Arranged by Pierce Group Benefits
ALAMANCE COUNTY GOVERNMENT January 1, 2019 - December 31, 2019
What’s Inside
Benefits Plan Overview...................................................................
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Online Enrollment Instructions ……………………………….…..……
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Health Insurance
Alamance County Government Plan Year January 1, 2019 through December 31, 2019
Alamance County Government is offering all eligible employees a comprehensive Benefits Program. This booklet highlights the benefits offered through your employer for the current plan year. Some benefits described in this booklet are fully or partially paid by your employer, while others are fully paid by the employee. You have the opportunity to select the benefits in which you wish to participate. Please see the Benefits Plan Overview section of the booklet for more details.
Arranged & Enrolled by
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Dental Benefits……………………………………………
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Vision Benefits…………………………….………………
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Health, Dental & Vision Rates - 2019………......…………
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Flexible Spending Accounts…………………..…………...
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Medical Bridge Benefits……………….…………………..
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Disability Benefits
This is neither an insurance contract nor a Summary Plan Description and only the actual policy provisions will prevail. All information in this booklet including premiums quoted is subject to change. All policy descriptions are for information purposes only. Your actual policies may be different than those in this booklet.
Pierce Group Benefits
Cigna Benefits Highlights…….…………….……..……………… Wellness Promotion Program………….…………...………….… Alamance County Health Clinic…………………..……………… Cigna Telehealth Connection……………………..……………… Your Pharmacy Benefits…………………………..……………… Access your HSA Funds……...…..……….………………………. myCigna Member Website…..…..……….……………………….
Short-Term Disability……………………………….…………….. Long-Term Disability………..……………………..………………
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Cancer Benefits…………………………………………...
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Accident Benefits…………………………………………
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Critical Care Benefits…………..……….…………………
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Life Insurance Group Term Life Insurance………………..……………………... Term Life Insurance……………………...………………………. Whole Life Insurance…………………….……………………….
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Medicare Part D Creditable Coverage Notification ………………..…..
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Mobile Apps – View Benefits On-the-Go………………………….……
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COBRA Continuation of Coverage Rights ……………………………..
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Authorization Form…………………………………….…..…………
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Rev. 10/22/2018
Notice of Insurance Information Practices…………………………….
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Supplemental Continuation of Coverage Form ………………………..
81
Alamance County Government | 1
ALAMANCE COUNTY GOVERNMENT EMPLOYEE BENEFITS PROGRAM Provided by Pierce Group Benefits
Pre-Tax Benefits Health Insurance*
Cigna*
Dental Insurance
UMR
Vision Insurance
Superior
Health Savings Accounts o Employee Maximum $3,500/year o Family Maximum $7,000/year HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP) Alamance County Government will contribute the following amounts yearly to the Health Savings Account for those enrolled in Plan 1-QHDHP (Qualified High Deductible Health Plan): $600 yearly for Full-time employees $300 yearly for Part-time employees Pro-rated amount for New Hires
Flexible Spending Accounts** o Medical Reimbursement FSA Maximum $2,650/year Minimum $120/year o Limited Purpose FSA Maximum $2,650/year*** Minimum $120/year o Dependent Care Reimbursement FSA Maximum $5,000/year Minimum $120/year
***Limited Purpose FSA funds can only be used for qualifying vision, dental and orthodontia expenses Medical Bridge Benefits
Colonial Life
Cancer Benefits
Colonial Life
Accident Benefits
Colonial Life
**You will need to re-sign for the Spending Accounts if you want them to continue next year. IF YOU DO NOT RE-SIGN, YOUR CONTRIBUTION WILL STOP EFFECTIVE December 31, 2018.
Post-Tax Benefits Disability Benefits o Short-Term Disability o Long-Term Disability*
Colonial Life Lincoln Financial*
Critical Care Benefits
Colonial Life
Life Insurance o Group Term Life Insurance (Employer Paid) o Term Life Insurance o Whole Life Insurance
Dearborn National Colonial Life Colonial Life
*EMPLOYEES WILL NEED TO RE-ENROLL IN HEALTH AND LONG-TERM DISABILITY BENEFITS IN ORDER TO CONTINUE COVERAGE FOR THE NEW PLAN YEAR BEGINNING JANUARY 1, 2019.
Insurance Products will remain in effect unless you see a representative to change them. ENROLLMENT PERIOD: EFFECTIVE DATES:
October 29, 2018 through November 16, 2018 January 1, 2019 through December 31, 2019
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Qualifications • Employees working 20 hours or more per week are eligible to participate in benefits. • Employees must work at least 40 hours per week to be eligible for Basic Group Term Life coverage.
Important Information The plan year for Cigna Health, UMR Dental, Lincoln Financial Long-Term Disability, Superior Vision, Colonial Insurance products and Spending Accounts lasts from January 1, 2019 through December 31, 2019. Deductions for Cigna Health, UMR Dental, Lincoln Financial Long-Term Disability, Superior Vision, Colonial Insurance products and Spending Accounts will begin January 2019. Health FSA Rollover Provision: Alamance County Government provides the rollover option for your FSA plan. Please see page 23 for more information on this provision. If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when meeting with the Benefits Representative. If you will be receiving a new debit card, whether you are a new participant or to replace your expired card, please be aware that it may take up to 30 days following your plan effective date for your card to arrive. Your card will be delivered by mail in a plain white envelope. During this time you may use manual claim forms for eligible expenses, available from your Benefits Representative during the open enrollment period. Please note that your debit card is good through the expiration date printed on the card. Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or the transition of spouse's employment from full-time to part-time or vice-versa. Once a family status change has occurred, an employee has 30 days to notify the North Carolina Service Center at 888-662-7500 to request a change in elections. Medical Reimbursement and Dependent Care Reimbursement expenses must be incurred during the Plan Year in order to be eligible for reimbursement. An employee has 90 days after the plan year ends to submit claims for medical reimbursement and/or dependent care expenses that were incurred during the plan year. Please note that if employment terminates during the plan year, that employee's plan year ends the day employment ends. The employee has 90 days after the termination date to submit claims. Unlike Medical Reimbursement Accounts, with Dependent Care Flexible Spending Accounts the maximum reimbursement you can get is equal to the current account balance in your Dependent Care account. The Colonial Cancer plan and the Health Screening Rider on the Colonial Accident and Colonial Medical Bridge plan have a 30-day waiting period for new enrollees. Coverage, therefore, will not begin until January 31, 2019. Additionally, some policies may include a pre-existing condition clause. Please read your policy carefully for full details. Please be aware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution. An employee taking a leave of absence, other than under the Family & Medical Leave Act, may not be eligible to reenter the Benefits Program until the next plan year. Please contact your Alamance County Government Benefit Administrator for more information.
To enroll or make changes to your Benefits Plan, please see the representative while he/she is at your location. Notice: Please refer to the Medicare Part D Creditable Coverage Notice on Page 73 of this Benefits Booklet Alamance County Government | 3
ONLINE ENROLLMENT INSTRUCTIONS FOR YOUR ANNUAL ENROLLMENT PERIOD You can make the following benefit elections online from October 29, 2018 through November 16, 2018: Enroll, change or cancel your Health insurance*. Enroll in Health Savings Account (HSA)
HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP)
Enroll in Flexible Spending Account (Medical, Limited Purpose & Dependent Care)*. Enroll, change or cancel your Vision insurance. Enroll, change or cancel your Dental insurance. Enroll, change or cancel your Long-Term Disability insurance*. Enroll, change or cancel your Colonial products (please see further details below)
*EMPLOYEES WILL NEED TO RE-ENROLL IN HEALTH, FLEXIBLE SPENDING ACCOUNTS AND LONG-TERM DISABILITY BENEFITS IN ORDER TO CONTINUE COVERAGE FOR THE NEW PLAN YEAR BEGINNING JANUARY 1, 2019.
The following benefit elections must be made with your Benefits Representative during the enrollment period and are not available for online enrollment. Enroll or change Colonial products (please see further details below)
BENSELECT ONLINE ASSISTANCE 1. Complete the following steps to begin the online enrollment process.
Go to https://harmony.benselect.com/Enroll
Enter your User Name: Social Security Number with or without dashes (ex. 123456789 or 123-45-6789)
Enter your PIN: Last 4 numbers of your Social Security Number followed by last 2 numbers of your Date of Birth year (ex. 678970)
Helpful Tips: If you are a new employee and unable to log into the online system, please see the Benefits Representative while he/she is at your location or at the scheduled make-up day. If you are an existing employee and unable to log into the online system, please contact Pierce Group Benefits at 888662-7500 between 8:30am and 5:00pm or speak with your Benefits Representative while he/she is at your location or at the scheduled make-up day. 2. 3. 4. 5. 6. 7. 8. 9.
The screen prompts you to create a NEW PIN [____________________________]. Choose a security question and enter answer [______________________________________]. Confirm (or enter) an email address Click on ‘Save New PIN’ to continue to the enrollment welcome screen. From the welcome screen click “Next”. The screen shows ‘Personal Information’. Verify that the information is correct and enter the additional required information (marital status, work phone, e-mail address). Click ‘Next’. The screen allows you to add family members. It is only necessary to enter family member information if adding or including family members in your coverage. Click ‘Next’. The screen shows ‘Benefit Summary’. Review your current benefits and make changes/selections for the upcoming plan year.
Health - Select family members that you wish to cover with your health insurance. Dental - Select family members that you wish to cover with your dental insurance. Vision - Select family members that you wish to cover with your vision insurance. Long-Term Disability – Select your long-term disability insurance coverage. Health Care FSA - Enter annual amount. MAX $2,650/year
MIN $120/year
Limited Purpose FSA - Enter annual amount. MAX $2,650/year
MIN $120/year
Limited Purpose FSA funds can only be used for qualifying vision, dental and orthodontia expenses
Dependent Care FSA - Enter annual amount. MAX $5,000/year
MIN $120/year
Health Savings Account - Enter annual amount. EMPLOYEE MAX $3,500/year FAMILY MAX $7,000/year HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP) Alamance County Government will contribute the following amounts yearly to the Health Savings Account for those enrolled in Plan 1-QHDHP (Qualified High Deductible Health Plan):$600 yearly for Full-time employees; $300 yearly for Part-time employees; Pro-rated amount for New Hires
Instructions continued on next page
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Online Enrollment Instructions
Group Disability You may enroll online in Group Disability coverage.
Cancer Assist You may enroll online in Cancer Assist coverage.
Critical Care You may enroll online in Critical Care coverage.
Medical Bridge You may enroll online in Medical Bridge coverage.
Accident 1.0 You may enroll online in Accident 1.0; however persons over age 64 applying for coverage and employees wishing to purchase an individual policy for their spouse must meet with the Benefits Representative.
Term Life 1000 You may enroll online in Term Life 1000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative.
Whole Life 1000 You may enroll online in Whole Life 1000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative.
10. 11. 12. 13. 14. 15.
Click ‘Sign & Submit’ once you have decided which benefits to enroll in. Review your coverage. If any items are ‘Pending’, you will need to decide whether to enroll or decline this benefit. Click ‘Next’ to review and electronically sign the authorization for your benefit elections. Review the confirmation, then if you are satisfied with your elections, enter your PIN and click ‘Sign Form’. Click ‘Download & Print’ to print a copy of your elections. Please do not forget this important step!!! Click ‘Log Out’.
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HEALTH INSURANCE Provided by Cigna Please visit www.piercegroupbenefits.com/alamancecountygovernment to review plan summaries and other required notices
Alamance County Government January 1, 2019 - December 31, 2019 Plan 1 - QHDHP w/HSA
ASO Open Access Plus
Plan 2 - Copay Plan 70
Plan 3 - Copay Plan 80
In-Network Benefits Below -- See website for Out of Network Schedule $2,000 / $4,000 Aggregate
$2,500 / $5,000 Embedded
$1,500 / $3,000 Embedded
20%
30%
20%
$4,000 / $8,000
$5,000 / $10,000
$4,000 / $8,000
Unlimited
Unlimited
Unlimited
$600
N/A
N/A
Plan pays 100%
Plan pays 100%
Plan pays 100%
Physician Office Services - Primary Care Physician (PCP) - All services including Lab & X-ray
Deductible / Coinsurance
$30 Copay
$20 Copay
Physician Office Services - Specialist - All services including Lab & X-ray
Deductible / Coinsurance
$70 Copay
$60 Copay
MD Live - $45 then covered at 100% after deductible is satisfied AmWell - $49 then covered at 100% after deductible is satisfied
$30 Copay
$20 Copay
Deductible / Coinsurance
$30 Copay - PCP $70 Copay - Specialist
$20 Copay - PCP $60 Copay - Specialist
Maternity Care
Deductible / Coinsurance
Initial visit to confirm pregnancy -- covered same as plan's Physician's Office Services. Global Maternity Fee -- 30% coinsurance after deductible
Initial visit to confirm pregnancy -- covered same as plan's Physician's Office Services. Global Maternity Fee -- 20% coinsurance after deductible
Ambulance Services -- Non-emergency not covered
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Urgent Care Services
Deductible / Coinsurance
$50 Copay
$40 Copay
Emergency Room Hospital and Physician Services - must meet Emergency criteria, subject to prudent layperson review
Deductible / Coinsurance
$350 Copay waived if admitted
$300 Copay waived if admitted
Inpatient Services -- Facility and Services
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Outpatient Facility and Professional Services -Includes, but is not limited to, services performed by Surgeon, Radiologist, Pathologist and Anesthesiologist.
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Private Duty Nursing (50 days max per Benefit Year)
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Skilled Nursing Facility (100 days max per Benefit Year)
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Hospice Care - Inpatient / Health Care Facility - Outpatient Services
Deductible / Coinsurance
30% coinsurance after deductible
20% coinsurance after deductible
Home Health Care (30 days max per Calendar Year)
Deductible / Coinsurance
30% after deductible
20% after deductible
Benefit Year Deductible (Individual/Family) Coinsurance (amount you pay) Benefit Year Out-of-Pocket Maximum (Individual/Family) (In and Out-of-Network Maximums are combined and includes health and pharmacy) Maximum Lifetime Benefit Per Member HSA Employer Contribution
Covered Services Preventative Care
Cigna Telehealth Connection Services - Includes charges for the delivery of medical and health-related consultations via secure telecommunications technologies, telephones and internet when delivered by contracted medical telehealth provers (see details on myCigna.com)
Allergy Treatment / Injection - performed in office
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Health Insurance Benefit Highlights
Alamance County Government January 1, 2019 - December 31, 2019 Plan 1 - QHDHP w/HSA
ASO Open Access Plus
Plan 2 - Copay Plan 70
Plan 3 - Copay Plan 80
In-Network Benefits Below -- See website for Out of Network Schedule
Short Term Rehabilitation Spinal Manipulation Services (limited to 20 days) Physical Therapy (limited to 20 days)
Deductible / Coinsurance
$70 Copay
$60 Copay
Deductible / Coinsurance
30% after deductible
20% after deductible
Inpatient -- includes Residential Treatment
Deductible / Coinsurance
30% after deductible
20% after deductible
Outpatient -- Physician office
Deductible / Coinsurance
$70 Copay
$60 Copay
Outpatient Care -- all other services
Deductible / Coinsurance
30% after deductible
20% after deductible
Inpatient -- includes Residential Treatment
Deductible / Coinsurance
30% after deductible
20% after deductible
Outpatient -- Physician office
Deductible / Coinsurance
$70 Copay
$60 Copay
Outpatient Care -- all other services
Deductible / Coinsurance
30% after deductible
20% after deductible
Occupational Therapy (limited to 20 days) Speech Therapy (limited to 20 days) Cardiac Rehabilitation (limited to 36 days) Rehabilitation Facility or Sub-Acute Services (limited to 100 days per Benefit Year) Mental Health
Substance Use Disorders
Transplant Benefits Inpatient Hospital Lifesource Facility
Deductible / Coinsurance
Plan pays 100%
Plan pays 100%
Inpatient Hospital NON-Lifesource Facility
Deductible / Coinsurance
30% after deductible
20% after deductible
Retail (up to 30 day supply)
90 day supply options 90 day supply options 90 day supply options Retail Retail Mail Order & Select Mail Order & Select Mail Order & Select (up to 30 day supply) (up to 30 day supply) Retail Locations Retail Locations Retail Locations
ACA Preventive Rx (See Cigna website for list of covered medications)
100% (deductible & coinsurance waived)
100% (deductible & 100% (deductible & 100% (deductible & 100% (deductible & 100% (deductible & coinsurance waived) coinsurance waived) coinsurance waived) coinsurance waived) coinsurance waived)
Preventative Generic
100% (deductible & coinsurance waived)
100% (deductible & coinsurance waived)
Rx Deductible
Plan deductible must be satisfied then benefit below will apply
Prescription Drug Coverage
Generic
$10 Copay
$20 Copay
N/A
N/A
N/A
$100 Individual $300 Family
$10 Copay
N/A
$100 Individual $300 Family
$20 Copay
$10 Copay
$20 Copay
Preferred Brand
20% Coinsurance ($25 min / $50 max)
20% Coinsurance 20% Coinsurance 20% Coinsurance 20% Coinsurance 20% Coinsurance ($25 min / $50 max) ($25 min / $50 max) ($25 min / $50 max) ($25 min / $50 max) ($25 min / $50 max)
Non-Preferred Brand
30% Coinsurance ($50 min / $100 max)
30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance ($50 min / $100 max) ($50 min / $100 max) ($50 min / $100 max) ($50 min / $100 max) ($50 min / $100 max)
Specialty
30% Coinsurance ($100 min / $250 max)
N/A
30% Coinsurance ($100 min / $250 max)
N/A
30% Coinsurance ($100 min / $250 max)
N/A
This is intended for information purposes only. It is not a complete listing of the benefits, exclusions, terms, or conditions of the Certificate of Coverage. Please refer to the Summary of Benefits and Coverage. This overview does not replace your Certificate of Coverage. Many words are defined in the Certificate, and other limitations or exclusions may be listed in other sections of your Certificate. Reading this overview by itself could give you an inaccurate impression of the terms of your coverage. This overview must be read with the rest of your Certificate of Coverage. Prior authorization is required for specific services. Benefits and Benefit Year: Benefits listed in this overview are for Covered Services only. The Benefit Year is the Calendar Year. Updated 10.10.18
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Health Insurance Wellness Promotion Program
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Health Insurance Alamance County Health Clinic
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Health Insurance Cigna Telehealth Connection
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Health Insurance Your Pharmacy Benefit
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Health Insurance Access your HSA Funds
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Health Insurance myCigna Member Website
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DENTAL INSURANCE Provided by UMR
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VISION INSURANCE Provided by Superior
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HEALTH, DENTAL & VISION RATES – Full-time Employees Alamance County Government January 1, 2019 - December 31, 2019 Full-time Employees - Contribution Schedule Health Insurance
Plan 1 - High Deductible Health Plan Employer provides $600 in HSA Contribution $702.00
Employee + Spouse $1,162.00
Employee + Children $1,052.00
Employee + Family $1,437.00
$702.00
$702.00
$702.00
$702.00
$0.00
$460.00
$350.00
$735.00
$727.00
Employee + Spouse $1,177.00
Employee + Children $1,092.00
Employee + Family $1,477.00
$702.00
$702.00
$702.00
$702.00
$25.00
$475.00
$390.00
$775.00
$752.00
Employee + Spouse $1,217.00
Employee + Children $1,107.00
Employee + Family $1,512.00
$702.00
$702.00
$702.00
$702.00
$50.00
$515.00
$405.00
$810.00
$39.50
Employee + Spouse $71.25
Employee + Children $63.75
Employee + Family $91.00
$39.50
$39.50
$39.50
$39.50
$0.00
$31.75
$24.25
$51.50
$39.50
Employee + Spouse $71.25
Employee + Children $63.75
Employee + Family $91.00
$29.62
$29.62
$29.62
$29.62
$9.88
$41.63
$34.13
$61.38
Employee Only
Employee + One
Employee + Family
$10.98
$21.31
$31.31
Employee Only Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Plan 2 - Copay Plan 70 Employee Only Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Plan 3 - Copay Plan 80 Employee Only Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Dental Insurance (working 40 hours/week) Employee Only Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution
Dental Insurance (working 30-39 hours/week) Employee Only Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution Vision Insurance
Employee Monthly Contribution*
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HEALTH, DENTAL & VISION RATES – Part-time Employees Alamance County Government January 1, 2019 - December 31, 2019 Part-time Employees (20 -29 hours/week) - Contribution Schedule Health Insurance
Plan 1 - High Deductible Health Plan Employer provides $300 in HSA Contribution Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
Employee Only $702.00 $351.00
Employee + Spouse $1,162.00 $351.00
Employee + Children $1,052.00 $351.00
Employee + Family $1,437.00 $351.00
$351.00
$811.00
$701.00
$1,086.00
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Plan 2 - Copay Plan 70 Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
Employee Only $727.00 $351.00
Employee + Spouse $1,177.00 $351.00
Employee + Children $1,092.00 $351.00
Employee + Family $1,477.00 $351.00
$376.00
$826.00
$741.00
$1,126.00
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Plan 3 - Copay Plan 80
Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution*
Employee Only $752.00 $351.00
Employee + Spouse $1,217.00 $351.00
Employee + Children $1,107.00 $351.00
Employee + Family $1,512.00 $351.00
$401.00
$866.00
$756.00
$1,161.00
Employee + Family $91.00 $19.75 $71.25
*Additional Non-Compliant Wellness Penalty of $50 will be added if applicable
Dental Insurance
Total Monthly Premium Employer Monthly Contribution Employee Monthly Contribution
Employee Only $39.50 $19.75 $19.75
Employee + Spouse $71.25 $19.75 $51.50
Employee + Children $63.75 $19.75 $44.00
Employee Only
Employee + One
Employee + Family
$10.98
$21.31
$31.31
Vision Insurance
Employee Monthly Contribution*
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FLEXIBLE SPENDING ACCOUNTS
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Flexible Spending Accounts
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Flexible Spending Accounts
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Flexible Spending Accounts
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Flexible Spending Accounts Limited Purpose FSA
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Flexible Spending Accounts Frequently Asked Questions
Employer: Alamance County Government Plan Year: January 1, 2019 through December 31, 2019
FREQUENTLY ASKED QUESTIONS What are my Maximum Annual Contributions?
The maximum you may contribute to the Healthcare Flexible Spending Account is $2,650 /year. The minimum you may contribute to the Healthcare Flexible Spending Account is $120 /year. The maximum you may contribute to the Limited Purpose Flexible Spending Account is $2,650 /year. The minimum you may contribute to the Limited Purpose Flexible Spending Account is $120 /year. The maximum you may contribute to the Dependent Care Account is $5,000 /year. The minimum you may contribute to the Dependent Care Account is $120 /year. What happens if I don’t use all the money in my FSA by the end of the plan year?
By law, employers are not allowed to return leftover money to participants. Please see below for information on the Rollover Provision provided by Alamance County Government. When can I start using the money in my FSA account?
You can access your annual contribution at the start of your plan year. Will I get paid less every pay period if I enroll in an FSA?
Your gross, or pre-tax, pay will remain the same. But your “net” pay will be lower because a portion of it will go into your FSA account. The advantage is that this money gets put into your FSA account before taxes, which lowers your “taxable” income. You have complete access to these funds for any qualified medical expense for you and your family. When do I choose my contribution amount and can I change it anytime?
You choose your FSA contribution amount during your annual enrollment; this is the time of year you can elect and/or change your benefits such as medical, dental, etc. Once your contribution election becomes effective, you won’t be able to change it until the next enrollment period, unless there is a change in your eligibility status, which the IRS refers to as a “qualifying event.” Some qualifying events include, but are not limited to (please refer to your Summary Plan Description for an exhaustive list):
Change in provider (Dependent Care only) Change in cost of day care (Dependent Care only) Change in legal marital status Change in number of legal dependents
The election change must be consistent with the qualifying event. A change is considered consistent with the qualifying event for healthcare FSAs if the following occurs:
The employee, spouse, or dependent is gaining or losing eligibility for health coverage. The election change corresponds with the gain or loss of coverage.
Instead of enrolling in an FSA, why shouldn’t I just make these deductions on my income tax?
Claiming a tax return deduction is only beneficial for people with substantial uninsured medical expenses. According to the IRS, only medical/dental expenses that exceed 10% of your “adjusted gross income” and are not covered by insurance can be deducted from your income taxes. Most people do not have uninsured medical expenses high enough to qualify for this deduction. Who is eligible to participate?
Employees who work at least 20 hours per week are eligible to participate. Eligible employees must sign a new enrollment form before the start of each plan year. New employees are eligible the first of the month following 30 days of employment. Eligible employees can claim expenses incurred by their dependents as defined under section 125 of the Internal Revenue Code. What happens to my FSA contributions if I leave or am terminated from my job?
If you leave or are terminated from your job and have a positive balance in your FSA account, you do have COBRA rights. If you do not exercise those rights, the balance remaining in your FSA will be forfeited. Ameriflex will deactivate the terminated employee’s MyAmeriflex Card on the date they are notified of the termination. Any eligible expenses incurred, and not yet submitted for reimbursement prior to or on the date of termination, must be filed using a manual claim form and must be received by Ameriflex within the run-out period described in the Summary Plan Description. How may I access my account information?
You may log in to your FSA account anytime to view your account balance, account activity and transaction history. Access your account at www.myameriflex.com. You may also call Ameriflex directly at 888-868-3539 to speak to a representative or to access the 24/7 Interactive Voice Response System.
MODIFICATION TO HEALTH FSA “USE IT OR LOSE IT” RULE FSA plan participants should note that up to $500 of any unused funds from the 2018 plan year will be rolled over into your 2019 FSA balance. The rollover modification applies to Health FSA plans only (and not to other types of FSA plans such as dependent care). The rollover does not affect the maximum contribution amount for 2019. In other words, even if you roll over the entire $500 from the previous plan year, you may still elect up to the maximum contribution limit allowed under your employer’s plan. For Alamance County Government, the maximum contribution amount allowed under your plan is $2,650; this means that you could have up to $3,150 in your account for the new plan year. For more information, please visit the AmeriFlex Website at www.myameriflex.com or contact AmeriFlex by calling 888.868.FLEX (3539).
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Flexible Spending Accounts Managing Your Account
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Flexible Spending Accounts The FSA Store
The FSAStore – One Convenient Location for All Your FSA Purchases Pierce Group Benefits recently partnered with the FSAStore to provide one convenient location for all your FSA eligible purchases. Through our partnership, Pierce Group Benefits and the FSAStore can help you shop for FSA eligible items, search for local and eligible physicians, and answer the many questions that come along with having a Flexible Spending Account. COMPONENTS The FSAstore focuses on three main channels to help you better understand your benefits and eligible services and products as an FSA participant:
Products – Shop for more than 4,000 FSA eligible products Services – Find FSA eligible services and providers in your area Learning Center – Learn more about your FSA and get answers to your questions BENEFITS
By utilizing FSAStore, you get the following benefits:
Easily understand which products require a prescription and which do not Get access to FSA eligible services and providers in your area Find answers to commonly and not-so-commonly asked FSA questions Enjoy free shipping on orders over $50 with a short 1-2 day turnaround time Have access to 24/7 customer support Get your favorite brands at discounted prices ACCESSING FSASTORE Accessing the FSAStore is easy. Simply visit www.FSAStore.com!
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MEDICAL BRIDGE BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Medical Bridge policy available through your benefits package. If you enrolled in a Medical Bridge Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Medical Bridge Indemnity Benefit
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Medical Bridge Indemnity Benefit
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Medical Bridge Indemnity Benefit
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Medical Bridge Indemnity Benefit
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Medical Bridge Indemnity Benefit
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SHORT-TERM DISABILITY BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Disability policy available through your benefits package. If you enrolled in a Disability Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Short-Term Disability Benefit
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Short-Term Disability Benefit
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Short-Term Disability Benefit
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LONG-TERM DISABILITY BENEFIT Provided by Lincoln Financial
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Long-Term Disability Benefit
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Long-Term Disability Benefit
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Long-Term Disability Benefit
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Long-Term Disability Benefit
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CANCER BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Cancer policy available through your benefits package. If you enrolled in a Cancer Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
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Cancer Benefit
Individual Cancer Rates LEVEL 1 – Monthly Premiums - Composite Rates Employee
Employee /Spouse
One-Parent Family
Two-Parent Family
$18.25
$28.75
Level 1 with $100 Cancer Wellness/Health Screening Premium
$18.10
$28.60
LEVEL 2 – Monthly Premiums - Composite Rates Employee
Employee /Spouse
One-Parent Family
Two-Parent Family
$21.95
$34.15
Level 2 with $100 Cancer Wellness/Health Screening Premium
$21.65
$33.85
LEVEL 3 – Monthly Premiums - Composite Rates Employee
Employee /Spouse
One-Parent Family
Two-Parent Family
$27.10
$44.85
Level 3 with $100 Cancer Wellness/Health Screening Premium
$26.65
$44.40
LEVEL 4 – Monthly Premiums - Composite Rates Employee
Employee /Spouse
One-Parent Family
Two-Parent Family
$36.20
$60.00
One-Parent Family
Two-Parent Family
$1.75
$1.25
$1.75
$2.50
$1.60
$2.60
$7.80
$17.05
Level 4 with $100 Cancer Wellness/Health Screening Premium
$35.60
$59.40
OPTIONAL RIDERS Employee
Employee /Spouse
Specified Disease Hospital Confinement Rider Premium
$1.25
Initial Diagnosis of Cancer Rider (per $1,000) Premium
$1.50
Initial Diagnosis of Cancer Progressive Payment Rider Premium
$7.80
$17.05
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ACCIDENT BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Accident policy available through your benefits package. If you enrolled in an Accident Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Accident Benefit
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Accident Benefit
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Accident Benefit
Accident 1.0 – Preferred with Health Screening Monthly Premiums Named Insured Employee & Spouse One-Parent Family Two-Parent Family
$21.15 $28.97 $32.67 $40.48
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CRITICAL CARE BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Critical Care policy available through your benefits package. If you enrolled in a Critical Care Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Critical Care Benefit Plan 1 – Cancer & Specified Disease
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Critical Care Benefit First Diagnosis Building Benefit Rider – Specified Disease & Cancer (Plan 1)
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Critical Care Benefit Plan 3 – Specified Disease
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Critical Care Benefit Plan 3 – Specified Disease
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Critical Care Benefit First Diagnosis Building Benefit Rider – Specified Disease (Plan 3)
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Critical Care Benefit Health Screening Benefit
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GROUP TERM LIFE INSURANCE Provided by Dearborn National
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Group Term Life Insurance
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TERM LIFE INSURANCE Provided by Colonial Life The following information highlights the benefits of the current Term Life policy available through your benefits package. If you enrolled in a Term Life Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Term Life Insurance
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WHOLE LIFE INSURANCE Provided by Colonial Life The following information highlights the benefits of the current Whole Life policy available through your benefits package. If you enrolled in a Whole Life Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features. Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions. Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.
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Whole Life Insurance
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Whole Life Insurance Long-Term Care Benefit Rider
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Whole Life Insurance Long-Term Care Benefit Rider
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Juvenile Whole Life Insurance
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Juvenile Whole Life Insurance
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ALAMANCE COUNTY GOVERNMENT MEDICARE PART D CREDITABLE COVERAGE NOTICE
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Alamance County Government Medicare Part D Creditable Coverage Notice
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Alamance County Government Medicare Part D Creditable Coverage Notice
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MOBILE APPS – VIEW BENEFITS ON-THE-GO
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General Notice of COBRA Continuation Coverage Rights ** Continuation Coverage Rights Under COBRA** Introduction You are receiving this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your spouse dies; Your spouse’s hours of employment are reduced; Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.” Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Alamance County Government, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: The end of employment or reduction of hours of employment; Death of the employee; Commencement of a proceeding in bankruptcy with respect to the employer; or The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Joann Taylor at Alamance County Government. Applicable documentation will be required i.e. court order, certificate of coverage etc.
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General Notice of COBRA Continuation Coverage Rights (continued)
How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information Alamance County Government Attn: Joann Taylor 124 West Elm Street, Graham, NC 27253 Phone: 336-228-1312 Fax: 336-513-5559 COBRA Administrator for Health and Dental Coverage Interactive Medical Systems P. O. Box 1349, Wake Forest, NC 27588 Phone: 919-877-9933 Physical Address: Interactive Medical Systems 11635 North Park Drive, Suite 330, Wake Forest, NC 27587 COBRA Administrator for Vision Coverage Superior Vision 11101 White Rock Road, Rancho Cordova, CA 95670 Phone: 800-507-3800 COBRA Administrator for FSA Coverage Ameriflex 7 Carnegie Plaza Ste. 200, Cherry Hill, NJ 08003 Phone: 844-423-4636
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Authorization for Colonial Life & Accident Insurance Company For the purpose of evaluating my application(s) for insurance submitted during the current enrollment and eligibility for benefits under any insurance issued including checking for and resolving any issues that may arise regarding incomplete or incorrect information on my application(s), I hereby authorize the disclosure of the following information about me and, if applicable, my dependents, from the sources listed below to Colonial Life & Accident Insurance Company (Colonial) and its duly authorized representatives. Health information may be disclosed by any health care provider or institution, health plan or health care clearinghouse that has any records or knowledge about me including prescription drug database or pharmacy benefit manager, or ambulance or other medical transport service. Health information may also be disclosed by any insurance company, Medicare or Medicaid agencies or the Medical Information Bureau (MIB). Health information includes my entire medical record, but does not include psychotherapy notes. Non-health information including earnings or employment history deemed appropriate by Colonial to evaluate my application may be disclosed by any person or organization that has these records about me, including my employer, employer representative and compensation sources, insurance company, financial institution or governmental entities including departments of public safety and motor vehicle departments. Any information Colonial obtains pursuant to this authorization will be used for the purpose of evaluating my application(s) for insurance or eligibility for benefits. Some information obtained may not be protected by certain federal regulations governing the privacy of health information, but the information is protected by state privacy laws and other applicable laws. Colonial will not disclose the information unless permitted or required by those laws. This authorization is valid for two (2) years from its execution and a copy is as valid as the original. A copy will be included with my contract(s) and I or my authorized representative may request access to this information. This authorization may be revoked by me or my authorized representative at any time except to the extent Colonial has relied on the authorization prior to notice of revocation or has a legal right to contest coverage under the contract(s) or the contract itself. If revoked, Colonial may not be able to evaluate my application(s) for insurance or eligibility for benefits as necessary to issue my contract(s). I may revoke this authorization by sending written notice to: Colonial Life & Accident Insurance Company, Underwriting Department, P.O. Box 1365, Columbia, SC 29202. You may refuse to sign this form; however, Colonial may not be able to issue your coverage. I am the individual to whom this authorization applies or that person’s legal Guardian, Power of Attorney Designee, or Conservator.
________________________ (Printed name of individual subject to this disclosure)
_____________ (Social Security Number)
___________________ (Signature)
________________ (Date Signed)
If applicable, I signed on behalf of the proposed insured as __________________________ (indicate relationship). If legal Guardian, Power or Attorney Designee, or Conservator.
________________________________ (Printed name of legal representative)
_____________________________ (Signature of legal representative)
___________ (Date Signed)
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Health Insurance – Cigna
Flexible Spending Accounts – AMERIFLEX
Customer Service.........................................................1-800-244-6224 Internet Address………………………...……..…www.myCigna.com
Mailing Address…..7 Carnegie Plaza Ste. 200, Cherry Hill, NJ 08003 Internet Address for Ameriflex………………www.myameriflex.com
See the inside of your Benefit Booklet for more details on how to access your benefits through Cigna!
UMR - Dental Insurance Customer Service.........................................................1-800-826-9781 Internet Address………………………………...…..…www.umr.com
For questions, duplicate cards and other service questions contact:
Medical or Dependent Care Customer Service……....1-888-868-3539 Please fax claims to the number printed on your form
For Directions on checking your Flexible Spending Account balance and history online (cardholders only) and accessing manual claim forms, please visit www.myameriflex.com.
Superior - Vision Insurance Customer Service.........................................................1-800-507-3800 Internet Address….........................................www.superiorvision.com
See page 24 of your Benefit Booklet for information on Managing your Flexible Spending Accounts!
Dearborn National – Term Life Insurance
To view your benefits online visit
Customer Service....................................................... 1-800-348-4512 Internet Address…....................................www.dearbornnational.com
Lincoln Financial – Long-Term Disability Customer Service......... 1-800-423-2765 Reference ID: ALAMANC Internet Address…................................... www.LincolnFinancial.com
www.piercegroupbenefits.com/ alamancecountygovernment or for additional information concerning plans offered to employees of Alamance County Government, please contact our North Carolina Service Center at 1-888-662-7500, ext. 100
Colonial Life Visit ColonialLife.com to set up your personal account. Download the free My Colonial Life app available at the Apple iTunes store to access claims and policy information! Customer Service & Wellness Screenings 1-800-325-4368 TDD for hearing impaired customers call 1-800-798-4040
Internet Address www.coloniallife.com
Claims Fax 1-800-880-9325
If you wish to file a Wellness/Cancer Screening claim for a test performed within the past 18 months, you need the name and date of the test performed as well as your doctor’s name and phone number. Colonial also needs to know if this is for you or another covered individual and their name and social security number. You may: FILE BY PHONE! Call 1-800-325-4368 and provide the information requested by Colonial’s Automated Voice Response System, 24 hours per day, 7 days a week, or SUBMIT ON THE INTERNET using the Wellness Claim Form at www.coloniallife.com, or Write your name, address, social security number and/or policy/certificate number on your bill and indicate “Wellness Test.” Fax this to Colonial at 1-800-880-9325 or MAIL to PO Box 100195, Columbia, SC 29202 If your Wellness/Cancer Screening test was more than one year ago, you must fax or mail Colonial a copy of the bill or statement from your doctor indicating the type of procedure performed, the charge incurred and the date of service. Please write your full name, social security number, and current address on the bill. Please Note: If your cancer policy includes a second part to the screening benefit, bills for tests covered and a copy of the diagnostic report (reflecting the abnormal reading of your first test) must be mailed or faxed to us for benefits to be provided.
When you terminate employment with Alamance County Government, you have the opportunity to continue your Colonial coverage either through direct billing or automatic payment through your bank account. Please contact Colonial at 1-800-325-4368 to request the continuation of benefits form.