Retiree Benefits Reference Guide

Retiree Benefits Reference Guide
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FSRBC | Table
of Contents
INTRODUCTION .....................................................................................................3
WELCOME........................................................................................................4
LEARN MORE..........................................................................................................5
ELIGIBILITY.......................................................................................................6
MEDICARE OVERVIEW......................................................................................6
MEDICARE SUPPLEMENT & PRESCRIPTION DRUG PLANS...............................9
MEDICARE ADVANTAGE................................................................................. 12
VOLUNTARY BENEFITS.........................................................................................20
DENTAL.......................................................................................................... 21
VISION............................................................................................................24
IT PLEASE........................................................................................................ 27
ID COMMANDER.............................................................................................29
PET INSURANCE............................................................................................. 31
TIME TO ENROLL ..................................................................................................33
HOW TO ENROLL IN MEDICARE PLANS.........................................................34
HOW TO ENROLL IN NON-MEDICAL BENEFITS.............................................. 35
BILLING ................................................................................................................36
TOOLS................................................................................................................. 38
COMPLIANCE AND LEGAL............................................................................. 40
NEEDS ASSESSMENT CHECKLIST....................................................................41
DIRECTORY....................................................................................................43
2 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Introduction | FSRBC
INTRODUCTION
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How the FSRBC Works For You!
School Districts join the Florida School
Retiree Benefits Consortium (FSRBC)
to take advantage of expanded benefit
options and lower rates.
FSRBC contracts with providers,
following a public request for proposal
process, to offer benefit products and
negotiate competitive rates based
upon the combined pool of retirees.
FBMC Benefits Management, Inc.
(FBMC) acts as the administrator to
communicate benefits information to
retirees, enroll retirees in voluntary
(non-medical) products and collect
premiums.
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INTRODUCTION
FSRBC | Welcome
Welcome
THE BENEFITS OF AGING
ABOUT US
Retirement is one of life’s greatest
milestones. It’s a time of reflection, family
and fun. This packet was mailed to you
because your School District has partnered
with the Florida School Retiree Benefits
Consortium (FSRBC) to offer benefits to
its retirees who have reached the age of
65 and are now Medicare eligible. With the
FSRBC’s reasonable rates, you can now
obtain quality, affordable coverage and
enjoy The Benefits of Aging.
On behalf of your School District, the
FSRBC provides Medicare-eligible retirees
with access to high quality Medicare and
Voluntary Benefits, tailored especially for
retirees age 65 or older. FBMC Benefits
Management, Inc. (FBMC) is the benefits
administrator for the FSRBC, and will be
your primary point of contact for your
benefit needs.
WHAT’S IN THIS GUIDE?
It is important to review this Benefits Guide
thoroughly. The information contained
within this guide will assist you in making
educated decisions regarding your benefit
selections. In this guide you will find:
• Eligibility information
• Details on available Medicare Plans
• Information on Voluntary Benefits
(non-medical) Plans (dental, vision,
IT Technical Support, ID Theft
Protection, pet insurance)
• Instructions on how to enroll and
enrollment forms
• Information on payment and billing
options
The FSRBC is pleased to offer competitively
priced, high-value Medicare Plans and
additional Voluntary Benefits to retirees from
participating School Districts throughout
Florida. Through the FSRBC, your options
include Medicare Supplement Plans,
Medicare Part D Pharmacy Plans, and
Medicare Advantage Plans*. In addition,
the FSRBC is also offering the following
Voluntary Benefits:
•
•
•
•
•
Dental
Vision
IT Technical Support
ID Theft Protection
Pet Insurance
*Note: The Medicare Advantage Plans available to
you are determined by your county of residence.
Refer to the residence chart on pages 17 - 19 to
see which plans you are eligible for.
4 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Learn More | FSRBC
IT’S TIME TO LEARN MORE ABOUT MEDICARE OPTIONS!
In the Learn More section of this guide, you will find important
information about available Medicare Plans and Voluntary Benefits.
LEARN MORE
Please review this Benefits Guide thoroughly as it contains
important information regarding all of the benefit plans available
to you. This information will help you choose the benefits that best
suit your needs and your budget!
Medicare Plans
The Learn More section provides information
about Medicare Parts A and B as well as
the additional coverage available through
the FSRBC. Medicare does not cover all
expenses, and this section explains the
options available to help pay those costs.
With the FSRBC, you have the security of
knowing you will have the coverage you need,
so that you can truly enjoy The Benefits of
Aging.
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FSRBC | Eligibility
Eligibility Information
As a Medicare eligible retiree age 65 or
over, your benefit plans will be changing.
You are now eligible for medical and
Voluntary Benefits (non-medical) offered
by the FSRBC. To be eligible for FSRBC
Medicare options, you and/or your spouse
or dependent must be 1) Medicare eligible
and 2) Enrolled in Medicare Part A and Part
B. If you enroll in a Voluntary Benefit (nonmedical) Plan through the FSRBC, you may
cover any eligible dependents; they do not
need to be Medicare eligible.
Your non Medicare eligible dependents will
remain eligible for the district’s medical
plans until they, too, become Medicare
eligible. At that time, they will have access
to the same FSRBC Medicare Plans that
are available to you.
Who is an Eligible Dependent?
1. Your Spouse – the person to whom
you are legally married.
2. Your Child(ren) – biological, legally
adopted, stepchild(ren), a child for
whom you have legal guardianship,
or foster child(ren) are currently
eligible for your district’s medical
plan.
If you haven’t already done so, you must
enroll in Medicare Part A and Part B to be
eligible for benefits through the FSRBC.
According to Medicare guidelines you have
seven months, beginning three months
prior to your birth month, to apply for Part
A and Part B. If you miss this opportunity to
enroll, you can sign up during the Medicare
General Enrollment Period from January 1–
March 31 each year.
Note: If you enroll after the initial sign-up period,
you may have to pay a higher premium for late
enrollment.
Medicare Overview
Medicare Basics
If you or your dependent will be turning 65
within the next few months, there are a few
things you need to know about Medicare.
Original Medicare is your coverage
managed by the federal government, and
includes:
Medicare Part A - Hospital costs
Medicare Part B - Doctor and outpatient
costs
Medicare Part C - Sometimes referred to as
Medicare Advantage Plans, allows private
health insurance companies to provide
Medicare benefits and additional benefits.
When you join a Medicare Advantage Plan,
you are still in the Medicare program and
must continue paying your Part B premium.
Medicare Part D - Provides outpatient
prescription drug coverage and is provided
only through private insurance companies
that have contracts with the government—it
is not provided directly by the government.
This coverage is optional, but if you don’t
sign up when you’re first eligible, you might
have to pay a late enrollment penalty if you
decide to enroll later.
FSRBC BENEFITS
Additional benefits options available to
you through the FSRBC include Medicare
Supplement Plans (Medigap), Medicare
Advantage Plans (Medicare Part C),
Prescription Drug Plans (Medicare Part D)
and Voluntary Benefits (non-medical).
6 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Medicare Overview | FSRBC
To get a Medicare Supplement Plan through
the FSRBC, you must already be enrolled in
Original Medicare Parts A and B. You can
then enroll in a Supplement Plan through
one of the available providers starting on
page 9, and the Supplement Plan will cover
some or all of the costs that Parts A and B
do not cover.
Note: Medicare Supplement Plans do not cover
most prescription drugs. If you enroll in a Medicare
Supplement Plan you should consider enrolling in
a Medicare Part D Prescription Drug Plan.
ADVANTAGE PLAN (MEDICARE PART C)
To get a Medicare Advantage Plan through
the FSRBC, you must already be enrolled
in Original Medicare Parts A and B. Look
for the Medicare Advantage Plans available
to you based on your county of residence
(see pages 17 - 19) and then enroll directly
with one of the available providers listed on
page 12; they will provide your benefits on
behalf of Medicare.
The Medicare Advantage Plans offered
through the FSRBC include prescription
drug coverage. Please review the plan
features carefully to ensure the plan you
select will meet your needs.
PRESCRIPTION DRUG PLAN (MEDICARE
PART D)
To get a Prescription Drug Plan through
the FSRBC, you must already be enrolled
in Original Medicare Parts A and B. You
can then enroll in one of the Prescription
Drug Plan options shown on page 9. You
can purchase a Prescription Drug Plan
alone or in conjunction with a Medicare
Supplement Plan. Medicare Advantage
Plans available through the FSRBC already
include your Part D drug coverage, so you
cannot purchase a separate Prescription
Drug Plan when you enroll in a Medicare
Advantage Plan.
Note: You must apply for a Prescription Drug Plan
when you are first eligible for Medicare to avoid a
late enrollment fee. Even if you do not currently
take prescription drugs you may want to take future
needs into consideration.
MEDICARE PLANS NEEDS ASSESSMENT
You should carefully consider your medical
needs when determining whether to
purchase any plans to help cover expenses
not normally covered by Medicare Part A
and Part B. Information to consider when
choosing a plan includes:
• Doctor and/or pharmacy
preferences
• Prescription medications and yearly
costs
• Any chronic conditions
• Your general health
• Travel frequency
• Other available retiree health
coverage (through a spouse, the
military, etc.)
• Where you live (county, own home,
assisted living, etc.)
You can find out more about which plan
works best for you by calling the providers
directly. Contact information for the providers
serving your area can be found on page
43 in this Benefits Guide. Use the handy
Needs Assessment Checklist on pages 41
and 42 to compare plans.
VOLUNTARY BENEFITS (NON-MEDICAL)
The
available
Voluntary
Benefits
administered by FBMC include dental,
vision, pet insurance, ID Theft Protection,
and IT Technical Support plans. These
plans are described more fully in the next
section of this guide.
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MEDICARE SUPPLEMENT PLANS
(MEDIGAP)
LEARN MORE
FSRBC | Medicare
Overview
ABOUT YOUR OPTIONS
You can elect to have Medicare Parts A and B along with a Medicare Supplement
Plan for your medical coverage and add a separate Medicare Part D Plan for your
prescription drug coverage. Or you can choose a Medicare Advantage Plan, which
offers additional benefits and includes prescription drug coverage.
Medicare Part A and B (Original Medicare)
You must be enrolled in Medicare Parts A and B to be
eligible for the FSRBC plans.
Medicare Part A
Medicare Part B
Hospital costs
Doctor and outpatient costs
With the FSRBC you can also enroll in a
and/or
Medicare
Supplement Plan
Medicare Part D
Plan
Covers some or all of the
cost not paid by Parts A
and B.
Options provide various
levels of prescription drug
coverage.
or
8 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Medicare
Advantage Plan
(Part C)
Provides traditional
Medicare and other
benefits. All FSRBC
Advantage Plans include
prescription drug
coverage.
Medicare Overview | FSRBC
Supplement Plan Options
While Medicare pays for many health care
services and supplies, a supplement plan
is an add-on to your Medicare Part A and
Part B and offers extra coverage to your
Medicare benefits expenses such as
copayments, coinsurance, and deductibles.
Information to Consider in a Medicare
Supplement Insurance Plan:
• You must be enrolled in Medicare
Part A and Part B.
• You should apply for a Prescription
Drug Plan when you apply for a
supplement plan to avoid incurring
extra fees.
• You pay a monthly premium in
addition to your direct payment to
Medicare.
• You and your Medicare-eligible
spouse
or
dependent
must
each buy your own policy.
MEDICARE PART D PRESCRIPTION DRUG
PLANS
Medicare Supplement Plans offered through
the FSRBC do not cover most prescription
drugs. A Medicare Part D Prescription Drug
Plan will help cover your prescription drug
costs. There are several levels of coverage
available to meet your needs. Contact
the provider(s) below to receive more
information.
Note: You must apply for a Prescription Drug Plan
when you are first eligible for Medicare to avoid a
late enrollment fee.
Supplement and Prescription Drug Plans
(PDP) are available nationwide. Contact
the providers listed below to receive more
information.
Supplement Plans and Prescription Drug Plans provider contact information.
Medicare Supplement Plans
Plan A
Plan F
Plan N
UnitedHealthcare®
Medicare Part D Prescription Drug Plan
Saver Plus Plan
Preferred Plan
UnitedHealthcare®
Comprehensive Pharmacy Plan
Premier Pharmacy Plan
You will receive an enrollment kit
from United Healthcare® at your
home address.
You will receive an enrollment kit
from United Healthcare® at your
home address.
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MEDICARE SUPPLEMENT INSURANCE
PLAN (MEDIGAP)
LEARN MORE
FSRBC | Medicare
Overview
Medicare Supplement Plan Benefits
AARP® Plan
Benefits
Part A Coinsurance plus 365 additional
hospital days after Medicare benefits
end Hospital Costs
Part B (Medical) Coinsurance or
Copayment
Blood (First Three Pints)
Hospice/Respite Care Coinsurance or
Copayment
Skilled Nursing Facility Care
Coinsurance
Part A Deductible
Part B Annual Deductible
Part B Excess Charges
Foreign Travel Emergency Care2
Plan A
Plan F
Plan N
√
√
√
√
√
Copay1
√
√
√
√
√
√
√
√
√
√
√
80%
√
80%
1 - Plan pays Part B coinsurance or copayment except for an insured copay of up to $20 for each doctor’s
office visit and up to $50 for each emergency room visit (emergency room copay waived if admitted as
inpatient).
2 - Beneficiaries must pay a separate deductible for a foreign travel emergency ($250 per year) and a
lifetime maximum benefit of $50,000 applies.
10 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Medicare Overview | FSRBC
Medicare Part D Plan Prescription Drug Benefits
UnitedHealthcare® MedicareRx Plan
Medicare RX
Saver Plus Plan
Medicare RX
Preferred
Comprehensive
Plan
Premier Plan
$360.00
$0
$0
$0
Tier 1 - Preferred
Generic
$1 - $3
$2 - $4
$10
$7
Tier 2 - Generic
$2 - $7
$15 - $20
$45
$30
$23 - $30
$36 - $47
$75
$60
30% - 40%
40% - 50%
Tier 4 - Specialty
33%
$75
25%
33%
N/A
N/A
N/A
Tier 1 - Preferred
Generic
58%
58%
Tier 1 - Generic
$10
$7
Tier 2 - Generic
58%
58%
45%
$30
45%
45%
45%
$60
45%
45%
Tier 4 - Specialty
45%
$75
45%
45%
N/A
N/A
N/A
Greater of $2.95
or 5%
Greater of
$2.95 or 5%
Greater of $7.40
or 5%
Greater of
$7.40 or 5%
N/A
N/A
$20
$14
$90
$60
$150
$120
33%
$150
N/A
N/A
$100.01
$249.35
Deductible
Initial Coverage Period
Tier 3 - Preferred
Brand
Tier 4 - Nonpreferred Brand
Tier 5 - Specialty
Tier 1 - Generic
Tier 2 - Preferred
Brand
Tier 3 - Nonpreferred Brand
Tier 3 - Preferred
Brand
Tier 4 - Nonpreferred Brand
Tier 5 - Specialty
Tier 2 - Preferred
Brand
Tier 3 - Nonpreferred Brand
Catastrophic
Tier 1 - Preferred
Generic
Tier 2 - Generic
Tier 3 - Preferred
Brand
Tier 4 - Nonpreferred Brand
Tier 5 - Specialty
Tier 1 - Generic
Greater of $2.95 Greater of $2.95
or 5%
or 5%
Tier 2 - Preferred
Brand
Tier 3 - Nonpreferred Brand
Greater of $7.40 Greater of $7.40
Tier 4 - Specialty
or 5%
or 5%
N/A
Mail Order
Tier 1 - Preferred
Generic
Tier 2 - Generic
$0
$0
Tier 1 - Generic
$0
$0
Tier 3 - Preferred
Brand
Tier 4 - Nonpreferred Brand
Tier 5 - Specialty
$64
$93
30%
40%
Tier 2 - Preferred
Brand
Tier 3 - Nonpreferred Brand
Tier 4 - Specialty
25%
33%
N/A
$27.50
$63.80
Premium
Monthly
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FSRBC | Medicare
Overview
Medicare Advantage Plans
When you enroll in a Medicare Advantage
Plan, you receive your Medicare Part A and
Part B benefits from your Advantage Plan, not
from Original Medicare directly. Medicare
Advantage Plans offered through the FSRBC
also include your Part D Prescription Drug
coverage; you do not need to purchase a
separate drug plan. Medicare Advantage
Plans also may offer enhanced benefits
such as wellness programs and care
management.
Medicare Advantage Plans must follow
Medicare guidelines. Each Advantage Plan
may have different out-of-pocket expenses
and have different rules regarding services.
Please check with each provider before
making a selection.
Note: Available providers may vary according to
your county of residence.
Eligibility Requirements:
The following conditions are required to
join a Medicare Advantage Plan:
• You must be enrolled in Medicare
Part A and Part B.
• You are not also enrolled in a
Medicare Supplement Plan or
separate Part D Plan.
• You live in the plan’s service area.
• If you have End Stage Renal
Disease (ESRD), please contact the
carriers for special details.
To select a Medicare Advantage Plan:
Please select your county of residence from
the chart on pages 17 - 19 to determine
which plan options are available to you.
Contact the providers to receive more
information.
Medicare Advantage Plans – County Specific
Medicare Choice HMO
Cigna Leon Cares
Rewards Plan
Group Plus A HMO
Group HMO POS
Zero Premium HMO
Comprehensive PPO
Zero Premium National PPO
Low Premium National PPO
Comprehensive National PPO
Premier National PPO
AvMed
Cigna Leon
Information will be mailed to you if you
live in the service area. Call AvMed to
request a complete packet.
Call Cigna Leon to have an enrollment kit
mailed to you.
Health First
Call Health First to have an enrollment kit
mailed to you.
Humana
Packet will be mailed to you if you live in
the service area.
UnitedHealthcare®
Information will be mailed to you
if you live in the service area. Call
UnitedHealthcare® to request a complete
packet.
12 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Medicare Overview | FSRBC
AvMed Medicare Advantage Plan (HMO)
(See chart for available Medicare Advantage Plan by county of residence.)
Medical
Annual Deductible
Annual Out-of-Pocket
Hospital Admit
Office Visit
Primary/Specialist
Emergency Care
Outpatient Surgery Non-hospital/Hospital
Rx
Tier 1 & 2 - Generic
Tier 3 & 4 - Brand
Preferred/Non-preferred
Tier 5 - Specialty
Coverage Gap
Medicare Choice
Miami Dade County
HMO
$0
$4,000
$0/ Day 1 - 5 Days
$55/Day 6 - 20 Days
$0/Day 21 - 90 Days
$0/$0 - $25
Broward County
HMO
$0
$5,000
$0/ Day 1 - 5 Days
$80/Day 6 - 20 Days
$0/Day 21 - 90 Days
$0/$10-$30
$75
$50/$150
$75
$75/$150
$0-$3
$35/$70
$0-$7
$35/$70
33%
Applies
33%
Applies
If you would like more information about the AvMed Medicare Advantage Plan or have questions, please call an AvMed
Benefits Consultant at 1-800-835-6137, or for TTY users, 711, from October 1, 2015 - February 14, 2016, from 8 a.m. - 8
p.m., 7 days a week, and February 15, 2016 - September 30, 2016, from 8 a.m. - 8 p.m., Monday-Friday 8 a.m. - 8 p.m.,
seven days a week.
Cigna Leon Medical Center Health Plans - Leon Cares (HMO)
(See chart for available Medicare Advantage Plan by county of residence.)
Benefit
Medical
Annual Deductible
Annual Out-of-Pocket
Hospital Admit
Office Visit
Emergency Care
Outpatient Surgery
Rx
Tier 1 - Generic
Tier 2 & 3 - Brand
Preferred/Non-preferred
Tier 4 - Specialty
Coverage Gap
Cigna Leon Cares
HMO
$0
$6,700
$0
$0
$0
$0
$0
$0
33%
Applies
If you would like more information about the Cigna Leon Medical Center Health Plans or have questions, please call Cigna
Leon Medical Center Health Plans Member Services, at 305-229-7543 or toll-free 1-866-266-8917 or, for TTY users, 711,
from 8 a.m. - 8 p.m., seven days a week.
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Benefit
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FSRBC | Medicare
Overview
Health First Medicare Advantage Plans
(See chart for available Medicare Advantage Plans by county of residence.)
Benefit
Rewards Plan
Group Plus A
HMO
HMO
In-Network
Out-of-Network
$0
$0
$0
$0
$6,650
$2,000
$3,000
$6,000
$275/Day to 7 Days
$250
$150/Day to 5 Days
20%
Office Visit
Primary/Specialist
$10/$40
$10/$20
$15/$25
20%
Emergency Care
$75
$50
$50
$50
$350
$125
$150
20%
Tier 1 - Generic
$0 to $10
$0 to $10
$0 to $10
N/A
Tier 2 & 3 - Brand
Preferred/Non-preferred
$45/$95
$25/$45
$45/$90
N/A
33%
$90
33%
N/A
Applies
No Gap
Applies
Applies
Medical
Annual Deductible
Annual Out-of-Pocket
Hospital Admit
Outpatient Surgery
Group HMO POS
Rx
Tier 4 - Specialty
Coverage Gap
If you would like more information about the Health First Plans or have questions, please call Health First Member Services,
at 1-800-716-7737, from 8 a.m. - 8 p.m., seven days a week.
Humana Medicare Advantage Plans
(See chart for available Medicare Advantage Plans by county of residence.)
Benefit
Medical
Annual Deductible
Zero Premium HMO
In-Network
Comprehensive PPO
In-Network
Out-of-Network
$0
$0
$3,400
$2,500
$0
$175
Office Visit
Primary/Specialist
$0/$0
$5/$15
Emergency Care
$75
$65
Outpatient Surgery
$50
$50
$0
$5
Tier 2 & 3 - Brand
$10/$40
$30/$60
Tier 4 - Specialty
33%
33%
Applies
Applies
Annual Out-of-Pocket
Hospital Admit
Rx
Tier 1 - Generic
Coverage Gap
If you would like more information about the Humana Group Medicare Advantage Plans or to receive a complete preenrollment plan guide, call Humana at 1-800-824-8242, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.
14 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Medicare Overview | FSRBC
UnitedHealthcare® Medicare Advantage Plans
(See chart for available Medicare Advantage Plans by county of residence.)
Benefit
Medical
Annual Deductible
Annual Out-of-Pocket
Hospital Admit
Office Visit
Primary/Specialist
Zero Premium Miami
Low Premium National
PPO
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
$0
$0
$0
$0
$400 Med & $360 Rx
$4,500
$10,000
combined
$5,900
$10,000
combined
$6,700
$200/Day to
8 Days
40%
$275/Day to
6 Days
40%
$230/Day to
7 Days
$10/$40
$35/$60
$20/$50
$35/$60
$25/$50
$75
$65
$65
20%
Emergency Care
Outpatient Surgery
Zero Premium National
PPO Plan
$65
In-Network
Out-ofNetwork
$200
40%
20%
40%
$10
N/A
$10
N/A
25%
N/A
$45/$100
N/A
$45/$100
N/A
25%
N/A
$100
N/A
$100
N/A
25%
N/A
Applies
N/A
Applies
N/A
Applies
N/A
Tier 1 - Generic
Tier 2 & 3 - Brand
preferred/non-preferred
Tier 4 - Specialty
Coverage Gap
If you would like more information about the UnitedHealthcare® Group Medicare Advantage plan or to receive a complete
pre-enrollment plan guide, call UnitedHealthcare® at 1-877-776-1466, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.
UnitedHealthcare® Medicare Advantage Plans
(See chart for available Medicare Advantage Plans by county of residence.)
Benefit
Medical
Annual Deductible
Comprehensive National PPO
In-Network
Out-of-Network
Premier National PPO
In-Network
Out-of-Network
$250
$0
$6,700
$2,500
$230/Day to 7 Days
$175
Office Visit
Primary/Specialist
$20/$30
$5/$15
Emergency Care
$65
$65
Outpatient Surgery
20%
$15
Annual Out-of-Pocket
Hospital Admit
Rx
Tier 1 - Generic
Tier 2 & 3 - Brand
preferred/non-preferred
Tier 4 - Specialty
Coverage Gap
$7
$5
N/A
$40/$90
$30/$60
N/A
$90
$80
N/A
No Gap
No Gap
N/A
If you would like more information about the UnitedHealthcare® Group Medicare Advantage Plan or to receive a complete
pre-enrollment plan guide, call UnitedHealthcare® at 1 877-776-1466, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.
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Rx
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FSRBC | Medicare
Overview
Medicare Advantage Plan Enrollment Options
By County of Residence
STEP 1: LOCATE YOUR COUNTY OF RESIDENCE.
Your county of residence will determine which
Medicare Advantage Plans you are eligible to
enroll in.
STEP 2: USE THE KEY TO IDENTIFY PROVIDERS
The providers available for each county are color
coded on the map. Some counties have multiple
providers.
STEP 3: REVIEW THE PLANS
Refer to the County of Residence chart on pages
17 - 19 for plan rates.
Providers by County
■ UnitedHealthcare® Plan (UHC)
■ UHC & Humana
■ UHC, AvMed & Humana
■ UHC, AvMed, Cigna & Humana
■ UHC & Health First
16 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
County/Metro
Area
Cigna Leon
Cares
Medicare
Choice
HMO
$0
Cigna
Leon Plan
AvMed
Plan
$0
Rewards
Plan
$174
Group
HMO POS
$0
Zero Premium HMO
$144.79
Comprehensive
PPO
Humana Plans
LEARN MORE
$176
Group Plus
A HMO
Health First Plans
$0
$0
$0
$0
$0
$0
Zero
Premium
National
PPO
$46.35
$25.75
Low
Premium
National
PPO
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
Comprehensive
National PPO
UnitedHealthcare® Plans
$309.82
$309.82
$310.03
$310.03
$309.82
$338.15
$309.82
$309.82
$309.82
$320.95
$309.82
$309.82
$320.95
$309.82
$320.95
$239.17
$239.17
$239.17
$338.15
$320.95
$309.82
$320.95
Premier National PPO
Find your county of residence in the chart below to see which Medicare Advantage Plans are available to you. If you would
like to enroll in one of the Medicare Advantage Plans or receive more information contact the appropriate provider listed
below. See the directory on page 43 for provider contact information.
Medicare Advantage Plans Enrollment Options By County of Residence
Medicare Overview | FSRBC
MYFSRBC.ORG
| 17
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
Levy
Liberty
Madison
Manatee
Marion
Martin
Miami-Dade
Monroe
Nassau
County/Metro
Area
$0
Cigna Leon
Cares
Medicare
Choice
HMO
$0
Cigna
Leon Plan
AvMed
Plan
$0
Rewards
Plan
$176
Group Plus
A HMO
$174
Group
HMO POS
Health First Plans
$0
Zero Premium HMO
$144.79
Comprehensive
PPO
Humana Plans
18 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Zero
Premium
National
PPO
Low
Premium
National
PPO
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
Comprehensive
National PPO
UnitedHealthcare® Plans
$320.95
$320.95
$338.15
$320.95
$320.95
$309.82
$309.82
$320.95
$320.95
$338.15
$320.95
$320.95
$309.82
$338.15
$309.82
$320.95
$320.95
$309.82
$320.95
$338.15
$338.15
$338.15
$309.82
Premier National PPO
Find your county of residence in the chart below to see which Medicare Advantage Plans are available to you. If you would
like to enroll in one of the Medicare Advantage Plans or receive more information contact the appropriate provider listed
below. See the directory on page 43 for provider contact information.
Medicare Advantage Plans Enrollment Options By County of Residence
LEARN MORE
FSRBC | Medicare
Overview
Okaloosa
Okeechobee
Orange
Osceola
Palm Beach
Pasco
Pinellas
Polk
Putnam
Santa Rosa
Sarasota
Seminole
St. Johns
St. Lucie
Sumter
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington
County/Metro
Area
Cigna
Leon Plan
Cigna Leon
Cares
AvMed
Plan
Medicare
Choice
HMO
Rewards
Plan
Group
HMO POS
$0
Zero Premium HMO
$144.79
Comprehensive
PPO
Humana Plans
LEARN MORE
Group Plus
A HMO
Health First Plans
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Zero
Premium
National
PPO
$56.65
Low
Premium
National
PPO
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
$148.34
Comprehensive
National PPO
UnitedHealthcare® Plans
$309.82
$320.95
$309.82
$239.17
$338.15
$320.95
$309.82
$309.82
$309.82
$309.82
$320.95
$320.95
$320.95
$309.82
$320.95
$320.95
$239.17
$320.95
$239.17
$320.95
$309.82
$320.95
Premier National PPO
Find your county of residence in the chart below to see which Medicare Advantage Plans are available to you. If you would
like to enroll in one of the Medicare Advantage Plans or receive more information contact the appropriate provider listed
below. See the directory on page 43 for provider contact information.
Medicare Advantage Plans Enrollment Options By County of Residence
Medicare Overview | FSRBC
MYFSRBC.ORG
| 19
LEARN MORE
FSRBC | Medicare
Overview
IT’S TIME TO LEARN MORE ABOUT VOLUNTARY BENEFITS!
In the Voluntary Benefits (non-medical) section of this guide, you
will find important information about additional benefits that are
valuable for retirees.
Please review this section of the Benefits Guide thoroughly as
it contains important information regarding all of the Voluntary
Benefits available to you. This information will help you choose the
benefits and coverage that best suit your needs and your budget!
Voluntary Benefits
The FSRBC and your School District are
making valuable Voluntary Benefits like
dental and vision coverage available to you;
these options may no longer be available
directly from your School District. Additional
options include IT Technical Support plans,
ID Theft Protection plans and pet insurance. A
Voluntary Benefits (non-medical) Enrollment
Form* is included in the back of this guide to
help you enroll in non-medical plans.
With the FSRBC, you have the security of
knowing you will have the coverage you need,
so that you can truly enjoy The Benefits of
Aging.
*Veterinary Pet Insurance (VPI) has an individual enrollment
process. Don’t forget to mention FSRBC when you enroll to receive
a 5 percent discount!
20 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Dental Plans | FSRBC
Dental Plans
Make dental visits a priority
One of the first lines of defense in overall
health is dental care. Regular dental
cleanings can help manage problems
throughout the body, such as heart disease,
diabetes and stroke. The HumanaDental
Plan enables you to take better care of your
teeth, and you’ll pay less for your dental
care doing so.
HumanaDental® offers two Dental Health
Maintenance
Organization
(DHMO)
Plans and two Dental Preferred Provider
Organization (PPO) Plans. Please review
each of the plans information carefully to
determine which plan will best suit your
dental care needs:
• Low PPO Plan
• Medium PPO Plan
• High PPO Plan
• Low DHMO Plan
• High DHMO Plan
Dental HMO benefits
After you enroll in a plan and receive your
Humana member identification (ID) card, you
can manage your plan information on your
personal home page on HumanaDental.
com.
• You have the freedom to select any
participating general dentist as your
primary care dentist. To select a
dental provider from our network,
simply visit HumanaDental.com.
Once there, you can also check
your benefits, email us and get a
new or temporary ID card. If you
prefer, contact us at 1-800-2334013.
• Life without claim forms! With the
HumanaDental Prepaid Plans (Low
DMHO Plan and High DHMO Plan)
you pay your dentist directly, when
applicable.
• Your primary dentist will provide
all of your routine dental care and
you will pay any copayment or
discounted charges at the time of
service.
• You must live in Florida to enroll in
the Humana DHMO Plan.
Questions?
Check out HumanaDental.com
Call 1-800-233-4013,
Monday through Friday, 8 a.m. to 6 p.m.
(TDD: 1-800-325-2025).
MYFSRBC.ORG
| 21
LEARN MORE
The Florida School Retiree Benefits
Consortium (FSRBC) is pleased to offer
you the choice of five dental plans provided
by Humana. The HumanaDental® Plans
have you covered for any circumstance.
Whether you simply need routine dental
care or unexpected dental treatment, you
know what to expect with HumanaDental.
• Broad network access
• No claims to file on DHMO
• No annual maximums (HD205 and
HS195 Plans)
LEARN MORE
FSRBC | Dental
Plans
Rate Chart
Monthly Rates
Retiree
Retiree + 1
Retiree + Family
Humana Low DHMO Plan HD205
$9.75
$19.31
$34.32
Humana High DHMO Plan HS195
$15.83
$31.34
$55.71
In-Network Benefits
ADA
Code
D120
D150
D330
D272
D1110
D2140
D2330
D2391
D2392
D2740
D2752
D3310
D3330
D4341
D5110
D6240
D6242
D6750
D6752
D7140
D7210
Humana DHMO Plans
Low DHMO
High
Plan
DHMO Plan
Services
HD205
HS195
OFFICE VISIT COPAY PER VISIT (normal visiting hours)
$0
$0
PERIODIC ORAL EVALUATION-ESTABLISHED PATIENT
$0
$0
COMPREHENSIVE ORAL EVALUATION
$0
$0
PANORAMIC RADIOGRAPHIC IMAGE
$0
$0
BITEWINGS - TWO RADIOGRAPHIC IMAGES
$0
$0
PROPHYLAXIS - ADULT
$0
$0
AMALGAM - ONE SURFACE - PERMANENT
$5
$0
RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR
$30
$0
RESIN-BASED COMPOSITE – ONE SURFACE, POSTERIOR
$45
$30
RESIN-BASED COMPOSITE – TWO SURFACES, POSTERIOR
$55
$45
CROWN - PORCELAIN/CERAMIC SUBSTRATE
$270*
$245*
CROWN - PORCELAIN WITH SEMIPRECIOUS METAL
$270*
$245*
ENDODONTIC THERAPY, ANTERIOR TOOTH
$110
$100
ENDODONTIC THERAPY, MOLAR
$250
$210
PERIODONTAL SCALING & ROOT PLANING-4 OR MORE TEETH
$55
$50
COMPLETE DENTURE - MAXILLARY
$375*
$325*
PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL
$270*
$245*
PONTIC - PORCELAIN FUSED TO NOBLE METAL
$270*
$245*
CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL
$270*
$245*
CROWN - PORCELAIN FUSED TO NOBLE METAL
$270*
$245*
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT
$0
$5
SURGICAL REMOVAL OF ERUPTED TOOTH
$40
$30
NUMBER OF ADA CODES COVERED UNDER PLAN
315
337
* Services marked with a single asterisk (*) also require separate payment of laboratory charges, not to exceed $200. The laboratory charges must be paid
to the plan dentist in addition to any applicable copayment for the service.
HD205 DHMO: Specialist services:
Should members need a specialist, (i.e.
endodontist, oral surgeon, periodontist,
pediatric dentist), they may be referred by
a participating general dentist, or members
can self-refer to any participating specialist.
For HD plans, and benefits for procedures
not listed on the schedule, members may
receive up to a 25 percent discount by
visiting certain participating specialists.
HS195 DHMO: Specialist services:
Should members need a specialist,
(i.e.,endodontist, oral surgeon, periodontist,
pediatric dentist), they may be referred
by a participating general dentist, or
members can self-refer to any participating
specialist. For HS plans, copayment
amounts are applicable when treatment is
performed by participating specialists. Visit
HumanaDental.com to find a participating
specialist.
22 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Dental Plans | FSRBC
The PPO Indemnity Plans are similar to
traditional dental insurance plans. You do
not have to pre-select a primary dentist.
When you need dental services, simply
make your appointment with any dentist.
For maximum benefits, select a dentist
from Humana’s extensive PPO network.
PPO dentists have agreed to accept a
discounted fee for services. When you
receive treatment from a participating
PPO dentist, your share of the cost will be
reduced. Once services are performed,
you or your dentist must file a claim form in
order to receive reimbursement.
Your claim will be paid based on your
plan’s Schedule of Benefits. The plan will
pay a percentage of the eligible charges,
up to the plan’s annual maximum limit for
benefits subject to the plan’s limitations
and exclusions.
Rate Chart
Humana Low
PPO Plan
$28.25
$56.24
$73.29
Monthly Rates
Retiree
Retiree + 1
Retiree + Family
Humana Medium
PPO Plan
$33.28
$57.15
$81.73
Humana High
PPO Plan
$38.69
$77.04
$100.04
In-Network Benefits
Low PPO Plan
Medium PPO Plan
Out-ofOut-ofBenefits
In-Network
Network*
In-Network
Network*
Plan
Humana Vol. PPO
Humana Vol. PPO
Identification
100/70/50 INFS
100/80/50 INFS
Annual Maximum $800 per person per year $1,250 per person per year
Annual
Deductible
Diagnostic
and Preventive
Services
Basic Services
Major Services
Out of Network
Allowance
$50/person
to max $150
for Basic
or Major
Services
100%
$100/
person to
max $300
for Basic
or Major
Services
100%
70%
70%
50%
50%
* Coverage based on
negotiated contracted
fees for the Preferred
Provider Network.
$25/person
to max $75
for Basic
or Major
Services
100%
High PPO Plan
Out-ofIn-Network Network*
Humana Vol. TRP
100/80/50 MAF
$1,500 per person per
year
$50/person $50 per person to max
to max $150 $150 for Basic or Major
for Basic
Services
or Major
Services
80%
80%
60%
50%
40%
* Coverage based on
negotiated contracted fees
for the Preferred Provider
Network.
100%
100%
80%
80%
50%
50%
* Coverage based on
usual, customary, and
reasonable fees.
MYFSRBC.ORG
| 23
LEARN MORE
PPO Indemnity Plans
LEARN MORE
FSRBC | Vision
Plans
Coverage Level
Monthly Rates
Option IOption II
Retiree $6.17
$7.01
Retiree + 1
$11.11
$12.62
Retiree + Family
$17.28 $19.63
The FSRBC is pleased to offer you the
choice of two vision plans provided by
Davis Vision.
Davis Vision Plan
Healthy eyes and clear vision are an
important part of your overall health and
quality of life. Your vision plan helps you
care for your eyes while saving you money
by offering:
Paid-in-full eye examinations,
eyeglasses and contacts!
• Frame Collection: Your plan
includes a selection of designer,
name brand frames that are
completely covered in full.1
• Contact Lens Collection: Select
from the most popular contact
lenses on the market today with
Davis Vision’s Contact Lens
Collection.1
• One-year eyeglass breakage
warranty included on plan eyewear
at no additional cost!
FOR MORE INFORMATION AND HOW TO
LOCATE A NETWORK PROVIDER
For more details about the plan, just visit the
Open Enrollment section of our member site at
www.davisvision.com/Open-Enrollment/
and enter Client Code: 4951 or call 1-877923-2847.
VALUE FOR DAVIS VISION MEMBERS
A comprehensive benefit ensuring low
out-of-pocket cost to members and their
families. Our goal is 100 percent member
satisfaction.
CONVENIENT NETWORK LOCATIONS
A national network of credentialed preferred
providers throughout the 50 states.
FREEDOM OF CHOICE
Access to care through any of our network
of independent, private practice doctors
(optometrists and ophthalmologists) or retail
partners such as: Visionworks, Costco,
Sam’s Club, Walmart, For Eyes, and others.
Value-Added Features:
• Replacement contacts through
Davis Vision contact lens
replacement service, saving both
time and money.
• Laser Vision Correction discounts
of up to 25 percent off the
provider’s usual & customary fees,
or 5 percent off advertised specials,
whichever is lower.
24 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Vision Plans | FSRBC
In-Network Benefits
Exam inclusive of Dilation (when professionally
indicated)
Spectacle lenses
Frames
Contact Lens Evaluation, Fitting & Follow-up Care
Contact Lenses (in lieu of eyeglasses)
Copayment
Exam
Spectacle Lenses
Contact Lens Evaluation, Fitting & Follow-up Care
Eyeglass Benefit – Frame
Non-Collection Frame Allowance (Retail):
Davis Vision Frame Collection/4 (in lieu of
Allowance):
Fashion Level
Designer Level
Premier Level
Plan Options
Option I Designer
Option II Designer
12 Months
12 Months
12 Months
24 Months
12 Months
12 Months
12 Months
12 Months
12 Months
12 Months
$10
$15
$01
$5
$15
$01
Up to $130
OR
Up to $180 Allowance2
Plus a 20% discount on
any overage3
Up to $130
OR
Up to $180
Allowance2
Plus a 20% discount
on any overage3
Included
Included
$25 copay
Included
Included
$25 copay
Eyeglass Benefit – Spectacle Lenses & Lens Options
Clear plastic single-vision, lined bifocal, trifocal or
lenticular lenses (any size or Rx)
Tinting of Plastic Lenses
Scratch-Resistant Coating
Polycarbonate Lenses (Children5/ Adults)
Ultraviolet Coating
Anti-Reflective (AR) Coating (Standard / Premium /
Ultra)
Progressive Lenses (Standard / Premium / Ultra6)
High-Index Lenses
Polarized Lenses
Plastic Photosensitive Lenses
Scratch Protection Plan: Single Vision / Multifocal
Lenses
Member Charges
Included
Included
Included
Included
$0/$30
$12
$35/$48/$60
Included
Included
$0/$30
$12
$35/$48/$60
$50/$90/$140
$55
$75
$65
$20/$40
$50/$90/$140
$55
$75
$65
$20/$40
1. Copayment applies to Collection Contact Lenses only.
2. Enhanced Allowance of $180 available only at all Visionworks locations nationwide. Cannot be combined with any
other discounts or offers.
3. Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.
4. Collection is available at most participating independent provider offices. Collection is subject to change.
Collection is inclusive of select torics and multifocals.
5. Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with
prescriptions +/- 6.00 diopters or greater.
6. Category includes digital free-form progressive lenses.
MYFSRBC.ORG
| 25
LEARN MORE
Benefits
Frequency – Once Every:
LEARN MORE
FSRBC | Vision
Plans
Benefits
Frequency – Once Every:
Plan Options
Option I Designer
Option II Designer
Up to $130
Plus a 15% discount on
any overage3
15% Discount3
Up to $130
Plus a 15% discount
on any overage3
15% Discount3
4 boxes/multi-packs
2 boxes/multi-packs
Included
4 boxes/multi-packs
2 boxes/multi-packs
Included
Contact Lens Benefit (in lieu of eyeglasses)
Non-Collection Contact Lenses: Materials
Allowance
Evaluation, Fitting & Follow-Up Care – Standard &
Specialty Lens Types
Collection Contact Lenses3 (in lieu of Allowance):
Materials
Disposable
Planned Replacement
Evaluation, Fitting & Follow-up Care
Medically Necessary Contact Lenses (with prior
approval)
• Materials, Evaluation, Fitting & Follow-up Care
Included
1. Copayment applies to Collection Contact Lenses only.
2. Enhanced Allowance of $180 available only at all Visionworks locations nationwide. Cannot be combined with any
other discounts or offers.
3. Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.
4. Collection is available at most participating independent provider offices. Collection is subject to change.
Collection is inclusive of select torics and multifocals.
5. Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with
prescriptions +/- 6.00 diopters or greater.
6. Category includes digital free-form progressive lenses.
Out-of-Network Benefits
Service
Eye Examination
Single Vision Lenses
Bifocals/Progressive Lenses
Trifocal Lenses
Lenticular Lenses
Elective Contact Lenses
Medically Necessary CL
Frame
With Davis Vision
$40
$40
$60
$80
$100
$105
$225
$50
Please send all Out-of-Network Claims to:
Vision Care Processing Unit
P.O. Box 1525
Latham, NY 12110
26 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Tech Support Plans | FSRBC
Your Monthly Rates
Unlimited Support Plan
$10.00
Unlimited Plus Support Plan
$14.00
Unlimited Support Plan
• Unlimited remote support
• On-site support (up to 50
percent off retail rates)
• Self-help solution library
• Best practices assessment
• Computer protection software
Unlimited Plus Support Plan
• Unlimited remote support
• On-site support (up to 50
percent off retail rates)
• Self-help solution library
• Best practices assessment
• Computer protection software
• Secure data backup (100GB)
Product Details
• 24/7 Remote Technical Support
Experienced and qualified
technicians are standing by 24/7
to instantly resolve your technical
issue. Technicians will utilize
cutting edge technology to fix your
computer over the Internet.
• On-site Support (at an additional
cost)
We have over 14,000 technicians
that can be dispatched to your
home or office as soon as the same
business day.
• Antivirus Software
BitDefender Total Security will
protect you from viruses, Trojans,
spyware and other malicious
software.
• Online Data Backup
Our data backup service provides
secure, enterprise-class remote
data backup solutions.
• Self-Help Database
Our self-help database contains
over 120,000 use solutions to
common computer problems.
• Best Practices Assessment
You will receive an online analysis
of your computing environment
and recommendation to improve
performance and security.
MYFSRBC.ORG
| 27
LEARN MORE
The FSRBC is pleased to offer two
technology support options through IT
Please.
IT Please is a whole-home technology
support program that gives members
unlimited 24/7/365 remote support
access via the Internet, chat, or phone, for
everything from virus removal and wireless
network troubleshooting to gaming console
setup.
LEARN MORE
FSRBC | Tech
Support Plans
Technologies Supported
•
•
•
•
•
•
•
•
•
Desktop and laptop
Computers (PC and Mac)
Smartphones and PDAs
Digital Cameras
Printers/Scanners
Routers
Modems
Mass Storage Devices
Gaming Consoles
Software Supported
•
•
•
•
•
•
•
•
•
•
•
Microsoft 365
Adobe Acrobat
Adobe Photoshop
Lotus
SmartSuite
Open Office
Microsoft Office (Excel, Word,
Project, Access, etc.)
Windows Media Player
Quicken
Corel Office Suite
QuickBooks
Services Supported
• Data transfer and backup
• Broadband/DSL install
• Network (wireless or wired) install
or troubleshooting
• VOlP install
• Audio and video component
installation
• PDA/Blackberry install or
troubleshooting
• Off-site data backup install and
configuration
• Desktop/laptop setup and
configuration
• Desktop/laptop memory upgrade
and install
• Desktop/laptop CD or DVD drive
install
• Desktop/laptop hard drive install
• Desktop I/0 gaming card install
configuration
• Software install and configuration
• Basic digital imaging (photo)
training
• Digital music training (setup sold
separately)
• Data or document recovery
• Virus removal and performance
optimization
Systems Supported
•
•
•
•
•
•
•
•
•
•
•
•
Windows 10
Windows 8
Windows 7
Windows Vista
WindowsXP
Windows 2000
Windows ME
Windows 98
Windows NT
Windows 95
Mac OS
LINUX
System Utilities Supported
•
•
•
•
•
•
•
•
•
•
BitDefender
AVG Anti-Virus
Norton Clean Sweep
Partition Magic
Norton Utilities
Dr. Solomon’s
Norton Anti-Virus
Windows Themes
WinZip
Lavasoft
28 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
ID Theft Protection Plans | FSRBC
Plan
Premium Ultimate
Individual
$ 7.00
$10.50
Family$15.00$22.50
ID Commander’s comprehensive identity
theft protection plans are available
to both individuals and families, with
complete access to benefits the moment
membership begins. The ID Commander
Family Protection Plan provides a truly
managed household program and
empowers individual family members
with the tools and data they need to
proactively manage the health and wellbeing of their identities.
The FSRBC is pleased to offer two
identity theft protection options through ID
Commander.
Premium Protection Plan
Restoration:
• Full-service identity restoration
• 24/7 lost wallet assistance
• $1 million insurance policy
• Identity safety resource center
Detection:
• Internet surveillance monitoring and
alerts
• Social security monitoring and alerts
• Change of address monitoring and
alerts
Ultimate Protection Plan
Restoration:
• Full-service identity restoration
• 24/7 lost wallet assistance
• $1 million insurance policy
• Identity safety resource center
If the worst happens, and you become
the victim of identity theft while covered
by ID Commander, we will restore your
identity and any related credit accounts
to pre-theft status. No limits, no fine
print, no “service guarantee.” In addition,
if you suffer any covered out-of-pocket
expenses as a result of a breach, you’re
covered by a real insurance policy that
will put money in your hands for qualified
losses.
Detection:
• Internet surveillance monitoring and
alerts
• Social Security monitoring and alerts
• Change of address monitoring and
alerts
• Court/criminal monitoring and alerts
• Sex offender monitoring and alerts
• Payday loan monitoring and alerts
Take command of your future with ID
Commander – sign up today!
Protection:
• Computer Detection Software
MYFSRBC.ORG
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LEARN MORE
Identity theft is the fastest growing crime
in America, with an identity stolen once
every four seconds. ID Commander,
a leader in proactive identity theft
protection, uses a variety of industryleading tools to help protect you from
the growing crime of identity theft:
• Advanced Identity Monitoring and
Alerts
• $1 Million Identity Theft Insurance
Policy, with $0 deductible
• Full-service Identity Restoration
• 24/7 Lost Wallet Assistance
• Award-winning Computer Protection
Software
FSRBC | ID Theft
Protection Plans
PLAN FEATURES
PREMIUM
Exceptional protection
at a great price
IDENTITY INSURANCE
FULL-SERVICE IDENTITY THEFT RESTORATION SERVICES
IDENTITY THEFT PROTECTION RESOURCE CENTER
24/7 LOST WALLET ASSISTANCE
INTERNET SURVEILLANCE MONITORING & ALERTS
LEARN MORE
SOCIAL SECURITY MONITORING & ALERTS
CHANGE OF ADDRESS MONITORING & ALERTS
COURT AND CRIMINAL RECORDS MONITORING & ALERTS
NON-CREDIT LOAN MONITORING & ALERTS
SEX OFFENDER MONITORING & ALERTS
ANTI-VIRUS / ANTI-SPYWARE SOFTWARE
ANTI-PHISHING, ANTI-SPAM SOFTWARE
SOFTWARE FIREWALL
DIGITAL VAULT
DIGITAL FILE SHREDDER
1
Member must provide a Social Security Number in order for the SSN Trace functionality to monitor SSN activity.
Note: Email address is require to receive notifications.
30 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
U LT I M AT E
Our most comprehensive
protection package
Pet Insurance Plans | FSRBC
The FSRBC is pleased to offer three pet
insurance options through Veterinary Pet
Insurance (VPI).
Veterinary Pet Insurance® is the leading
pet insurance provider of pet health
insurance.
With comprehensive plans designed to
protect you financially when the unexpected
occurs, affordable coverage from VPI® Pet
Insurance allows you to focus on providing
optimal healthcare for your pet rather than
worrying about the cost of treatment. You
can be reimbursed for veterinary expenses
such as surgeries, diagnostic tests,
hospitalization, prescriptions, vaccinations
and more.
HOW TO ENROLL
Once you’ve decided on which plan best
protects your pet, visit:
www.petinsurance.com/fsrbc or
call 877-PETS-VPI and mention
FSRBC to receive your 5% discount.
AVAILABLE PLANS
The following plans are available for
both dogs and cats:
Major Medical Plan - Comprehensive
covers accidents, illnesses & hereditary
conditions
If you want a safety net for big vet bills, this
is the dog and cat insurance plan you’re
looking for. It’s our most comprehensive
protection, with our highest level of benefits.
• Our most popular plan
• $250 annual deductible
• Covers accidents, illnesses,
procedures, X-rays and more
• Chronic condition coverage
included
• Freedom to use any vet, anywhere
• Benefits renew in full each year
• Limited hereditary coverage after
the first year
• Includes 24/7 access to Vet
HelplineSM ($170 value)
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LEARN MORE
5%
Discount
code:
FSRBC
LEARN MORE
FSRBC | Pet
Insurance Plans
Pet Wellness Basics - Economical Covers Accidents & Illnesses
Routine pet care plan that gives you cash back.
• No deductible
• Freedom to use any vet, anywhere
• Covers prescription flea control
• Covers vaccinations
• Includes 24/7 access to Vet HelplineSM ($170 value)
Major Medical Plan + Wellness
$250 annual medical deductible
• $250 maximum annual wellness benefit
• Covers accidents and injuries
• Illnesses
• Cancer
• X-rays
• Surgeries
• Hereditary coverage
• Vaccinations, exams, flea/heartworm, and more
• Freedom to use any vet, anywhere
• Includes 24/7 access to the Vet HelplineSM ($170 value)
5%
Discount
code:
FSRBC
32 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
TIME TO ENROLL!
Enroll | FSRBC
It’s easy! The Enrollment section of this book describes how to
Medicare Plans
You may receive information from the various
Medicare providers participating with the
FSRBC to provide you with great options.
Feel free at any time to call the providers
for information and to get answers to your
questions. A list of all providers is on page
43.
Note: Check your mailbox for any materials
with the FSRBC logo.
Voluntary Benefits
Everything you need to enroll for Voluntary
Benefits, including plan and rate information,
is in this book. Dental, vision, IT Technical
Support, ID Theft Protection and pet insurance
are all available to you and your eligible
spouse and/or dependents (see eligibility
requirements on page 6). We have even
provided a comprehensive enrollment form
and return envelope at the end of this book.
Note: Veterinary Pet Insurance (VPI) has their own enrollment
procedure. Please call VPI directly for enrollment instructions.
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LEARN MORE
enroll in:
LEARN MORE
FSRBC | Enroll
in Medicare Plan
Steps to enroll in a Medicare Plan:
To receive additional Medicare coverage through the FSRBC, you
must enroll in the Medicare Plan directly through the provider.
STEP 1: DO YOUR HOMEWORK
Review the plans available to you from the providers
serving your county. You may receive detailed plan
information mailed directly from the providers, or you can
call to request their materials. If you are interested in
one of the plans, please call the provider(s) listed in
the directory on page 43.
STEP 2: DO A NEEDS ASSESSMENT
Call the provider(s) of your choice to take a needs
assessment. This will help you choose the best plan(s)
for you based on your individual needs.
Note: You can find a needs assessment checklist on page 42.
The answers to these questions can help you choose Medicare
coverage that may fit with your needs.
STEP 3: ENROLL
Once you choose your plan, submit a provider-specific
enrollment form as directed by the appropriate provider.
You may also enroll by phone. Call providers for details
on enrolling by phone.
STEP 4: CONFIRMATION OF MEDICARE PLAN
ENROLLMENT
The Medicare carrier(s) you select will send you
acknowledgment of your enrollment in their plan(s), ID
cards and other important plan materials.
Look for the FSRBC Logo
on provider materials
34 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Enroll in Non-Medical Plans | FSRBC
Steps to complete the FBMC Voluntary
Benefits (non-medical) Enrollment Form:
STEP 1: DO YOUR HOMEWORK
Read about the Voluntary Benefits available to you in this
Benefits Guide to select the coverage that is right for you,
and complete the FBMC Voluntary Benefits (non-medical)
Enrollment Form.
STEP 2: SELECT BENEFITS
Place a “√” in the box next to the plan in which you would
like to enroll. Be sure to specify the coverage level (e.g.,
Retiree plus Spouse). You will be able to calculate your
total monthly premium by adding the amounts of your
selections in the premiums column.
Note: The pet insurance enrollment form is separate from the other
Voluntary Benefits.
LEARN MORE
STEP 3: SUBMIT FORM AND PAYMENT TYPE
Submit your enrollment and payment form(s) to FBMC in
the envelope enclosed in your Benefits Guide.
Please call FBMC at 1-855-44FSRBC (1-855-443-7722)
with any questions about Voluntary Benefits (non-medical),
Monday - Friday, 7 a.m. - 7 p.m. ET.
STEP 4: CONFIRMATION OF BENEFITS
Once FBMC has received and processed your Voluntary
Benefits (non-medical) Enrollment Form and been notified
of your Medicare Plan enrollment (if applicable), you
will receive a Confirmation Notice of your benefits and
payment method.
Existing participants will receive this notification during
the second week of December. New Participants will
receive this approximately three weeks after enrollment.
You can also receive information on how to access your
FSRBC benefits at: https://secure.myRSC.com
CHANGES TO COVERAGE
The coverage you select will remain in effect for the entire
2016 plan year. If you cancel coverage during the plan
year, you may or may not be able to reinstate coverage at
the next annual open enrollment period.
If you experience qualifying life changes during your
coverage as a retiree, you may be able to increase or
decrease your coverage levels based on the type of event.
Contact your provider(s) for more information.
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LEARN MORE
FSRBC | Billing
BILLING
The Billing section of this book describes the choices you have in
deciding how to pay for the plans you have selected.
When deciding on a payment method, you may want to consider
each method and ask the following:
Florida Retirement System (FRS):
Q: Do you have sufficient funds in your FRS retirement account
to cover the payments?
A: Yes.
If you are able, having your premium payments deducted
from your FRS account is a highly recommended, hassle-free
method to pay for your coverage selections.
Automated Clearinghouse Contribution (ACH):
Q: Do you travel often?
A: Yes.
If FRS is not an option and you travel frequently or are
often busy, ACH payments offer the convenience of being
automatically deducted from your personal bank account.
Direct Billing
Q: Do you have multiple accounts and wish to vary your
payment methods from month-to-month?
A: Yes.
With Direct Billing, you will receive an annual coupon book
that will last throughout the plan year. If you choose this
option, please always send a coupon in with your premium
payment.
36 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Billing | FSRBC
Payment and Billing
FLORIDA RETIREMENT SYSTEM (FRS)
DEDUCTION (RECOMMENDED)
Your premium payments can easily be
deducted from your FRS retirement account.
FRS deductions are taken one month prior
to the month of coverage. For example,
your January premiums will be deducted
in December. If you choose this method,
FBMC requires a completed and signed FRS
Insurance Payroll Deduction Authorization
Form (included in this package). Until FRS
deductions begin (in 6 to 8 weeks if you
are completing this form with us for the first
time), you must pay by personal check or
money order.
You can access the details of your FRS
pension including all deductions by
registering and logging on to the following:
http://www.DMS.myflorida.com/
Note: Your monthly retirement benefit must be
sufficient to cover the entire premium deduction –
partial payments cannot be deducted.
AUTOMATED CLEARING HOUSE (ACH)
PAYMENT
You have the option of setting up electronic
payments through your personal bank
account. If you choose this method of
payment, be sure you notify your bank
each time premium costs change to ensure
your coverage continues. FBMC requires a
completed and signed Direct Debit (ACH)
Form, which is included in this package. All
premiums must be paid by the due date.
Note: ACH deductions occur on the 22nd of the
month before the benefit month: For example,
deduction for your September benefits occur on
August 22nd, etc.
DIRECT BILL (PERSONAL CHECK OR
MONEY ORDER PAYMENT)
Premium payments can be submitted by
personal check or money order directly to
FBMC. If you choose this payment method,
you will receive payment coupons to send
in with your premiums. All premiums must
be paid by the due date.
Note: Premium payments are due on the first of
the benefit month. Payments must be received NO
LATER than the fifth of the benefit month to avoid
cancellation of benefits.
REFUNDS
If you are having premium payments
deducted from your FRS retirement benefit
or from your personal bank account (ACH)
and are owed a refund, your refund will
be completed as soon as verification is
received that your deduction has changed.
Refunds are processed once a month and
mailed no later than the 15th of the following
month.
INCREASES IN PREMIUMS
If you have a change in coverage that
results in an increase in the premium to be
deducted from your FRS retirement benefit
or personal bank account (ACH), you
may need to pay the difference by check
or money order until your deductions are
flowing correctly.
Please send enrollment forms,
correspondence and premium payments
to:
FBMC Benefits Management, Inc.
Retiree and Direct Bill Department
P.O. Box 10789
Tallahassee, FL 32302-2789
Fax: 1-850-514-5803
Please keep this guide for use during the
plan year. It is also available at
www.myFSRBC.org.
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LEARN MORE
You have three options to pay the premiums
for the plans you select:
LEARN MORE
FSRBC | Tools
Tools
Just the facts.
The next few pages contain:
FBMC’s Privacy Statement:
• We will never share your information with anyone.
• We protect your personal information - health or otherwise.
• We only collect the information we need to provide you with
the best service.
Directory:
• Medicare contacts for applying for Part A and Part B.
• Voluntary Benefits contacts to learn details about each type
of benefit.
• Medicare Advantage and Supplement Plan providers so
you can request information and take a personal Needs
Assessment.
Needs Assessment Page:
The page is a resource to have in front of you when you call
Medicare providers for your needs assessment.
38 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Compliance and Legal | FSRBC
Compliance and Legal
FBMC Privacy Statement
This statement applies to products administered by FBMC Benefits Management,
Inc. FBMC takes your privacy very seriously. As a provider of products and services
that involve compiling personal-and sometimes, sensitive-information, protecting
the confidentiality of that information has been, and will continue to be, a top priority
of FBMC. This Privacy Statement explains how FBMC handles and protects the
personal information we collect. Please note that the information we collect and the
extent to which we use it will vary depending on the product or service involved. In
many cases, we may not collect all of the types of information noted below. Note
this Privacy Statement is not meant to be a Privacy Notice as defined by the Health
Insurance Portability and Accountability Act (HIPAA), as amended.
LEARN MORE
FBMC’s privacy statement is as follows:
I. We collect only the customer information necessary to consistently deliver
responsive services.
FBMC collects information that helps serve your needs, provide high standards of
customer service, and fulfill legal and regulatory requirements. The sources and
types of information collected generally vary depending on the products or services
you request and may include:
Information provided on enrollment and related forms - for example, name, age,
address, Social Security number, e-mail address, annual income, health history,
marital status, and spousal and beneficiary information.
Responses from you and others such as information relating to your employment
and insurance coverage.
Information about your relationships with us, such as products and services
purchased, transaction history, claims history, and premiums.
1.Information from hospitals, doctors, laboratories and other companies about
your health condition, used to process claims and prevent fraud.
II. Under Federal Law you have certain rights with respect to your protected
health information.
You have rights to see and copy the information, receive an accounting of certain
disclosures of the information and, under certain circumstances, amend the
information. You also have the right to file a complaint with your Employer or with
the Secretary of the U.S. Department of Health and Human Services if you believe
your privacy rights have been violated.
III. We maintain safeguards to ensure information security. We are committed
to preventing unauthorized access to personal information.
We maintain physical, electronic, and procedural safeguards for protecting personal
information. We restrict access to personal information to those employees,
insurance companies, and service providers who need to know that information to
provide products or services to you.
IV. We limit how, and with whom, we share customer information.
MYFSRBC.ORG
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LEARN MORE
FSRBC | Compliance
and Legal
We do not sell lists of our customers, and under no circumstances do we share
personal health information for marketing purposes. With the following exceptions,
we will not disclose your personal information without your written authorization.
We may share your personal information with insurance companies with whom you
are applying for coverage, or to whom you are submitting a claim. We will share
personal information of VISTA 401(k) participants with the plan’s recordkeeper.
We also may disclose personal information as permitted or required by law or
regulation. For example, we may disclose information to comply with an inquiry
by a government agency or regulator, in response to a subpoena, or to prevent
fraud. If you no longer have a customer relationship with us, we will still treat your
information under our Privacy Policy, the words “you” and “customer” are used to
mean any individual who obtains or has obtained an insurance, financial product
or service from FBMC that is to be used primarily for personal or family purposes.
Notice of Administrator’s Capacity
This notice advises insured persons of the identity and relationship among the
contract administrator, the policyholder and the insurer:
1.Contract Administrator. FBMC Benefits Management (FBMC) has been authorized
by your employer to provide administrative services for your employer’s insurance
plans offered within your benefit program. In some instances, FBMC may also
be authorized by one or more of the insurance companies underwriting the
benefits to provide certain services, including, but not limited to: marketing;
billing and collection of premiums; and processing insurance claims payments.
FBMC is not the policyholder or the insurer.
2.Policyholder. This is the entity to whom the insurance policy has been issued; the
employer is the policy holder for group insurance products and the employee is
the policyholder for individual products. The policyholder is identified on either
the face page or schedule page of the policy or certificate.
3.Insurer. The insurance companies noted herein have been selected by your
employer, and are liable for the funds to pay your insurance claims.
If FBMC is authorized to process claims for the insurance company, we will do
so promptly. In the event there are delays in claims processing, you will have no
greater rights to interest or other remedies against FBMC than would otherwise be
afforded to you by law. FBMC is not an insurance company.
40 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Needs Assessment | FSRBC
Needs Assessment Checklist
Meeting Checklist
WHAT ARE MY OPTIONS?
• If you are currently enrolled in an FSRBC plan and are happy with that plan you
do not need to re-enroll.
• See pages 17 - 19 to see what Medicare Advantage Plans are available in your
area.
• The Medicare Supplement Plans and Medicare Part D Pharmacy Plans are
available throughout the state and nationwide.
NEEDS ASSESSMENT
• The worksheet on page 42 will let you compare your medications, commonly
used doctors and preferred hospitals across all of the plans.
• Each carrier has a dedicated team that will answer all of your questions
regarding costs and networks for each plan you have available. Please call the
number provided for each carrier you are interested in. At that time the service
representative will walk you through your plan offerings and discuss your
particular needs.
• When comparing multiple plans and carriers it is helpful to write down what you
learn. Please use the following pages to take notes regarding how each plan will
fit your needs.
Questions to consider when picking a plan
How is your general health?
Any chronic health issues?
How often do you see the doctor?
Do you travel frequently or live part of the year in a different state?
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LEARN MORE
• If you live outside of the state of Florida, the Medicare Advantage Premier Plan is
also available.
LEARN MORE
FSRBC | Needs
Assessment
Medicare Plan Options
(Use the table below to compare each plan option)
List Plan Name
Cost of Plan
My Prescriptions
Compare the cost of each prescription under each plan
My Doctors
Compare each plan’s network. Write “In-Network” or “Out-of-Network”
My Hospitals
Compare each plan’s network. Write “In-Network” or “Out-of-Network”
My Pharmacies
Compare each plan’s network. Write “In-Network” or “Out-of-Network”
TIME TO ENROLL
Enroll in the plan you have decided on by:
□□ Enrolling telephonically using the number listed in this booklet
or
□□ Complete and return the paper application sent by the carrier. Please return this
directly to the carrier.
42 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM BENEFITS GUIDE
Directory | FSRBC
AvMed
Enrollment & Premium Services
P.O. Box 569004
Miami, FL 33256-9942
Enrollment Telephone number:
1-800-835-6137, (TTY 711)
Post enrollment for Member Engagement Center:
1-800-782-8633, (TTY 711)
www.avmed.org
Health First Medicare Plan
Customer Service
1-800-716-7737, (TTY 711)
7 days a week, 8 a.m. - 8 p.m.
www.myhfhp.org
Humana Medicare Enrollment
P. O. Box 14330
Lexington, KY 40512
Enrollment Telephone number:
1-800-824-8242
Customer Telephone number (post enrollment):
1-866-396-8810
www.humana.com
UnitedHealthcare®
Customer Service (for all plans)
1-877-776-1466, (TTY 711)
7 days a week, 8 a.m. - 8 p.m. ET
Enrollment materials for UHC Medicare
Supplement Plan should be returned to:
UnitedHealthcare® Enrollment Division
P. O. Box 105331
Atlanta, GA 30348-5331
Enrollment materials for UHC Part D Prescription
Plan or Medicare Advantage Plan should be
returned to:
UnitedHealthcare® Enrollment Department
P.O. Box 29675
Hot Springs, AR 71903 or
Fax to: 501-262-7070
Voluntary Benefits Providers
Davis Vision
Client Code# 4951
Customer Service
1-877-923-2847
Mon - Fri, 8 a.m. - 11 p.m. ET.
Sat - 9 a.m. - 4 p.m. ET.
Sun - 12 p.m. - 4 p.m. ET.
www.davisvision.com
Humana Dental
Customer Service
1-800-233-4013
Mon - Fri, 8 a.m. - 6 p.m.
www.humanadental.com
IDCommander (Identity Theft)
Membership Services
1-855-592-7941
Mon - Fri, 9 a.m. - 6 p.m. ET.
LEARN MORE
Medicare Provider Contacts
ITPlease (Technology support)
Membership Services
1-888-384-7935
Mon – Fri, 9 a.m. - 6 p.m. ET.
Administrative Contacts
FBMC Benefits Management, Inc.
Retiree and Direct Bill Department
(Contract Administrator)
Service Center
1-855-44FSRBC (1-855-443-7722)
Mon - Fri, 7 a.m. - 7 p.m. ET.
www.myfsrbc.org
Florida Retirement System (FRS)
Bureau of Retirement Calculations
1-888-738-2252
Enrollment Section
1-877-377-3675
www.myfrs.com
Medicare
1-800-MEDICARE (1-800-633-4227)
www.medicare.gov
Social Security
1-800-772-1213
SocialSecurity.gov
MYFSRBC.ORG
| 43
The FSRBC looks forward to providing you access to
high quality Medicare and Voluntary Benefits, tailored
especially for retirees age 65 or older.
To have your premium automatically
deducted from your bank account each
month, please complete this form and
return it to FBMC Benefits Management
in the enclosed envelope.
BENEFITS MANAGEMENT
P.O. Box 10789 • Tallahassee, Florida 32302-2789
Service Center 1-855-44FSRBC (1-855-443-7722)
www.myFSRBC.org/2016
© 2015 FBMC Benefits Management, Inc.