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- Expansion of the Responsible Rx Program for April 1
Effective April 1, 2013, Florida Blue will expand their Responsible Rx pharmacy program for BlueCare, BlueChoice and BlueOptions. Responsible Rx refers to an umbrella of programs including Prior Authorization, Responsible Step and Responsible Quantity programs.
- Florida Blue has some helpful information on using MyBlueService, the online tools, programs & information available through the Florida Blue member website. MyBlueService BrainShark is the most current MyBlueService education available for members. This guide provides information on navigating through the site, finding a doctor, comparison tools, WebMD and more.
- What is "Care Profile"?
"Care Profile" is a payer-based health record (PBHR), which is a secure electronic record maintained by Florida Blue that contains information collected from claims and provided by physicians, pharmacies, labs and other healthcare providers. For more information, please refer to the Florida Blue “Care Profile” – Frequently Asked Questions
- Over-aged Dependant Coverage is available for dependents who are between the ages of 26 and 30 and do not have medical insurance. Employees electing this additional medical-only coverage are financially responsible for this premium in addition to their current medical premium.
Premiums for this coverage are $260.55 for PPO and $253.38 for HMO per pay period.
Employees can enroll dependents during annual open enrollment or when a qualifying event occurs.
Please contact Human Resources 343-9596 if you have any questions about the Over-aged Dependent medical-only coverage.
- Medicare Part D Notice
This notice has information about your current prescription drug coverage with Lake County Board of County Commissioners – Employee Health Benefit Plan and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan.
- HIPAA Privacy & Portability Rights Notice
HIPAA's privacy rules require covered entities to provide individuals with a "notice of information practices." The notice describes (1) the uses and disclosures of Protected Health Information (PHI) that a covered entity may make; (2) an individuals' rights; and (3) a covered entity's responsibilities.
- Medicaid and the Children's Health Insurance Program (CHIP)
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.
The County has two plans; an HMO and a PPO plan. The BlueCare (HMO - Open Access) and BlueChoice (PPO) plans provided through Florida Blue (formerly Blue Cross
and Blue Shield of Florida). The HMO and PPO networks include both Lake County hospitals as well as providers state-wide.
Through Florida Blue, members may have access to coverage outside of the state of Florida. The BlueCare (HMO - Through Florida Blue, members
may have access to coverage outside of the state of
Florida. The BlueCare (HMO - Open Access) plan offers guesting privileges in
other Florida Blue networks around the country, and the BlueChoice (PPO) plan offers the
BlueCard program which allows access to doctors and hospitals around the world.
The medical coverage includes a 24-hour live nurse line, health management and
wellness programs, and Blue Compliments. Blue Compliments provides members with
a wide range of discounted services for vision care, alternative medicine,
hearing care, weight management and fitness memberships. Please review the BCBSF
documents and website for more information. There are two types of medical
plans to choose from.
NOTE 1:
Verifying Provider Participation-Members are responsible for verifying the participation status of a Physician, Hospital, or other provider prior to receiving Health Care Services.
NOTE 2:
“Independent Clinical Labs” - Quest Diagnostics
The Florida Blue (formerly Blue Cross and Blue Shield of Florida) in-network provider for laboratory services (i.e., screenings) is
Quest Diagnostics. Members enrolled in the BlueCare HMO plan are responsible for ensuring that they and their physician
are using the in-network provider, Quest Diagnostics, for their lab work. Lab work performed by any provider other than Quest Diagnostics is not
covered under the HMO plan. Members enrolled in the BlueChoice PPO plan may use an out-of-network provider for laboratory services,
but will be required to pay 40% of the cost (member responsibility for in-network lab work is 20%). Members can schedule their lab appointments
online with Quest Diagnostics and search locations by visiting Quest Diagnostic’s
website for locations and to schedule appointments.
The online appointment scheduler also has a feature that will remind members of their appointment.
- BlueCare HMO
- BlueChoice PPO
- Diabetes Management Program
Florida Blue Summary of Benefits and Coverage (SBC)
As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.
To help you make an informed decision, Florida Blue provided a Summary of Benefits and Coverage (SBC). The SBC summarizes important information about your health options in a standard format.
Lake County Board of County Commissioners intends that the SBC is in good faith compliance with the requirements under the recent Health Care Reform Law. http://www.healthcare.gov/law/features/rights/sbc/index.html
If you have any questions please contact Human Resources at 343-9596.
HMO Plan - Balance Billing Prohibited
A contracted or non-contracted Florida licensed medical provider or facility cannot bill a subscriber if the HMO fails to pay a claim for a covered service. Florida Law prohibits providers from billing members for covered services except for applicable co-payments, co-insurance or deductibles.
- Effective 10/01/08, employees/members on the County's medical plan are eligible for Mental Health and Substance Abuse services through Florida Blue. Florida Blue members may locate a participating behavioral health network provider in Florida by contacting a Florida Blue Care Consultant at 1.800.FLA.BLUE (352.2583) or search in the "My Blue Service" section on the website at www.bcbsfl.com. For more information about New Directions Behavioral Health visit www.ndbh.com. They can also be reached by phone at 1-866-287-9569.
The Provider's responsibilities are listed in their Provider Manual located on our website here: http://providermanual.bcbsfl.com/brs/MMUMS/Pages/Behavioral-Health-Services.aspx.
Several times throughout the year, a Florida Blue representative will be available for one-on-one on-site
meetings with employees regarding their medical coverage. Employees who are not able to attend a meeting, but would still like to speak with the rep that day, can reserve a time on the online training calendar and call into Human Resources, 352-343-9596, at the reserved time to speak with the Florida Blue representative directly.
Employees are also welcomed on a call-in/walk-in basis.
The days, times and locations of the one-on-one Florida Blue representative visits will be announced via email.
If an employee has an urgent matter that cannot wait until one of these visits, they are advised to contact one of the following Florida Blue's customer service lines directly.
BlueCare (HMO) - 877.352.2583
BlueChoice (PPO) - 800.322.2808
Flexible Spending Account (FSA) - TASC
TASC is our Flexible Spending vendor. To contact TASC, call customer service at 800-422-4661, or go online at www.tasconline.com.
Please use the information and forms below when referencing your TASC Flexible Spending Account.
Employees may enroll in a Flexible Spending Account, within the provisions of the IRS Section 125 plan, which allows employees to have money deducted from their paycheck before it is taxed. This results in an employee reimbursing themselves for medical and dependent care expenses with tax-free dollars.
- Dependent Care Reimbursement- Allows payroll deduction of qualified expenses for daycare or nursing home care for an eligible dependent while you or your spouse is at work.
- Health Care Reimbursement- Allows payroll deduction for qualified health care costs not covered by insurance, e.g., physician office visit co-pays, deductible,
co-insurance and prescription drug co-pays. Dental and vision expenses not covered by insurance are also eligible.
- Revised Section 125 Flexible Spending Account Documents
In accordance with the Internal Revenue Code, the County's Section 125 Plan Flexible Spending Account Program has been in effect since October 1, 2001. Having a Section 125 Plan allows employees to purchase benefits on a pretax basis and participate in a Flexible Spending Account (FSA) Program. The FSA Program provides employees with an opportunity to defer pretax funds from their paycheck to pay for medical and dependent care expenses.
FSA Enrollment / Change Form
Section 125 Flexible Spending Account - Adopting Resolution
Section 125 Flexible Spending Account Plan
Section 125 Flexible Spending Account Plan Summary
The revised Section 125 Flexible Spending Account documents approved by the BCC 6/12/2012 incorporates the following:
- The Patient Protection and Affordable Care Act (PPAACA) has a provision that goes into effect on January 1, 2013 that impacts the County’s Flexible Spending Account (FSA). Under this new provision the health FSA medical/health care reimbursement is reduce from $5,000 to $2,500. Currently participants in the medical/health FSA can have a maximum deduction and reimbursement of $5,000.
- The change in legislation does not impact the dependent care deferral of up to $5,000 per year.
The revised Section 125 Flexible Spending Account documents replace the previous Section 125 document approved on 2/17/2009, and later amended and approved on 6/12/2012.
Dental - Humana/CompBenefit
You can contact CompBenefits at 1-800-342-5209. There are three types of dental plans offered through CompBenefits:
- Dental Health Maintenance Organization (DHMO)
Includes predetermined fees paid directly to dentist for services, does not have a deductible or a claim form to file, but does have a limited network of dentists.
- Advantage Plan
An open access plan, which provides a wide variety of benefits through participating providers (a network similar to that of the PPO). At the time of service, the member pays the dentist for any applicable co-payments according to the schedule of benefits.
- Preferred Provider Organization (PPO)
Allows employee to use any dentist; in or out of network. The employee pays a percentage of the Reasonable & Customary Charge, and there is an annual cap on benefits paid by the plan.
Under the VSP Vision Plan, offered through Ameritas, members have the option of obtaining services from a network of
providers who accept the fees as full payment for services under prearranged guidelines. Additionally, members have access
to vision-related discounts. You can contact VSP at 1-800-877-7195.
New enrollment in the Cancer Plan is currently closed.
If you currently participate in this benefit, call 1-800-845-7519 for additional information and policy number.
This is an optional benefit the employee pays for each month. Under the cancer plan members have additional coverage to help if cancer strikes. The plan also covers 32 other diseases such as, Malaria and Muscular Dystrophy. The following are some benefits of the cancer plan:
- In and out of hospital benefits
- Wellness and donor benefits
- Portable (take it with you if you leave County employment)
- Pays regardless of other coverage
Employee Assistance Program (EAP)
The Employee Assistance Program (EAP) provides employees and their family members up to six (6) free counseling sessions per year along with
a variety of counseling and informational services. The EAP offers:
- Face-to-face Counseling for, but not limited to:
- Marital and Family Relationships
- Stress Management
- Alcohol and Drug Issues
- Work-related Concerns
- Depression and Anxiety
- Bereavement
- Life Coaching Services on topics including:
- Stress Management and Balance
- Spirituality and Personal Growth
- Career Planning and Development
- Motivation and Time Management
- Finances and Budgeting
Up to three 50-minute telephonic coaching sessions per issue
- Online Services and Access to many resources including:
- Interactive self-assessment tools
- Tip sheets
- Articles
- Resource guides
- Webinars
- Monthly Webinars—offered several times each month
- On Demand Webinars—ready to access anytime, anywhere that it is convenient
- Legal Services
- Includes one 30-minute office or telephone consultation per separate legal matter
- Financial Services
- 30 days of unlimited telephonic assistance with financial coaching staff
The EAP is available for problems such as stress, weight loss, financial issues, family problems, etc. that are not normally covered under the mental health provisions of the County’s Group Health Plan, Employees who need help determining how to tackle a personal or workplace problem can also use the EAP for information and referral. A supervisor may also refer an employee to the EAP if it appears personal issues are interfering with work performance. The EAP is a tool to help regain equilibrium during a stressful period.
Information
- Employee Assistance Program
- EAP Legal and Financial Services
- 2013 Monthly Topic Calendar
- 2013 Webinar Calendar
- EAP Newsletters
- MHNet EAP Website
The MHNet EAP website contains a full collection of information tools and resources to support emotional well-being, including hundreds of tip sheets, articles, and resource guides.
This site allows employees to access Employee Assistance Services Online, Legal and Financial Resource Center, Quarterly Newsletters, Online Care Library, Satisfaction
Survey, and contact a MHNet coach. To access the website, please follow the instructions below:
- Go to www.mhneteap.com
- On the top right-hand corner in the "On-line services login" section, type in:
Username: lakecounty Password: lakecounty
Type these in exactly as they are written
- Lifehub Website
The Lifehub website delivers continually updated information on a variety of topics,
including health, fitness, stress management, relationships and career skills. To access the website, please follow the instruction below:
- Go to www.lifehub.com
- First Time Users: Use the link "Click Here To Register" located on the right side of the page
- Enter: Name, Email, Password, Re-enter Password, and Keycode: lakecounty
- Once in the Life Hub site, members can view information within any of the articles and special learning programs that interest them.
- Registered Users Login: on the left side of the page enter Email and Password
- Enter: Email and Password
- Once in the Life Hub site, members can view information within any of the articles and special learning
programs that interest them.
- Once registered, members will only need to access the page beginning with the Login Screen.
For more information about the EAP or to schedule a consultation or appointment, please call 1-800-272-3626 (1-800-BRADMAN).
EAP counselors are available to members and their family 24 hours a day, 7 days a week.
Please remember that the EAP is not a substitute for medical diagnosis and treatment. Employees should
always consult with their physician regarding their health concerns.
A federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires that health plans protect the confidentiality of employee/member private health information. A complete description of employee/member rights under HIPAA can be found in the Plan's Privacy Notice. The documents provided below are distributed to employees upon enrollment in the plan.
If adding spouse or dependent(s) for the first time to any of the benefits plan(s), copies of marriage license and/or birth certificate(s) must be submitted with the Benefits Open Enrollment Election Form.
Download Dependent Age 19-26 Affidavit
Medical, Dental and Vision
- Legally married spouse of an employee or retiree
- The natural child, stepchild, adopted child of an employee,
- Birth up to the end of the calendar year in which he or she turn twenty-six (26), if they are not eligible for coverage under their own employer plan
- Between the ages of twenty-six (26) and the end of the calendar year in which he or she turns thirty (30) if the child:
- Is unmarried with no dependents of his or her own;
- Resides in the state of Florida OR is a full-or part-time student
- Does not have medical insurance available through his or her employer or is not eligible for Medicare, and is not covered under any other medical insurance plan including Medicare
- A child of a covered dependent child (Covered Employee's grandchild), is eligible for coverage from birth to age 18 months.
Supplemental Life and AD&D
- The Covered Employee's spouse under a legally valid existing marriage;
- The natural child, stepchild or adopted child of an employee,
- 15 days old or older, until the end of the calendar year in which the child reaches age 19
- 19-25 if the child meets the following requirements
- dependent upon the covered employee for financial support and;
- living in the household of the covered employee or
- a full-time or part-time student
- 19 or older if the child is
- incapable of self-support prior to age 19 (25 if a full-time student) and are financially dependent on the employer for more than half of their support
Legal Services
- Legal spouse residing in same residence or domestic partner (upon proof of being in a committed relationship for 1 year or more)
- An unmarried child, stepchild, adopted child
- under 18 years of age and is dependent upon the employee for support and maintenance
- 18-23 years of age if the child meets the following requirements
- who is dependent upon the plan member for support and maintenance and
- is a full time student
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