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Broward 100
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Section I - Employee Agreement
Section II - Eligibility and Documentation Requirements
Section III - Pre-Tax Health, Dental, Vision and FSA Plans
Health Insurance - Humana
Pharmacy Rx Plan
Dental Insurance
Vision Insurance
Flexible Spending Accounts (only for CDH Plans)
Health Saving Account (HSA)
Section IV - After-Tax Supplemental Plans
Section V - Well-Being Programs
Section VI - Deferred Compensation and Retirement Plans
Section VII- Notices
Section VIII - Learning and Organizational Development Training
Section III - Pre-Tax Health, Dental, Vision and FSA Plans
Section three - pre-tax, health, dental, vision and FSA plans

WHAT IS A PRETAX BENEFIT PLAN?

IRS Code Section 125 plan permits employees to elect benefits from a broad selection of choices according to their individual needs and the needs of their families on a pretax basis. The County’s Section 125 Benefit Plan includes:

  • Health insurance (including self-funded pharmacy, Health Reimbursement Account or
    Health Savings Account)
  • Dental insurance
  • Vision insurance
  • Flexible Spending Accounts
  • Health Care Account (maximum annual deferral reduced to $2,500 for 2015)
  • Dependent Day Care Account (maximum annual deferral $5,000 for 2015)

IRREVOCABLE ELECTION

Once you enroll in a pretax benefit plan your election is irrevocable until the next annual open enrollment unless you experience a relevant Qualifying Event. See Relevant Qualifying Events/Change in Status.

HOW DO I BENEFIT FROM A PRETAX PLAN?

Payroll taxes are reduced when premiums and/or FSA contributions are deducted on a pretax basis. In addition, any employer subsidy is not taxable income to you under most circumstances. Under current tax law, the portion of the premiums and the County subsidy that applies to coverage for the following dependents cannot be deducted on a pretax basis and becomes imputed income to you:

  • Domestic Partner*
  • Domestic Partner children to age 30*
  • Non-Domestic Partner children age 26-30 (Over Age Dependents)

*Domestic Partner Tax Equity: Beginning in 2015, the County will provide a Domestic Partner Imputed Income Tax Equity to those employees who have registered domestic partners enrolled in the County’s health plan and who can show proof that they reside in the same primary residence. The equity will be based on the employee’s imputed income tax, grossed up at the applicable IRS Supplemental tax rate (currently 25%). This equity will be paid as taxable income to the employee. See Dependent Eligibility and Documentation Requirements Section for details.

COVERAGE EFFECTIVE DATES FOR PRETAX BENEFIT PLANS

TYPE OF ELIGIBILITY EFFECTIVE DATE
New Hire 

On the first of the month following 60 days of employment in a benefit-eligible position

Rehire less than 30 days

First of the month following rehire – elections remain the sam

Rehire more than 30 days

First of the month following 60 days of re-employment

Part Time 20 (PT20) to Full-time

First of the month following change of status date

Part Time 19 (PT19) to Benefit-eligible

First of the month following 60 days in new classification (Must attend the Benefits session of Employee Essentials)

Return from Leave of Absence (LOA)

First of the month following change of status date

Qualifying Event (birth of baby, adoption, foster care)

Within 60 days of the event (coverage effective on the date of the event)

Qualifying Event (marriage, domestic partner registration, loss of other group coverage, Qualified Medical Child Support Order, etc)

Within 31 days of the event (coverage effective on the first of the month following receipt and processing of paperwork)

COVERAGE END DATES FOR PRETAX BENEFIT PLANS

TYPE OF CHANGE HEALTH, PHARMACY, DENTAL & VISION FSA PLANS

Benefit-eligible to Non-Benefit-eligible position

Last day of the month in which classification change is effective

Date of position change

Retirement

Last day of the month in which employment ends

Date of retirement

 Separation/Termination

Last day of the month in which employment ends

Date of separation / termination

Gain coverage through another group plan 

Last day of the month in which qualifying event occurs

Not applicable

PRIOR AUTHORIZATION

Certain medical tests and procedures require Prior Authorization by the insurer’s Medical Management Department prior to receiving the service. Your physician will submit the request and medical necessity to the carrier for Prior Authorization when it is required; however, it is recommended that the member verify the Prior Authorization is in place before receiving the service as benefits that may have otherwise been covered will be denied. The following treatment or services are examples of some services that must be preauthorized:

  1. Hospital confinements and Skilled Nursing Facility confinements
  2. Non-emergency transportation; air ambulance
  3. All non-emergency outpatient hospital services, including but not limited to, surgical, laboratory and diagnostic, except mammograms;
  4. Non-emergency wound care procedures
  5. Inpatient rehabilitative services
  6. Outpatient rehabilitative services at a hospital
  7. Durable medical equipment;
  8. Prosthetics, braces, hospice
  9. Pain management
  10. CPAP machine (see Sleep Studies benefit).

For a current list of all services requiring prior authorization visit the health carrier’s website or contact Customer Service at the number printed on the back of your health ID card.

EXCLUSIONS AND LIMITATIONS

All health plans have specific Exclusions and Limitations. It is recommended that prior to enrollment you review the list of Exclusions and Limitations for the plan you are choosing. Services that are excluded from coverage will not be covered even if there is medical necessity for the service.

SURVIVOR BENEFITS

All of the health insurance plans offer a 12-month survivor benefit for dependents enrolled in a County health plan. Under this benefit, dependents who are not eligible for Medicare continue to be covered, at no charge, under the same insurance plan they were enrolled in at the time of the employee’s death for a period up to 12 months. During this 12-month period, a dependent must continue to meet eligibility requirements per the conditions set forth for this benefit. This 12-month Survivor Benefit is counted towards the period of COBRA or Domestic Partner Continuation Coverage for which the Survivor and/or dependents would be eligible.

If a plan is no longer offered, or if the survivor changes plans during open enrollment or due to a qualifying event, the survivor benefit will end and coverage may be continued under another plan at the full COBRA rate in effect at that time.

Please note: Survivor benefits are not offered for vision or dental insurance plans.



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