eligible County
retirees to assist in off-setting the cost of post-retirement medical insurance
premiums. To be eligible, the retiree must be under 65 years of age and have a
minimum of 20 years of full time service with the County. The plan participant
must be collecting FRS monthly retirement benefits. The monthly supplement
will be $10 for each year of service. Minimum of 20 years of service is required
(20 yrs × $10 = $200 per month). Time in the FRS "Drop" Program is
not included in the calculation of this benefit. The maximum monthly
benefit is $300 per month. This supplement will be deducted from the retiree’s
medical insurance invoice on a monthly basis. If the retiree’s medical insurance
is not with the county, a check will be issued on a monthly basis payable to the
retiree. Proof of other insurance is required annually. If the subsidy is greater
than the premium, the difference is taxable.
The County’s Retiree Supplement will cease when the retiree becomes eligible for
Medicare. The retiree may continue coverage under the County’s Group Retiree
Health Plan but the Supplement will no longer be deducted from the premium.
IAFF Supplemental Benefit
Any IAFF retiree must be under 65 years of age to be eligible. Under age 65
retirees who are Medicare-eligible due to SSI are not eligible. Retirees over the
age of 65, who are covered under Medicare or a Medicare Supplements are
not eligible. Under age 65 retirees who are Medicare-eligible due to being on
Social Security Disability for more than two years are also not eligible. At the
time of retirement the IAFF employee must have completed 20 years of service
with the Charlotte County Fire/EMS Department. The plan participant must be
collecting FRS monthly retirement benefits. The monthly supplement is $20
per each year of service. Minimum of 20 years of service is required (20 yrs ×
$20 = $400 per month). Time in the FRS “DROP” Program is not included
in the calculation of this benefit. The maximum monthly benefit is $600
per month. If retiree’s medical insurance is not with the County, the subsidy
will be direct deposited in the retirees bank account on a monthly basis. If
retiree is covered under the County’s medical insurance, the amount of the
supplement will be deducted from the monthly invoice. Any overage due will
be paid to retiree and will be handled on an individual basis.
Retiree Life Insurance
At retirement, if employee is age 55+ and has a minimum of eight (8) years
of service with Charlotte County, they will have the opportunity to continue
50% of the amount of the term group Basic Life insurance currently in force
while employed with Charlotte County. For example, if employee retires with
$50,000 group Basic Life insurance in force, employee would be eligible to
keep $25,000 at retirement.
Group Retiree Life insurance premiums are based on the current contract the
County has in force and premiums are subject to change annually. Beneficiary
forms may be obtained from Risk Management.
Premium Payments
Medical, dental and vision coverage is offered to all benefit-eligible retirees
as a package, however, retiree may elect to opt-out of dental and/or vision
and remain on the medical plan only (please note that this will not affect the
total premium). Electing dependent medical coverage also entitles retiree's
dependent(s) to receive dental and vision benefits unless they opt-out of
dental or vision coverage.
20
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
COBRA Benefits
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a Federal law
that provides employee the opportunity to continue existing group insurance
coverage upon separation of service from the County. After electing health
insurance benefits at New Hire Orientation, employee will be mailed an
initial COBRA Notice which explains the COBRA rights as a County employee.
Employee and covered dependent(s) may choose to elect COBRA if one (1) of
the following qualifying events occurs:
• Termination of employment from the County, unless it was due to
gross misconduct,
• A reduction of hours which would result in no longer meeting the
eligibility requirements for coverage,
• In the event of death,
• In the event of divorce or legal separation,
• Becoming eligible for Medicare, or
• A child no longer meets eligibility requirements to be covered as a
dependent.
Certain coverages may be continued for up to 18 months in the event of
termination or up to 36 months for other qualifying events. Once a qualifying
event is reported, employee or employee's covered dependent will be notified
of the right to continue coverage and state the current COBRA premiums
effective at that time. Employee and dependent(s) will have 60 days in
which to elect COBRA coverage. This election period will end on the latter, 60
days from the qualifying event or, 60 days from the date the County notifies
employee of COBRA rights.
Medical Insurance - COBRA Rates
*Medical includes Dental, Vision Coverage and the use of Employee Health Center
Tier of
Coverage
Employee
Monthly
Premium
2% Admin
Fee
Total Monthly
Premium
Employee Only $1,159.00 $23.00 $1,182.00
Employee +
Spouse
$2,439.00 $49.00 $2,487.00
Employee +
Child(ren)
$2,119.00 $42.00 $2,161.00
Employee + Family $2,679.00 $54.00 $2,732.00
P&A Group | Phone: (716) 852-2611 | www.padmin.com
Medicare Supplemental Insurance
Medicare-eligible retirees and employees may want to consider United American
Insurance Group Medicare Supplement as an alternative to electing group
insurance coverage. The group Medicare Supplement is a Guarantee Issue and
has low, affordable group rates. There are 10 plans to choose from including those
with prescription drug coverage. Depending on employee's personal situation,
a Medicare Supplemental Policy combined with current Medicare coverage may
provide employee with an adequate, lower cost alternative; especially retirees
and employees over the age of 65 who insure a spouse.
To learn more about Medicare Supplemental Insurance or to schedule a personal
appointment, contact the Valery Insurance Agency by using the contact
information provided below.
Valery Insurance Agency
Customer Service: (800) 330-8445 | www.valeryagency.com
Legal and Identity Theft Protection
Two (2) voluntarily benefits are available to employee and family member(s)
from LegalShield that provide protection, security and peace of mind
concerning identity theft and other legal issues that touch family's lives. These
benefits are paid by employee through personal bank or credit card draft, with
no long term commitment. (Payroll deduction is not available at this time.)
LegalShield
Advice on any legal issue - Talk to an attorney about any legal issue from the
trivial to the traumatic. Home - Purchase, Refinance, Foreclosure, Landlord/
Tenant; Financial - Collections, Warranties, Guarantees, Contracts; Family
Matters - Divorce, Child Custody, Child Support; Estate Issues - Wills, Living
Wills, Power of Attorney; Auto - Moving Violations, Accidents
IDShield
Monitor more of what matters - IDShield monitors employee’s identity
from every angle, not just Social Security; Counseling - identity specialists
are focused on protecting employees 24 hours a day, seven (7) days a week;
Restore Identity - IDShield provides participants with a top-notch internal
team of U.S.-based, professionally-licensed private investigators who will
work tirelessly on behalf of the covered members to fully restore their identity
to pre-theft status, including pre-existing identity theft matters. $3 million
identity fraud protection - The plan covers certain expenses and legal costs
incurred as a result of a covered identity theft event.
Enrollment in these services covers employee, spouse or domestic partner, and
dependent child(ren). See plan brochures or the dedicated website for more
information and details. Rates vary depending on plans selected. To receive the
discounted group rate, or have any questions, please contact our LegalShield
Independent Associate, Jim Carroll.
LegalShield | Agent: Jim and Andrea Carroll
https://www.legalshield.com/info/charlottecounty | (941) 276-7412
21
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Employee Health Centers
The Employee Health Centers (EHC) were established to provide County
employees easy and cost-free access to the highest quality medical care for
acute and chronic conditions. The EHC is available to individuals who are
enrolled in the County’s medical plan, including employee, spouse, child(ren)
and retirees.
The EHC is administered by My Health Onsite, a third party vendor. Utilization
is completely voluntary. All visits with Health Center staff are completely
confidential and no personal health information is shared with the employer.
Employee still has access to primary care providers, specialists, hospitals, and
outpatient facilities through the County’s medical plan with Cigna.
Why choose the Employee Health Center?
9
No Copays
9
Online scheduling with dedicated 20-minute appointments —
no long stay in a waiting room!
9
Many prescriptions dispensed onsite cost-free
9
100% confidential and HIPAA compliant
What services can be performed at the Health Center?
9
Primary Care
9
Acute Care & Urgent Care
9
Prescription Dispensing
9
Labs performed onsite — no
trip to a separate facility!
9
Digital X-Rays
9
Stress Tests and EKGs
9
Vital Health Profiles (VHP)
9
Flu Shots & Pneumonia Shots
Please be advised that Physicians at the EHC do not have hospital rights and
can’t admit patients directly from the EHC.
Accessing the Employee Health Center
All employees, dependents and retirees on the County’s medical plan have
cost-free access to the EHC. Appointments are required for all primary care
visits and are scheduled in 20-minute intervals. The medical staff will advise
if a longer appointment is needed.
The EHC does not allow walk-ins, unless it is specifically announced (i.e., flu
shots or tobacco test). Appointments are always needed. To contact the EHC
with questions for a doctor or nurse, please call (941) 764-0301.
In all emergency situations, please call 911.
Registration
Register to use the Employee Health Centers
All patients with a unique valid email address should receive an email invitation
from “[email protected]” with the subject line: Patient Portal Access
Information from My Health Onsite (MHO). (Please check spam/junk folders)
To access your New Patient Portal, simply follow instructions in the email sent
which includes:
• Your User Name and Temporary Password
Validate access by using your “Date of Birth”.
If you have not received the email invitation, please call (941) 800-2005 to
update your email address.
Proxy Authorization
For patients younger than 18 or adults wishing to provide web portal access to
another person, a Patient Portal Proxy Authorization Form must be completed
to comply with regulatory requirements. The proxy form can be obtained at
the Employee Health Center, Risk Management Department or downloaded from
MHO’s web site at the following URL: www.MyHealthOnsite.com/patient-access.
The forms must be completed and turned into the Employee Health Center
staff to establish web portal access for proxy accounts.
A proxy is when you allow a spouse, parent, or guardian access to another
family member’s medical records. This form gives permission to have
someone else access your patient portal. It can be between spouses, adult
dependents, guardians, or parents and minors between the ages of 13
– 17. The Proxy Authorization form is available at the Employee Health
Centers. It is also available under Forms on Connect at Work, as well as Risk
Management, Wellness at Work website, and the My Health Onsite website:
www.MyHealthOnsite.com/patient-access.
How to Login
1. Go to www.MyHealthOnsite.com.
2. Click Login.
3. Select Patient Access.
4. Select the Patient Access Hyperlink to take you to the Patient Portal page.
5. On the Patient Portal page, Enter User Name and Password to log in to
book, cancel or reschedule your appointment.
Please Note: Each covered dependent must register with My Health Onsite and create
an account.
22
Charlotte County
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Employee Benefit Highlights
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2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Bob Pryor EHC Location –
Port Charlotte
EMPLOYEE HEALTH
CENTER
Bob Pryor Employee Health Center/My Health Onsite
1050 Loveland Blvd., Port Charlotte, FL 33980
(941) 800-2005 • (941) 764-0301
www.MyHealthOnsite.com/patient-access
Health Center Hours of Operation
Monday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Tuesday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Wednesday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Thursday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Friday 8:00 a.m. - 6:00 p.m. (closed 1:00 - 2:00)
Saturday 8:00 a.m. - 4:00 p.m. (closed 12:30 - 1:00)
Lab Hours
Monday 8:00 a.m. - 11:00 a.m.
Tuesday 7:00 a.m. - 10:00 a.m.
Wednesday 8:00 a.m. - 11:00 a.m.
Thursday 8:00 a.m. - 11:00 a.m.
Friday 8:00 a.m. - 11:00 a.m.
South County EHC Location –
Punta Gorda
EMPLOYEE HEALTH
CENTER
South County Employee Health Center/My Health Onsite*
514 E. Grace Street, Punta Gorda, FL 33950
(941) 800-2005 • (941) 764-0301
www.MyHealthOnsite.com/patient-access
Health Center Hours of Operation
Monday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Tuesday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Wednesday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Thursday 8:00 a.m. - 7:00 p.m. (closed 1:00 - 2:00)
Friday 8:00 a.m. - 6:00 p.m. (closed 1:00 - 2:00)
Saturday Closed
Lab Hours
Monday 8:00 a.m. - 11:00 a.m.
Tuesday 8:00 a.m. - 11:00 a.m.
Wednesday 8:00 a.m. - 11:00 a.m.
Thursday 8:00 a.m. - 11:00 a.m.
Friday 8:00 a.m. - 11:00 a.m.
*Please Note: This location does not treat any workers compensation or
occupational visits, nor do they have a x-ray machine.
23
Charlotte County
|
Employee Benefit Highlights
|
2024-2025
© 2016, Gehring Group, Inc., All Rights Reserved
Employee Health Centers Services
Save Money - Use the Employee Health Centers
Prescription Medications
The EHCs dispense generic and brand name medications at no cost to patients.
Health Center staff can prescribe medication for a variety of acute and chronic
conditions. If the Health Center does not stock a prescribed medication, staff
will provide a prescription to take to the local pharmacy and purchase through
the Cigna medical plan.
Schedule an appointment with a staff provider today to review current
prescriptions. Please Note: The Health Centers are not pharmacies. Member is
required to meet with the medical staff before a prescription can be dispensed
for employee or a dependent.
Brand Name Generics Available at the EHC
9
Glucophage
9
Mevacor
9
Synthroid
9
Prilosec Omeprazole
(Can often be substituted for Nexium)
9
Metformin
9
Lovastatin
9
Levothyroxine Sodium
FREE Medications Available
9
Acid Reflux/Heartburn
9
Allergy
9
Anti-Depressants
9
Diabetes
9
Blood Pressure
9
Cholesterol
9
Antibiotics
9
And Many More!
My Health Onsite Rx Mail-Order Program with Elixir
The EHCs offer medications available through an exclusive mail-order
program. This program will not replace the Cigna program, but will provide
an alternative at a reduced cost. Narcotics will not be available through this
program, but employee will have access to additional medications, including
name brand. If employee is currently filling medication through Cigna and
paying a copay, please schedule an appointment today and have medications
reviewed by the EHC physicians.
Employee Cost for 90-Day Supply
Tier 1 - Generic
Cigna Copay Elixir
$30.00 $10.00
Tier 2 - Formulary Brand
Cigna Copay Elixir
$60.00 $20.00
Tier 2 - Non-Formulary Brand
Cigna Copay Elixir
$120.00 $40.00
Elixir Pharmacy
Customer Service: (866) 909-5170 | www.elixirsolutions.com
Access Your Elixir Account:
User Name: ccbocc+(SSN) | BIN number: 009893 / PCN: CPLUS
Radiology/Imaging Referrals
The EHCs have an agreement with American Imaging and Akumin for County
employees to obtain radiology services, at no cost. Some of the tests include
CT scans, mammograms and bone density screenings. Employees may get a
referral from an EHC physician, or they can bring a prescription from an outside
provider for the referral.
Tobacco Cessation - Self Paced
Employee may be supported with an online program, educational material,
and reading material and while working with a Health Coach to become
tobacco free. The provider may also request the County to pay for Chantix.
24
Charlotte County
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Employee Benefit Highlights
|
2024-2025
Notes
Use this section to make notes regarding personal benefit plans or to keep track of important information such as doctors' names and addresses or prescription medications.
© 2016, Gehring Group, Inc., All Rights Reserved
FINAL
Last Modified: July 16, 2024 3:49 PM
To access your benefits online,
visit the Employee Benefits Center at:
https://www.mybentek.com/charlottecounty
To access benefit
booklet, use a
mobile device to
scan code.
3500 Kyoto Gardens Drive, Palm Beach Gardens, Florida 33410
Toll Free: (800) 244-3696
|
Fax: (561) 626-6970
|
www.gehringgroup.com
© 2016, Gehring Group, Inc., All Rights Reserved
