YOU YOUR BENEFITS COBRA & Retiree Participants Your Open Enrollment is: October 20, 2014 through November14, 2014. Your Period of Coverage is: January 1, 2015, through December 31, 2015. Welcome to Broward County’s Open Enrollment 2015. Current coverage will automatically rollover. If you would like to make a change or cancel coverage, complete and mail the attached Change Form to WageWorks by November 14, 2014. WHAT’S NEW for 2015! • Pharmacy Rx co-pay Increases for CDH plans • CDH Low and High Deductible Health Plan rate DECREASES • CDH High and CDH Out of Network rate INCREASES IMPORTANT NOTICE: The County’s contract with WageWorks ends on December 31, 2014. We have issued two RFP’s for a Third Party Vendor but none of the respondents had a Certificate of Authority as a TPA as required by the Florida Office Of Insurance Regulation. We are working on a temporary solution for January, 2015 and will notify you in advance of any changes. Please continue to submit payments to WageWorks until notified of a change. Thank you, Broward County Employee Benefit Services. COBRA Participants: At Open Enrollment, a Qualified Beneficiary under COBRA will be given the same opportunity as similarly-situated active participants and beneficiaries, to change his or her group health plans, to drop dependents or to add eligible dependents who are not already covered under COBRA. HRA participants can continue to use their funds if they elect and pay for continuation of HRA coverage. Retiree Participants: At Open Enrollment, a retiree may continue, cancel or decrease coverage. A Retiree may not add coverage. Once a coverage is cancelled, it may not be reinstated or added at a later date. Any changes to your Retiree benefits will require your written authorization. Premium changes required because of such written authorization will be initiated as soon as possible after your written request is received. If you are having FRS deductions for premium payments, any required refunds will be completed as soon as it is verified that FRS has changed your deduction. A new FRS Deduction Authorization form is not needed. If you currently do not have your premiums deducted from your Florida Retirement System (FRS) monthly benefit check, and would like to, please request an FRS Deduction Authorization Form from WageWorks and return it with your Enrollment Form. Your deductions will start as soon as possible. Please be aware that you must make your payments via personal check or money order until the FRS deductions begin. Dependents: If you are enrolling in coverage for your dependents, please record each dependent’s Social Security numbers and dates of birth on your Enrollment Form. For more information, contact W a g e W o r k s Customer Care at 877-502- 6272, Monday-Friday, 8 a.m.-8 p.m. ET. Any coverage you elect to cancel cannot be reinstated. Please send your written requests to: WageWorks, P.O. BOX 14357, Lexington, KY 40512-4357.Elections will roll over unless notified in writing to change or cancel coverage. OPEN ENROLLMENT RET-H&D
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YOU YOUR BENEFITS
COBRA & Retiree Participants Your Open Enrollment is: October 20, 2014 through November14, 2014. Your Period of Coverage is: January 1, 2015, through December 31, 2015.
Welcome to Broward County’s Open Enrollment 2015. Current coverage will automatically rollover. If you would like to make a change or cancel coverage, complete and mail the attached Change Form to WageWorks by November 14, 2014.
WHAT’S NEW for 2015! • Pharmacy Rx co-pay
Increases for CDH plans• CDH Low and High
Deductible Health Planrate DECREASES
• CDH High and CDH Out ofNetwork rate INCREASES
IMPORTANT NOTICE: The County’s contract with WageWorks ends on December 31, 2014. We have issued two RFP’s for a Third Party Vendor but none of the respondents had a Certificate of Authority as a TPA as required by the Florida Office Of Insurance Regulation. We are working on a temporary solution for January, 2015 and will notify you in advance of any changes. Please continue to submit payments to WageWorks until notified of a change. Thank you, Broward County Employee Benefit Services.
COBRA Participants: At Open Enrollment, a Qualified Beneficiary under COBRA will be given the same
opportunity as similarly-situated active participants and beneficiaries, to change his orher group health plans, to drop dependents or to add eligible dependents who are notalready covered under COBRA.
HRA participants can continue to use their funds if they elect and pay for continuation ofHRA coverage.
Retiree Participants: At Open Enrollment, a retiree may continue, cancel or decrease coverage. A Retiree
may not add coverage. Once a coverage is cancelled, it may not be reinstated oradded at a later date. Any changes to your Retiree benefits will require yourwritten authorization.
Premium changes required because of such written authorization will be initiated assoon as possible after your written request is received. If you are having FRS deductionsfor premium payments, any required refunds will be completed as soon as it is verifiedthat FRS has changed your deduction. A new FRS Deduction Authorization form is notneeded.
If you currently do not have your premiums deducted from your Florida RetirementSystem (FRS) monthly benefit check, and would like to, please request an FRS DeductionAuthorization Form from WageWorks and return it with your Enrollment Form. Yourdeductions will start as soon as possible. Please be aware that you must make yourpayments via personal check or money order until the FRS deductions begin.
Dependents: If you are enrolling in coverage for your dependents, please record each
dependent’s Social Security numbers and dates of birth on your EnrollmentForm.
For more information, contact W a g e W o r k s Customer Care at 877-502-6272, Monday-Friday, 8 a.m.-8 p.m. ET.
Any coverage you elect to cancel cannot be reinstated. Please send your written requests to: WageWorks, P.O. BOX 14357, Lexington, KY 40512-4357.Elections will roll over unless notified in writing to change or cancel coverage.
OPEN ENROLLMENT
RET-H&D
HEALTH PLAN OPTIONS FOR 2015 –NO PLAN DESIGN CHANGES• High Deductible Health Plan (HDHP)
How does the High Deductible Health Plan work?• All health and prescription services are subject to the annual deductible and coinsurance based on tier of coverage
with the exception of mandated preventive services or designated preventive prescriptions.• Medical and prescription expenses will be applied toward meeting an annual integrated deductible and coinsurance
amount based on tier of coverage.• Once the integrated deductible is met, the health and pharmacy plan pays 70% and you pay 30% coinsurance of the
eligible discounted costs.• When you reach the integrated out-of-pocket maximum, the Plan pays 100% of eligible in-network health and
prescription expenses.• Preventive services and designated preventive prescriptions are covered at 100%
CDH AND HDHP PLAN COMPARISONS (See Humana Brochure for more details)
SERVICE CDH PLANS HDHP Deductible Individual x 2 max for dependent
coverage Single Coverage ($2,100), or Dependent Coverage ($4,200)
Coinsurance Individual x 2 max for dependent coverage
Single Coverage ($1,500), or Dependent Coverage ($3,000)
coinsurance Lab Work Covered under office visit copay Deductible and if met, 30%
coinsurance Diagnostic Tests, lab and x-ray (performed during office visit)
Covered under office visit copay Deductible and if met, 30% coinsurance
Diagnostic Tests – Nuclear Medicine (MRI, CT, etc.)
Max $100 Deductible and if met, 30% coinsurance
Urgent Care Centers Copay Deductible and if met, 30% coinsurance
Emergency Room Copay Deductible and if met, 30% coinsurance
*Preventive medications are defined as those prescribed to prevent the occurrence or recurrence of a chronic disease or condition, such as highblood pressure, high cholesterol, diabetes, asthma, osteoporosis, and heart disease. See applicable category on Catamaran’s Formulary list for covered generic and formulary medications.
• Consumer Driven Health (CDH) Plans No changes to CDH Plan design, deductibles, coinsurance,copays, and out-of-pocket maximums for CDH High, CDH Low and Out-of-Network Plans.• CDH Low (utilizing Humana’s Florida Premier HMO network-Open Access*)• CDH High (utilizing Humana’s Florida Premier HMO network-Open Access*)• CDH with Out-of-Network (utilizing Humana’s National POS-Open Access*)* Open Access means a referral to see most network specialists is not required. However, certain services require Prior Authorization.
NOTE: If moving outside of the CDH High or Low network, you must notify WageWorks and change to the CDH with Out of Network coverage.
Highlights of CDH Plans • Preventive services covered 100% in-network• Some services received for a copay (varies by CDH plan)• Some services subject to the annual deductible/co-insurance (varies by CDH plan)• Student passport program for dependents attending college outside of the service area• Behavioral health out-patient services first 20 visits covered at no cost• Five lab providers to select from (LabCorp, Quest, Solstas Laboratory Group, Integrated Regional
Laboratories, Ameripath South Florida).• Diagnostic tests at a participating freestanding facility capped at $100 per test• Annual eye exam at no cost at a participating optometrist• Discount dental plan included at participating dental providers
REMINDER: I f you or your spouse/ domestic partner are eligible for Medicare, the County’s health plans w ill only pay as secondary. P lease enroll in Medicare Part A and B as soon as you are eligible.
Need assistance with Humana health or dental coverage?
Contact one of the Humana on-site Representatives:
PHARMACY PLAN – COPAY INCREASES FOR ALL CDH PLANS Pharmacy benefits are provided under the County’s self-insured plan through Catamaran. The pharmacy plan includes:
• An open formulary with five tiers of coverage (generic, brand preferred, non-preferred, specialty andDispense As Written)
• 90 day mandatory maintenance medication program at retail or mail order• Large network of participating pharmacies (Walgreens, Target, CVS, Publix super markets, etc.)• Restricted generic policy (generics will be dispensed if available unless the doctor indicates “Dispense
As Written” (DAW1) on the prescription• 30 day Specialty pharmacy home delivery
CDH PLANS HDHP
Prescriptions subject to applicable copay based on tier of coverage. See chart below.
Prescriptions on the designated Preventive Drug List provided at no cost to member. All other prescriptions subject to combined Health and Pharmacy Deductible and Coinsurance
CDH PLANS ONLY HDHP
Tiers 30 Day Supply* 90 Day Supply (Maintenance Medication) All Tiers
Generic $7 $14 Combined Health and Pharmacy Deductible/Coinsurance EE Only: $2,100, then 30% EE+Deps: $4,200, then 30%
Brand-Preferred $30 $60 Non-Preferred $45 $90 Dispense As Written (DAW1)
$75 $150
Specialty $75 N/A * Pharmacy can only fill a 30 day supply for maintenance medication 3 times before requiring a 90 day fill
Clinical Prior Authorization Program Certain prescriptions require “clinical prior authorization,” or approval from your plan, before they will be covered. The categories/medications that require clinical prior authorization may include, but are not limited to: Acne (topical-after age 24), ADHD/Narcolepsy (after age 19), Botulinum Toxins, Lamisil/Sporanox, Obesity and Peniac. Upon receipt of a prescription falling into a covered category, Catamaran will contact your doctor’s office and request the documentation needed for Prior Authorization. To verify in advance, members may contact Catamaran.
Contact Catamaran Member Services at 1-855-356-3216 or mycatamaranrx.com for more information.
Specialty Pharmacy Briova Rx is Catamaran’s specialty pharmacy provider. They will assist members with their specialty medications to ensure safe and effective administration. Briova Rx provides free home delivery to your home/work address. Please contact Briova Rx at 1-855-427-4682 or briovarx.com for more information regarding specialty pharmacy.
DENTAL PLANS – NO PLAN DESIGN OR PREMIUM CHANGES
DHMO DENTAL Plan – Humana/CompBenefits – See Humana’s Dental brochure for more information Highlights:
• In-network coverage only• No referral for specialty services• Must select a Primary Care Dentist or Facility• Covered services based on Fee Schedule, all other services received at a discount• Orthodontia coverage for children and adults• No claim forms to file
PPO HIGH DENTAL PLAN – Humana – See Humana’s Dental brochure for more information Highlights:
• In- or out-of network coverage• Extensive national network• Maximum annual benefit of $1,500 per person in-network, $1,000 per person out-of-network• Orthodontia coverage for children (must be banded by 17th birthday)• Some exclusions and limitations (missing tooth)
VISION PLAN UnitedHealthcare – NO PLAN DESIGN OR PREMIUM CHANGES – See UHC’s material for more information Highlights:
• In- and out-of-network coverage• Exams, Eyeglass Frames Lenses and Contact Lens coverage• Large network of providers
WELLBEING INITIATIVES – WELLBEING IS A PRIORITY
Continuing in 2015 - Pharmacy Copay Waiver Incentive Program We are pleased to continue the Wellbeing Program Pharmacy Copay Waiver Program for members and spouses/domestic partners enrolled in the County’s health plan. The Rx copay waiver program will run through 12/31/15 (or through plan termination date, if sooner) and will cover generic and formulary medications for the following disease states:
Note: Only drugs that are classified in the drug therapeutic class for the eligible disease state will be covered.
Eligibility Criteria: • Enroll in the Humana Vitality online wellness program• Complete the free Vitality Check (finger stick screening for cholesterol, blood sugar)• Complete the online Vitality Health Risk Assessment• Participate in Disease Management Coaching through Humana (if applicable)
To receive the Rx copay waiver, members will submit a form to Humana’s on-site representatives who will verify completion of the eligibility criteria and, with the member’s consent will release the member’s name and disease state(s) to Employee Benefit Services who will then request an Rx copay override for the applicable prescription drug(s) through our Pharmacy Benefit Manager, Catamaran Rx.
Disease Management Programs Managing chronic, long term diseases by following established medical protocols can keep the disease under control and help the member live a more healthy and productive life. The Disease Management Program managed by Humana will focus on several disease states in 2015 including:
Participants will receive one-on-one coaching and education from Humana’s Disease Management nurses and will be eligible for the Rx copay waiver and rewards based on compliance with following the established protocols for each disease state. Example: Diabetic care is not just monitoring blood sugar levels. It is recommended that patients have an annual exam, foot exam, dental exam, vision exam, along with semi-annual AIC blood tests.
Tobacco Cessation Pharmacy Waiver The County will continue to waive the copay or cost for prescription or Over-the-Counter smoking cessation products up to the plan cost maximum of $500 per person per year. Over-the-Counter products (Nicorette gum, Nicoderm patches, etc.) require a prescription to be eligible for coverage through the pharmacy plan.
HumanaVitality Wellness Program Healthy living is all about the choices you make. Drive or walk to the coffee shop? Pizza or salad for lunch? Couch or health club? It's not always easy. HumanaVitality rewards its members for making healthy choices and striving to achieve wellness goals — with rewards like brand name merchandise, hotel stays, and more. No matter your stage in life or health, HumanaVitality has something to offer everyone. Log in to or register for MyHumana to go to HumanaVitality today.
• Make a Plan – learn your Vitality age by completing the Vitality Assessment, see your current healthstatus by getting a Vitality Check, set personalized goals, participate in online conversations and courses.
• Earn Vitality Points – earn points for getting active: download steps from a pedometer, workouts usingheart rate monitor, taking a CPR class, donating blood and much more.
• Get Rewards – redeem Vitality Bucks on over 600,000 rewards, including movie tickets, events,merchandise, or even a hotel stay!
Flu shots The Health Department recommends getting an annual flu shot. Flu shots are covered at no cost through our health plans as a Preventive benefit and may be obtained through your physician or at a retail health clinic such as Walgreens Take Care Clinic or CVS Minute Clinic. If service is for anything other than the flu shot, you will be responsible for the applicable copay or cost. Flu shots are not available through the pharmacist.
2015 Open Enrollment Vendor Fairs Informal Walk-In Event – Chat with your benefit plan representatives!
DATE LOCATION ROOM/BLDG. TIME
Monday October 27th
Governmental Center 115 S. Andrews Ave Fort Lauderdale, FL
Wellness Resource Center Third Floor
8:30 a.m. – 4:30 p.m.
Tuesday October 28th
Traffic Engineering 2300 W Commercial Blvd.
Fort Lauderdale, FL Training Room 7:00 – 11:00 a.m.
Central Broward Park 3700 NW 11th Place
Lauderhill, FL Field House Hall 1:30 – 4:30 p.m.
Wednesday October 29th
Transit Div. – Ravenswood 5440 Ravenswood Road
Fort Lauderdale, FL Operations Modular 10:00 a.m. – 3:00 p.m.
Thursday October 30th
Water & Wastewater Services 2555 W Copans Rd Pompano Beach, FL
Fort Lauderdale, FL Port Everglades Auditorium 9:00 a.m.
Friday November 7th
Governmental Center 115 S. Andrews Avenue
Fort Lauderdale, FL
Commission Chambers Fourth Floor, Room 422
9:00 & 11:00 a.m. 3:00 p.m.
Open Enrollment Period: October 20th, 2014 – November 14th, 2014
FRMWW WW-3581-COBRA-OE-ELECT-PAS-V0814 Page 1
BROWARD COUNTY GOVERMENT
Retiree Open Change Election Form - HEALTH & DENTAL PLANS THIS FORM MUST BE RETURNED NO LATER THAN November 14, 2014 IN ORDER TO MAKE CHANGES TO YOUR
RETIREE COVERAGE FOR THE NEW PLAN YEAR. ALL CHANGES WILL BE EFFECTIVE January 1, 2015
PLEASE PRINT CLEARLY
PARTICIPANT INFORMATION
Last First Middle
Street Address
City State Zip Phone
Email Address SSN DOB
LIST ALL DEPENDENTS TO BE COVERED. Mark (X) the appropriate box for Medical (M) Dental (D) Vision (V) and EAP (E)
DEPENDENT INFORMATION
Name (Last, First, Middle) DOB SSN Relationship Gender M D V E
BENEFIT ELECTIONS. Please circle the benefit plan names and coverage levels for each plan you are electing below.
MEDICAL COVERAGE
Plan Name Individual Individual + Spouse
Individual +
Child(ren) Family
Individual +
Domestic Partner
Individual + DP +
Children
Other Other
DENTAL COVERAGE
Plan Name Individual Individual + Spouse
Individual +
Child(ren) Family
Individual +
Domestic Partner
Individual + DP +
Children
Other Other
CURRENT COVERAGE WILL AUTOMATICALLY ROLL OVER
HDHP - HUMANA
CDH LOW - HUMANACDH HIGH - HUMANA
CDH OUT OF NETWORK
DHMO - HUMANA/COMPBEN
PPO - HUMANA
FRMWW WW-3581-COBRA-OE-ELECT-PAS-V0814 Page 2
VISION COVERAGE
Plan Name Individual Individual + Spouse
Individual +
Child(ren) Family
Individual +
Domestic Partner
Individual + DP +
Children
Other Other
EAP COVERAGE
Plan Name Individual Individual + Spouse
Individual +
Child(ren) Family
Individual +
Domestic Partner
Individual + DP +
Children
Other Other
RX COVERAGE
Plan Name Individual Individual + Spouse
Individual +
Child(ren) Family
Individual +
Domestic Partner
Individual + DP +
Children
Other Other
Statement of Understanding and Election: I hereby apply for benefits under the terms and conditions of the benefits program, and I agree to pay the premium as required. I understand that continuation coverage may terminate under several circumstances, including: the date I become entitled to Medicare, or on the date on which the group health/dental plan coverage offered by my former employer ends. I understand that if I was disabled at the time of my qualifying event, I may be eligible for extended continuation coverage. I also understand that payments are due on the 1st of each month and that failure to remit payments within the grace period specified under federal COBRA legislation will result in termination of coverage. I understand and agree that any omission or incorrect statements knowingly made by me on this application may invalidate my coverage and the benefits under this plan.
PARTICIPANT SIGNATURE DATE:
(Election Forms received without a signature will be rejected and potentially cause delay in your COBRA coverage.)
Return all pages of this Open Enrollment Election Form to:
WageWorks, Inc. FAX: (877) 220-3249 P.O. Box 14055 Lexington, KY 40512-4055
NOT APPLICABLE
NOT ELIGIBLE
CATAMARAN RX (if making changes to health coverage
