The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives you the right to choose continuation of health care coverage if you and/or your eligible dependents lose County coverage. You may continue health care coverage for up to 18, 29 or 36 months, depending on the situation and who is being covered. Within a couple of weeks of the loss of coverage, you will receive a separate COBRA notification from FBMC, our COBRA TPA, explaining these rights.
If you think you or your dependents’ health care coverage will end because an event is occurring causing ineligibility under the plan, there are certain things you must do to continue coverage under COBRA. In some cases, you must notify the County of the event. If COBRA is an option for you, you must make an election and pay for coverage within certain time periods.
If you retire, the County will notify you and your dependents of your right to continue health care coverage under COBRA. This notification will explain in detail how COBRA works. You may elect Retiree coverage or COBRA coverage.
If you die, the County will notify your dependents of their right to continue health care coverage under COBRA. This notification will explain in detail how COBRA works.
If you divorce or legally separate or your child loses dependent status under a group health plan, you or your covered dependents are responsible for notifying the County within 60 days from the date of these events. The County’s Third Party Administrator, FBMC, will then notify your dependents of their right to continue health care coverage under COBRA. This notification will explain in detail how COBRA works. COBRA rights will be forfeited if FBMC is not notified within 60 days of the qualifying event.
Continuation of Coverage Notice – Domestic Partner
A domestic partner and/or their dependents are not eligible under COBRA law; however, the Broward County Board of County Commissioners extends continuation of group health, dental and/or vision coverage to employee’s domestic partner and their dependents for up to a period of 18 months, if they experience one of the events listed below.
employee’s termination or reduction of hours of employment
death of the employee
employee becomes entitled to Medicare
dissolution of the domestic partnership registered with Broward County Records Division (Per County Ordinance, domestic partner’s remain on your coverage through the end of the month, 30 days after the dissolution date.)
a dependent child will also have the opportunity to apply for continuation coverage for up to 18 months if the dependent ceases to qualify as a “dependent child” as defined by the insurance plan.
You will have the opportunity to continue the same coverage in which you were enrolled the day before you experienced one of the events described above. You do not have to show that you are insurable to choose continuation coverage. No additional time extensions past the 18 months are available under this continuation benefit.
Should the employee and the domestic partner or their dependents want continuation coverage because of the same event, the employee would apply separately for COBRA and the domestic partner and their dependents would apply for domestic partner continuation benefits.
If you have any further questions regarding COBRA or Domestic Partner Continuation of Coverage benefits,
please contact Employee Benefit Services at 954-357-6700, for billing and payment questions, contact FBMC at: 800-342-8017.
DOMESTIC PARTNER AND OVER AGE DEPENDENTS (AGE 26 - 30)
Premiums and County Subsidy
Federal Tax laws governing taxation of domestic partner and Over Age Dependents benefit plan enrollment are continually evolving. Because of these tax laws, the County must include the fair market value of benefits in employees’ income, referred to as “imputed income.” In this case, “imputed income” is defined by the IRS as monies that are taxable to the employee when received as a benefit in relation to covering a domestic partner, dependents of a domestic partner or over age dependents. The Internal Revenue Service allows the employee to receive “tax free” insurance subsidies for themselves and their eligible dependents as defined under IRS guidelines, but excludes those amounts attributable to coverage of a domestic partner, dependents of domestic partner or over age dependents. The premium charts for health, dental and vision premiums, illustrate the imputed income and after-tax amounts for which you would be responsible based on various scenarios.
- “Pre” and “After” Tax – The employee’s full deduction for health insurance is separated into two parts: When the “Pre” tax and “After” tax amounts are added together, that amount is the full employee deduction for health insurance.
- Imputed Income – As described above, the amounts shown in the column marked “Imputed Income” become additional income to the employee, per IRS rules, and are taxed accordingly. That is why we suggest you consult a tax adviser on how to best claim exemptions on your W2 and on your income tax.
Additionally, a domestic partner, dependents of a domestic partner or over age dependents are not eligible to receive reimbursement from a “Health Reimbursement Account (HRA)” under a Consumer Driven Health plan. These dependents can be insured and receive coverage as any other insured and be subject to the same copayments, coinsurance and deductible; however, the employee would not receive the portion of the HRA attributable to coverage for a domestic partner, their dependents or an over age dependent.
IMPORTANT DISCLAIMER NOTICE: Because there will be additional “out-of-pocket” costs associated with taxation of these related benefits you should consult a tax adviser in order to determine your individual tax liability based on the exemptions you claim. The information shown on the Rate Sheet is the dollar amount that will be used in calculating your pre and after-tax deduction as well as imputed income, where shown.
Health Insurance Portability and Accountability Act (HIPAA)
Under HIPAA, enrollment in health, dental or vision insurance (outside of Open Enrollment) is allowed for employees and their dependents in certain circumstances. Special enrollment is allowed if the following criteria are met:
- The individual is benefit eligible but not enrolled, and
- When enrollment was previously offered and declined, the individual had other coverage, and
- When enrollment was declined, the individual stated in writing he/she was declining coverage because he/she had other coverage (this point only applies if the plan required such a statement at the time coverage was declined and the individual was notified of the requirement and consequences of not providing the statement), and
Special enrollment is also allowable for employees and their dependents if they lose coverage due to a loss of coverage, which might include:
- a death
- decreased work hours (some restrictions may apply)
- loss of employment
The employee must notify Employee Benefit Services within 31 days of the qualifying event and the employee must take prompt action to complete enrollment. If notice is not timely, re-enrollment can be done only during an Open Enrollment or when a subsequent qualifying event occurs. Verification of the loss of coverage event will be required.
Contact Employee Benefit Services for more information about HIPAA. Employees may also call the Department of Labor at: 866-4-USADOL (866-487-2365) or visit their web site, dol.gov, regarding rights under HIPAA.
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) OFFER FREE OR LOWCOST HEALTH COVERAGE TO CHILDREN AND FAMILIES
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP you can contact your State Medicaid or CHIP office or dial: 877-KIDSNOW (877-543-7669) or go to insurekidsnow.gov to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial: 877-KIDSNOW (877-543-7669) or insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
MEDICARE D PRESCRIPTION COVERAGE NOTICE
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) added a new prescription drug program to Medicare effective January 1, 2006. (See Part D of Title XVIII of the Social Security Act (Act), referred to here as “Part D” of Medicare.)
Eligible members can join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
Broward County has determined that the prescription drug coverage offered by Catamaran is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because the County’s existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, participants can keep this coverage as part of their group health plan and not pay a higher premium (a penalty) if they later decide to join a Medicare drug plan.
Eligible participants can join a Medicare drug plan when they first become eligible for Medicare and each year from October 15 through December 31. However, upon loss of coverage under Broward County’s plan due to termination or retirement; participants are eligible to join a Part D plan at that time using an Employer Group Special Enrollment Period.
Contact Employee Benefit Services at firstname.lastname@example.org or 954-357-6700 for further information. Eligible employees and dependents will receive a notice each year in November, or sooner, if this coverage through Broward County changes. For more information about Medicare prescription drug coverage, visit medicare.gov.
NOTICE OF PRIVACY PRACTICES PHARMACY BENEFIT PLAN
Division of Human Resources — Employee Benefits Section (Referred to in this document as “EBS”)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Broward County is required by law to maintain the privacy of your health care information. The law also requires us to give you this Notice telling you about the law, your rights and our privacy practices.
This Notice went into effect on April 14, 2003, and will last until we replace it. If our Privacy Practices change, this Notice will change. We are required to abide by the terms of the most current Notice in effect. You will find the current Notice posted in the Human Resources office and on our Internet site. If you would like additional copies or to learn more, please contact us at the address listed at the end of this Notice.
Use and Disclosure of Your Protected Health Information
Broward County has engaged a Third Party Administrator (TPA) Catamaran PBM to operate the Pharmacy Benefit Plan on behalf of our employees. In most cases, the use and disclosure of any health information about you is handled by the TPA to make sure you get the benefits you qualify for, to administer the plan accurately and fairly, and as otherwise required by law. Your health information may not be used or disclosed for employment related purposes other than the administration of the plan.
Employee Benefit Services (EBS) may gather and maintain information needed to determine your eligibility and keep track of your enrollment in the plan. To operate the plan, your health information may be used or disclosed as described in the following examples without your written approval:
- Treatment. The TPA may discuss your medical condition with doctors, nurses, technicians or hospital staff as necessary to authorize or consider medications or services covered by the plan.
- Payment. The TPA may use or disclose information to discuss your condition, any treatments given to you, or to review the cost for services, as necessary to arrange for payment or coordinate benefits under the plan. We may use your information to pay for or account for services.
- Health Care Operations. EBS or contracted auditors may review your medical information to assure you receive quality care, to verify you are actually receiving the services that are scheduled, or to develop better ways to provide care. We may use your information to manage or purchase services. It may be used to evaluate our providers and contractors. Health information may be used or disclosed as necessary for legal, auditing and management purposes. In most of these cases, we use aggregate or statistical data.
Other Uses and Disclosures
EBS may contact you as necessary for the administration of the Pharmacy Benefits Management plan. EBS may provide information to government officials as required or allowed by law for:
- Public health and disease reporting
- Health Oversight by an authorized state or federal agency
- Judicial requests (subpoenas, trials, court hearings)
- Law enforcement purposes
- Reporting and investigating deaths (the Medical Examiner)
- Military or intelligence activities
- Workers’ Compensation laws
- Responding to threats to public safety from unsafe products, unsafe drinking water, or disease
- Cases of abuse, neglect, domestic violence and other crimes
EBS may provide information to:
- Licensed researchers or care groups, who are under strict rules regarding how they use and disclose protected health information. Those researchers or medical review members may use the information about individuals with your condition for a study to improve ways to treat or manage diseases like diabetes, high blood pressure, or cancer.
- Hearing and Appeals groups to resolve disputes, render opinions and provide independent reviews.
- Other providers of medical services involved in your care.
- Responders in emergency situations.
- Funeral directors.
- Organizations that handle organ procurement or transplants as necessary to facilitate organ or tissue donation and transplantation.
- Others as required or allowed by law.
You may authorize EBS to use or disclose information, to restrict access to your information, or to object to use of your information for situations not described above. When an authorization is received, we will use that authorization until it expires or you change or revoke (or cancel) it. If you revoke your permission, we will no longer use or disclose the protected health information covered in the written authorization you revoked.
Other uses and disclosures of your protected health information require your written authorization. If you cannot give your authorization due to an emergency, EBS may release your health information if we believe it to be in your best interest. If you sign such an authorization you have the right to cancel it any time.
Under the law, you have rights that EBS will uphold. You have the right to:
- Request Restriction: Request, in writing, restrictions of the uses and disclosures of your information. These restrictions can go beyond the restrictions already in the law. However, EBS may not always agree to implement these additional restrictions.
- Request Confidential Communications: Request to receive communications at a different address or in a different way to better protect your privacy. While EBS cannot promise to communicate in every possible way individuals might request, we will work with you to find a practical way of communicating with you in confidence, if necessary to protect your privacy. EBS requires written requests for confidential communications.
- Access (Copy and Inspect): Inspect and get copies (with some exceptions) of your health care information held by EBS by making a request in writing. EBS may charge a reasonable fee to cover only the cost of providing this information.
- Request Amendment: Request an amendment or change information kept about you. To make such a change, EBS will ask you to make the request in writing with a description of the reason you want your record changed. EBS may not always agree to such requests. For example, EBS may deny a request if the information to be amended was:
- not created by EBS, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the protected health information kept by EBS;
- is not part of the information which you would be permitted to inspect or copy; and
- the request is inaccurate or incomplete.
- Request an Accounting of Disclosures: Receive a record of disclosures made by EBS of your protected health information that were not authorized by you and were not related to treatment, payment and EBS operations described above. EBS requires requests for disclosure to be in writing. Requests must relate to disclosure information stored by EBS. EBS stores records of disclosures for six years, beginning April 14, 2003. Patients will receive one free copy of accountings per 12-month period; fees may be assessed for each additional request.
- Where to send requests: Any of these requests should be mailed to HIPAA Privacy Liaison, Employee Benefit Services, 115 S. Andrews Ave., Room 514, Fort Lauderdale, FL 33301. If you do not agree with a decision made by the HIPAA Privacy Liaison, you may ask for a review of the decision by contacting the Broward County HIPAA Privacy Official at the address below.
Questions and Complaints
If you have any questions or complaints about the way EBS handles your protected health information or if you believe your privacy rights have been violated, you may complain by contacting the Broward County Privacy Office at HIPAA Privacy Office, Broward County Governmental Center, 115 S. Andrews Ave., Suite A680, Fort Lauderdale, FL 33301, phone 954-357-6500.You can also contact the secretary of the U.S. Department of Health and Human Services. Please note that there will be no retaliation against you for filing a complaint or for making requests regarding your health care information or if you disagree with EBS decisions about your protected health information.
EBS may need to change its privacy practices from time to time. Before making such changes, however, EBS will modify this Notice and post the revised Notice in our office and on our website. These new practices will then apply to all information held by EBS. At any time, you have a right to get a paper copy of the latest version of this Notice by contacting the Broward County Privacy Office or EBS. A current copy of this Notice will be posted on our website at www.broward.org.
NOTICE OF PRE-EXISTING EXCLUSION
The County’s health plans do not include a Pre-existing Exclusion.
HIPAA stands for the “Health Insurance Portability and Accountability Act of 1996.” The original purpose of HIPAA was to make health insurance more “portable” so that workers could take their health insurance with them when they moved from one job to another, without losing health coverage. The scope of HIPAA was broadened to require the health care industry to adhere to uniform codes and forms. This would help streamline the processing and use of health data and claims, and contribute to better, more accessible care. The scope of HIPAA also was broadened to better protect the privacy of people’s health care information and give them greater access to that information. The HIPAA Privacy Rule was finalized on August 14, 2002, with a firm deadline for compliance of April 14, 2003.
Broward County’s Employee Benefit Services (EBS) respects the privacy of legally protected health information, and understands the importance of keeping this information confidential and secure. Certain divisions or division sections within the County have access to what is called “Protected Health Information” or “PHI,” as it is defined by HIPAA. Not all health care information handled by Broward County is included in the definition of PHI. Only certain kinds of health care information are protected by the Privacy Rule. The following divisions or division sections are called “covered components” because they have access to the PHI covered by the HIPAA rules and regulations: the Elderly and Veterans Services Division, the Employee Benefits Section of the Human Resources Division and the Substance Abuse Section of the Broward Addiction Recovery Centers (BARC) Division.
EBS will use or transmit only the minimum amount of PHI needed to communicate enrollment, eligibility and termination data to Third Party Administrators or to any other entity to which we are required to respond. In addition, EBS will transmit only the minimum amount of PHI to appropriate entities for assistance with claims processing, claims reconsideration and review. EBS also ensures that the vendors with whom we contract for benefit services, have been duly informed of their need to fully comply with all HIPAA Rules and Regulations.
All Broward County employees receive basic awareness training in HIPAA, which will be updated as required by law. Employees who work for the covered components and certain support agencies receive more extensive training to better enable them to comply with HIPAA.
For more information about rights under HIPAA, employees may contact Broward County’s Privacy Officer at: 954-357-6500. Employees may also contact the Employee Benefits Manager at 954-357-6700.
SOCIAL SECURITY NUMBER, COLLECTION OF
Broward County, Division of Human Resources, Employee Benefit Services, shall collect your Social Security Number as allowed under section 119.071(5)(a)2, Florida Statutes, for the following purpose: to match, verify and retrieve benefit plan information as well as for the purpose of payment and audit of premiums collected. You are being provided notice of this activity pursuant to section 119.071(5)3, Florida Statutes.
The County shall also collect the Social Security number of all enrolled dependents as required under the Mandatory Insurer Reporting Law (Section 111 of Public Law 110173) which requires group health plan insurers, third party administrators and plan administrators or fiduciaries of self-insured/self-administered group health plans to report, as directed by the secretary of the Department of Health and Human Services, information that the secretary requires for purposes of coordination of benefits. The law also imposes this same requirement on liability insurers (including self-insurers), no-fault insurers and workers’ compensation laws or plans. Two key elements that will be required to be reported are SSNs (or HICNs) and EINs. In order for Medicare to properly coordinate Medicare payments with other insurance and/or workers’ compensation benefits, Medicare relies on the collection of both the SSN or HICN and the EIN, as applicable.
SPECIAL ENROLLMENT NOTICE
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage or Declaration of Domestic Partnership, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage or Declaration of Domestic Partnership.
If you have a new dependent as a result of birth, adoption, guardianship or placement for adoption, or foster care you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the event.
To request special enrollment or obtain more information, contact Employee Benefit Services at: email@example.com or 954-357-6700.
SUMMARY PLAN DESCRIPTION
The following is important information about your participation in the County’s Section 125 Benefit Plan and about certain benefits and benefit practices. Please take time to read this information carefully. Contact Employee Benefit Services at firstname.lastname@example.org or 954-357-6700 if you have questions.
Purpose: This document provides only a brief description of available benefits for easy reference. Official plan documents for the Broward County Section 125 Benefits Plan, Flexible Spending Account (Medical Expense and Dependent Care) Plans are available for review at the office of Employee Benefit Services, 115 S. Andrews Ave., Room 514, Fort Lauderdale, FL 33301. The purpose of this handbook is to set forth, or incorporate by reference, a description of the various benefits which benefit eligible employees are entitled to participate in by virtue of their employment. The County intends that all such benefits be legally enforceable and are for the exclusive benefit of its employees. These benefits are intended to be eligible for exclusion from the employees’ gross income for Federal income tax, Social Security tax and state and local tax purposes, where applicable, except to the extent that the rules under the Internal Revenue Service Code may require taxation of any such benefits to those employees deemed to be “highly compensated.”
Plan Changes: The County reserves the right to amend, expand, reduce or terminate any of the benefits and the plan or its benefit policies and practices at any time. If any of the benefits are terminated and coverage is not replaced with comparable coverage, ample notice will be given. If benefits under a County health plan are materially reduced, you will be notified within 60 days of the effective date of such material reduction in benefits. Participation in this plan is not a guarantee or contract of employment between employees and Broward County.
Plan Summaries: Descriptions of the various benefit plans available to you under the County’s Section 125 Benefit Plan, Dependent Care Accounts and Medical Expense Accounts are explained in this book. Plan summaries for the Section 125 Benefit Plan are available for employee’s review in Employee Benefit Services; these documents explain the eligibility for, limitations on, funding of and duration of the various benefit plans.
Plan Documents: Copies of plan documents for Broward County’s Section 125 Benefit Plan, Dependent Care FSA and Medical Expense FSA are available upon written request submitted to Employee Benefit Services. A reasonable charge may be imposed for copies.
Termination of Benefits: Benefits under any of the plans may terminate, unless the plan specifically provides otherwise, if:
- your employment terminates or your employment status changes to one that is not eligible for benefits
- the group plan terminates
- premiums are not paid
- the County amends or terminates the plan
Plan Sponsor: The Broward Board of County Commissioners is the plan sponsor. All notices concerning benefits should be sent to:
Broward County Commission, Employee Benefit Services
Attn: Plan Administrator
115 S. Andrews Ave., Room 514
Fort Lauderdale, FL 33301
More Information: Contact Employee Benefit Services at 954-357-6700 or email@example.com if you have any questions about plans or your benefits.
USERRA (UNIFORMED SERVICES EMPLOYMENT AND RE-EMPLOYMENT RIGHTS ACT)
USERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service. For more information on USERRA, please consult the posters which have been displayed prominently in public areas.