Retiree Beneﬁts Reference Guide Open for addition formshumanresources.brevardschools.org/Shared...

Retiree Benefits

Plan year January 1, 2017 - December 31, 2017

Open for addition forms Reference Guide

To enroll in Voluntary Benefitsplease complete this form and return it to

FBMC Benefits Managementin the enclosed envelope.

To have your premium automatically deducted from your bank account each month, please complete this form and

return it to FBMC Benefits Management in the enclosed envelope.

To have your premium automatically deducted from your Florida Retirement System (FRS)account each month, please complete this

form and return it to FBMC BenefitsManagement in the enclosed envelope.

© 2016 FBMC Benefits Management, Inc.

P.O. Box 10789 • Tallahassee, Florida 32302-2789Service Center 1-855-44FSRBC (1-855-443-7722)www.myFSRBC.org

BENEFITS MANAGEMENT

2 | FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM | BENEFITS GUIDE

FSRBC | Table of ConTenTsLE

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InTRoDUCTIon ....................................................................................................3

WELCOME .......................................................................................................4

leaRn MoRe .........................................................................................................5

ELIGIBILITY ......................................................................................................6

MEDICARE OVERVIEW .....................................................................................6

MEDICAL NEEDS ASSESSMENT CHECKLIST .....................................................9

TIMe To enRoll .................................................................................................. 11

STEPS TO ENROLL ......................................................................................... 12

MeDICaRe Plans ................................................................................................14

MEDICARE ADVANTAGE PLANS .....................................................................14

MEDICARE ADVANTAGE RATES BY COUNTY OF RESIDENCE ......................... 15

MEDICARE SUPPLEMENT & PRESCRIPTION DRUG PLANS.............................22

GLOSSARY OF TERMS ....................................................................................26

non-MeDICal benefITs .....................................................................................27

DENTAL .........................................................................................................28

VISION ........................................................................................................... 31

HEARING AID BENEFIT ...................................................................................34

IT TECHNOLOGY SUPPORT ...........................................................................36

IDENTITY THEFT PROTECTION .....................................................................38

PET INSURANCE ........................................................................................... 40

PET RX ...........................................................................................................41

PaYMenT & bIllInG ........................................................................................... 42

PAYMENT & BILLING ......................................................................................43

Tools ................................................................................................................ 44

COMPLIANCE & LEGAL ..................................................................................45

DIRECTORY ...................................................................................................46

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INTRODUCTION

How the FSRBC Works For You!School Districts join the Florida School Retiree Benefits Consortium (FSRBC) to take advantage of expanded benefit options and lower rates. The listed Districts are currently participating in the FSRBC Program.

Your District has joined with the FSRBC to offer benefit products and negotiate competitive rates based upon the combined pool of retirees.

FBMC Benefits Management, Inc. (FBMC) is the administrator for the FSRBC program and will be your primary contact for program information, enrollment, confirmation of benefits, billing and providing your service needs.


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THE BENEFITS OF AGINGRetirement is one of life’s greatest milestones. It’s a time of reflection, family and fun. This packet was mailed to you because your School District has partnered with the Florida School Retiree Benefits Consortium (FSRBC) to offer benefits to its retirees who have reached the age of 65 and are now Medicare eligible. With the reasonable rates offered by your District, you can now obtain quality, affordable coverage and enjoy The Benefits of Aging.

WHAT’S IN THIS GUIDE?It is important to review this Benefits Guide thoroughly. The information contained within this guide will assist you in making educated decisions regarding your benefit selections. In this guide you will find:

• Eligibility information• Details on available Medicare Plans• Information on Non-Medical

Benefits Plans• Instructions on how to enroll • Enrollment forms• Information on billing and payment

options

ABOUT US On behalf of your School District, the FSRBC provides Medicare-eligible retirees with access to high quality Medicare and Non-Medical Benefits, tailored especially for retirees age 65 or older. FBMC Benefits Management, Inc. (FBMC) is the administrator for your benefits, and will be your primary point of contact for your benefit needs.

Your District is pleased to offer competitively priced, high-value Medicare Plans and additional Non-Medical Benefits to retirees from participating School Districts throughout Florida. Through the FSRBC, your options include Medicare Advantage Plans*, Medicare Supplement Plans, and Medicare Part D Pharmacy Plans. In addition, the FSRBC is also offering the following Non-Medical Benefits:

• Dental• Vision• NEW! Hearing Aid Benefit• IT Technology Support• ID Theft Protection• NEW! Pet Rx• Pet Insurance

*Note: Refer to the Medicare Advantage Plans By County of Residence to see which plans you are eligible for.

Welcome

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In the Learn More section of this guide, you will find important information about available Medicare Plans and Non-Medical Benefits.

Please review this Benefits Guide thoroughly as it contains important information regarding all of the benefit plans available to you. This information will help you choose the benefits that best suit your needs and your budget!

Medicare PlansThe Learn More section provides information about Medicare Parts A and B as well as the additional coverage available through your School District. Medicare does not cover all expenses, and this section explains the options available to help pay those costs.

With the benefits offered through your School District and the FSRBC, you have the security of knowing you will have the coverage you need, so that you can truly enjoy The Benefits of Aging.

IT’S TIME TO LEARN MORE - ABOUT MEDICARE OPTIONS!


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YOUR DISTRICT BENEFITSAdditional benefits options available to you include Medicare Advantage Plans, Medicare Supplement Plans, Medicare Advantage Plans, Prescription Drug Plans, and Non-Medical Benefits.

MEDICARE ADVANTAGE PLANTo be eligible for a Medicare Advantage Plan through the FSRBC, you must already be enrolled in Original Medicare Parts A and B. Look for the Medicare Advantage Plans available to you based on your county of residence (review the rate chart of Medicare Advantage By County of Residence) and then enroll directly with one of the available carriers; they will provide your benefits on behalf of Medicare.

The Medicare Advantage Plans are structured the most like the plan you had through your District, including coverage for medical services, labs and other medical services, prescription drug coverage, and more. Please review the plan features carefully to ensure the plan you select will meet your needs.

MEDICARE SUPPLEMENT PLANSTo be eligible for a Medicare Supplement Plan through the FSRBC, you must already be enrolled in Original Medicare Parts A and B. You can then enroll in a Supplement Plan through one of the available carriers, and the Supplement

Medicare Overview Eligibility InformationAs a Medicare eligible retiree age 65 or over, your benefit plans will be changing. You are now eligible for Medicare and Non-Medical Benefits offered by the FSRBC. To be eligible for FSRBC Medicare options, you and/or your spouse or dependent must be 1) Medicare eligible and 2) Enrolled in Medicare Part A and Part B. If you enroll in a Non-Medical Benefit Plan through the FSRBC, you may cover any eligible dependents; they do not need to be Medicare eligible. Your non Medicare eligible dependents will remain eligible for the district’s medical plans until they, too, become Medicare eligible. At that time, they will have access to the same FSRBC Medicare Plans that are available to you.

Who is an Eligible Dependent?1. Your Spouse/Domestic Partner –

the person to whom you are legally married, or meet the definition of domestic partnership.

2. Your Child(ren) – biological, legally adopted, stepchild(ren), a child for whom you have legal guardianship, or foster child(ren) are currently eligible for your district’s medical plan.

If you haven’t already done so, you must enroll in Medicare Part A and Part B to be eligible for benefits through the FSRBC. According to Medicare guidelines you have seven months, beginning three months prior to your birth month, to apply for Part A and Part B. If you miss this opportunity to enroll, you can sign up during the Medicare General Enrollment Period from January 1–March 31 each year. If you have End Stage Renal Disease (ESRD), please contact the carriers for special details. Note: If you enroll after the initial sign-up period, you may have to pay a higher premium for late enrollment.

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Plan will cover some or all of the costs that Parts A and B do not cover.Note: Medicare Supplement Plans do not cover most prescription drugs. If you enroll in a Medicare Supplement Plan you should consider enrolling in a Medicare Part D Prescription Drug Plan.

PRESCRIPTION DRUG PLAN (PDP) To enroll in Prescription Drug Plan through the FSRBC, you must already be enrolled in Original Medicare Parts A and B. You can then enroll in one of the Prescription Drug Plan options. You can purchase a Prescription Drug Plan alone or in conjunction with a Medicare Supplement Plan. Medicare Advantage Plans available through the FSRBC already include your Part D drug coverage, so you cannot purchase a separate Prescription Drug Plan when you enroll in a Medicare Advantage Plan.Note: You must apply for a Prescription Drug Plan when you are first eligible for Medicare to avoid a late enrollment fee. Even if you do not currently take prescription drugs you may want to enroll in a plan with minimal coverage and premiums to avoid a life long late enrollment penalty.

MEDICAL PLANS NEEDS ASSESSMENTYou should carefully consider your medical needs when determining whether to purchase any plans to help cover expenses not normally covered by Medicare. Information to consider when choosing a plan includes:

• Doctor and/or pharmacy preferences

• Prescription medications and yearly costs

• Any chronic conditions • Your general health • Travel frequency • Other available retiree health

coverage (through a spouse, the military, etc.)

• Where you live (county, own home, assisted living, etc.)

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You can find out more about which plan works best for you by calling the carriers directly. Contact information for the carriers serving your area can be found in the Directory. Use the handy Needs Assessment Checklist to compare plans.

NON-MEDICAL BENEFITS The available Non-Medical Benefits administered by FBMC include: • Dental• Vision• Hearing Aid Benefit• ID Theft Protection• IT Technology Support• Pet Rx plan• Pet insurance

These plans are described more fully in the next section of this guide.


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Medicare Part A and B (Original Medicare)

Medicare Part AHospital costs

Medicare Part BDoctor and outpatient costs

Medicare Advantage Plan

(Part C)Provides traditional Medicare and other benefits. All District

Advantage Plans include prescription drug

coverage.

You must be enrolled in Medicare Parts A and B to be eligible for the District plans.

With the FSRBC you can also enroll in a

Medicare Supplement Plan

Covers some or all of the cost not paid by Parts A

and B.

Medicare Part D Plan

Options provide various levels of prescription drug

coverage.

and/oror

ABOUT YOUR OPTIONSYou can elect to have Medicare Parts A and B along with a Medicare Supplement Plan for your medical coverage and add a separate Medicare Part D Plan for your prescription drug coverage. Or you can choose a Medicare Advantage Plan, which offers additional benefits and includes prescription drug coverage.

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Needs Assessment ChecklistWHAT ARE MY OPTIONS?

• If you are currently enrolled in an FSRBC plan and are happy with that plan you do not need to re-enroll.

• See what Medicare Advantage Plans are available in your area on the rate chart by County of Residence. Many Medicare Advantage plans offered under this program are Nationwide PPO plans, available throughout the US.

• The Medicare Supplement Plans and Medicare Part D Pharmacy Plans are available throughout the state of Florida and nationwide.

• If you live outside of the state of Florida, any of the nationwide PPO plans will provide you with coverage that will meet your needs.

NEEDS ASSESSMENT• This document will help you compare your medications, your current doctors,

hospitals, and other medical facilities to determine if your current medical prescriptions, doctors and facilites are on a carriers plan, as well as potential out of pocket expenses by carrier and plan.

• Each carrier has a dedicated team that will answer all of your questions regarding costs and networks for each plan you have available. Please call the number provided for each carrier you are interested in. At that time the service representative will walk you through your plan offerings and discuss your particular needs.

• When comparing multiple plans and carriers it is helpful to write down what you learn. Please use the following pages to take notes regarding how each plan will fit your needs.

Questions to consider when picking a planHow is your general health?________________________________________________________________________________________________________________________________________________________

Any chronic health issues?________________________________________________________________________________________________________________________________________________________

How often do you see the doctor? ________________________________________________________________________________________________________________________________________________________

Do you travel frequently or live part of the year in a different state?________________________________________________________________________________________________________________________________________________________


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Medicare Plan OptionsUse the table below to record the name of the plan you enroll in as well as the

quoted cost.List Plan Name Cost of Plan

My DoctorsCompare each plan’s network. Write “In-Network” or “Out-of-Network”

Doctor’s Name Specialty In-Network or Out-of-Network

My Hospitals/Medical FacilitiesCompare each plan’s network. Write “In-Network” or “Out-of-Network”

Hospital/Medical Facilities Name In-Network or Out-of-Network

My PrescriptionsCompare the cost of each prescription under each plan

Medication Quantity Cost of Prescription

My PharmaciesCompare each plan’s network. Write “In-Network” or “Out-of-Network”

Pharmacy Name In-Network or Out-of-Network

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TIME TO ENROLL!

It’s easy! The Enrollment section of this book describes how to enroll in:

Medicare PlansFeel free at any time to call the carriers for information and to get answers to your questions. A list of all carriers is located in the Directory at the end of this Guide.

Non-Medical BenefitsEverything you need to enroll for Non-Medical Benefits, including plan and rate information, is in this book. Dental, Vision, IT Technical Support, ID Theft Protection, Hearing Aid Benefit, Pet Prescription plans, and Pet Insurance are all available to you and your eligible spouse and/or dependents (see eligibility requirements section of this guide). We have even provided a comprehensive enrollment form and return envelope at the end of this book.

Note: Nationwide Pet Insurance has their own enrollment procedure. Please call Nationwide directly or visit www.petinsurance.com/fsrbc to enroll.


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Steps to enroll in a Medicare Plan:

STEP 1: DO YOUR HOMEWORKReview the plans available to you from the carriers serving your county. You will receive a Medicare Supplement benefit package from UnitedHealthcare. If you want detailed plan books for any other benefit, you should request this from the Medicare Carriers listed in the directory.

STEP 2: DO A NEEDS ASSESSMENTCall the carrier(s) of your choice to complete your needs assessment. This will help you choose the best plan(s) for you based on your individual needs.Note: You can find a needs assessment checklist to help you choose Medicare coverage that may fit with your needs.

STEP 3: ENROLLOnce you choose your plan, complete your enrollment telephonically directly with the carrier or enroll with the carrier’s paper enrollment form.

STEP 4: CONFIRMATION OF MEDICARE PLAN ENROLLMENTThe Medicare carrier(s) you select will send you acknowledgment of your enrollment in their plan(s), ID cards and other important plan materials.

If enrolling for your Medicare Plan by telephone make sure tell the Medicare Carrier you are a part of the FSRBC and will pay premiums through this program.

Send FBMC a completed FRS or ACH form included in this packet to set up automated payments for your benefits.

To receive additional Medicare coverage through the FSRBC, you must enroll in the Medicare Plan directly through the carrier.

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Steps to complete the FBMC Non-Medical Benefits Enrollment Form:

STEP 1: DO YOUR HOMEWORKRead about the Non-Medical Benefits available to you in this Benefits Guide to select the coverage that is right for you, and complete the FBMC Non-Medical Benefits Enrollment Form.

STEP 2: SELECT BENEFITSPlace a “√” in the box next to the plan(s) in which you would like to enroll. Select ALL plans you you want to have for the 2017 plan year, even if you have the coverage in 2016. Be sure to specify the coverage level (e.g., Retiree plus Spouse). You will be able to calculate your total monthly premium by adding the amounts of your selections in the premiums column. Note: The pet insurance enrollment form is separate from the other Non-Medical Benefits.

STEP 3: SUBMIT FORM AND PAYMENT TYPESubmit your enrollment and payment form(s) to FBMC in the envelope enclosed in your Benefits Guide.

Please call FBMC at 1-855-44FSRBC (1-855-443-7722) with any questions about Non-Medical Benefits, Monday - Friday, 7 a.m. - 7 p.m. ET.

STEP 4: CONFIRMATION OF BENEFITSOnce FBMC has received and processed your Non-Medical Benefits Enrollment Form and been notified of your Medicare Plan enrollment (if applicable), you will receive a Confirmation Notice of your benefits and payment method.Existing participants will receive this notification during the second week of December. New Participants will receive this approximately three weeks after enrollment.You can also receive information on how to access your FSRBC benefits at: www.myfsrbc.org

CHANGES TO COVERAGEThe coverage you select will remain in effect for the entire 2017 plan year. If you cancel coverage during the plan year, you may or may not be able to reinstate coverage at the next annual open enrollment period.If you experience qualifying life changes during your coverage as a retiree, you may be able to increase or decrease your coverage levels based on the type of event. Contact your carrier(s) for more information.

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S Medicare Advantage PlansWhen you enroll in a Medicare Advantage Plan, you receive your Medicare Part A and Part B benefits from your Advantage Plan, not from Original Medicare directly. Medicare Advantage Plans offered through the FSRBC also include your Part D Prescription Drug coverage; you do not need to purchase a separate drug plan. Medicare Advantage Plans also may offer enhanced benefits such as wellness programs and care management.Medicare Advantage Plans must follow Medicare guidelines. Each Advantage Plan may have different out-of-pocket expenses and have different rules regarding services. Please check with each carrier before making a selection. Note: Available carriers may vary according to your county of residence.

Eligibility Requirements:The following conditions are required to join a Medicare Advantage Plan:

• You must be enrolled in Medicare Part A and Part B.

• You are not also enrolled in a Medicare Supplement Plan or separate Part D Plan.

• You live in the plan’s service area.

TO SELECT A MEDICARE ADVANTAGE PLAN:Please review the Medicare Advantage Plans By County of Residence chart to determine which plan options are available to you. Contact the carriers to receive more information.

UnitedHealthcare® Group National PPO

Customer Service (for all plans)1-877-776-1466, (TTY 711)7 days a week, 8 a.m. - 8 p.m. ET

Low Premium National PPOComprehensive National PPOPremier National PPO

Humana Zero Premium HMO Enrollment Telephone number: 1-800-824-8242 (TTY 711)7 days a week, 8 a.m. - 8 p.m.Comprehensive PPO

Health First Rewards Plan Customer Service

1-800-716-7737, (TTY 711)7 days a week, 8 a.m. - 8 p.m.

Group Plus A HMOGroup HMO POS

Florida Hospital Care Advantage

Group Plus CGroup POS B (HMO-POS)SunSaver Plan (HMO-POS)

Customer Service1-855-882-6467, (TTY 711)7 days a week, 8 a.m. - 8 p.m.

Cigna Leon Cigna Leon CaresCustomer Service1-866-266-8917, (TTY 711)7 days a week, 8 a.m. - 8 p.m.

AvMed Medicare Choice HMOMember Sales and Retention Center 1-800-835-6137, (TTY 711)

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EDIC

ARE

AD

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TAG

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Benefit Group National PPOMiami Only

Group National PPO Plan

Low Premium National PPO

Medical In-Network Out-of-Network

In-Network Out-of-Network


Annual Deductible $0 $0 $0 $0 $400 Med & $400 Rx

Annual Out-of-Pocket $4,500 $10,000 combined

$5,900 $10,000 combined

$6,700

Hospital Admit $200/Day to 8 Days

40% $275/Day to 6 Days


Office Visit Primary/Specialist

$10/$40 $35/$60 $20/$50 $35/$60 $25/$45

Emergency Care $65 $75 $65

Outpatient Surgery $200 40% 20% 40% 20%

RxTier 1 $15 N/A $15 N/A 25% N/A

Tier 2 $47 N/A $47 N/A 25% N/A

Tier 3 $100 N/A $100 N/A 25% N/A

Tier 4 $100 N/A $100 N/A 25% N/A

Coverage Gap Applies N/A Applies N/A Applies N/A

If you would like more information about the UnitedHealthcare® Group Medicare Advantage plan or to receive a complete pre-enrollment plan guide, call UnitedHealthcare® at 1-877-776-1466, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.

UnitedHealthcare® PPO Medicare Advantage Plans(See chart for available Medicare Advantage Plans by county of residence.)

Benefit Comprehensive National PPO Premier National PPOMedical In-Network Out-of-Network In-Network Out-of-NetworkAnnual Deductible $250 $0

Annual Out-of-Pocket $6,700 $2,500

Hospital Admit $230/Day to 7 Days $175


$20/$30 $5/$15

Emergency Care $65 $65

Outpatient Surgery 20% $15

RxTier 1 $7 N/A $5 N/A

Tier 2 $40 N/A $30 N/A

Tier 3 $90 N/A $60 N/A

Tier 4 $90 N/A $80 N/A

Coverage Gap No Gap N/A No Gap N/AIf you would like more information about the UnitedHealthcare® Group Medicare Advantage Plan or to receive a complete pre-enrollment plan guide, call UnitedHealthcare® at 1 877-776-1466, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.

UnitedHealthcare® National PPO Medicare Advantage Plans(See chart for available Medicare Advantage Plans by county of residence.)

MYFSRBC.ORG | 19


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Benefit Rewards Plan Group Plus A HMO

Group HMO POS

Medical HMO HMO In-Network Out-of-NetworkAnnual Deductible $0 $0 $0 $0

Annual Out-of-Pocket $6,650 $2,000 $3,000 $6,000

Inpatient Hospital Care $275/Day to 7 Days $250 $150/Day to 5 Days 20%


$10/$37 $0/$20 $0/$25 20%

Emergency Care $75 $50 $50 $50

Outpatient Surgery $350 $125 $150 20%

RxTier 1 $5 $5 $5 N/A

Tier 2 $15 $15 $15 N/A

Tier 3 $45 $25 $45 N/A

Tier 4 $90 $45 $90 N/A

Tier 5 33% $90 33% N/A

Tier 6 $0 $0 $0 N/A

Coverage Gap Applies No Gap Coverage for Tiers 1, 2, & 6

N/A

If you would like more information about the Health First Plans or have questions, please call Health First Member Services, at 1-800-716-7737, from 8 a.m. - 8 p.m., seven days a week.

Health First Medicare Advantage Plans(See chart for available Medicare Advantage Plans by county of residence.)

Benefit Zero Premium HMO Comprehensive PPO

Medical In-Network In-Network Out-of-NetworkAnnual Deductible $0 $0


Hospital Admit $0 $175


$0/$0 $5/$15


Outpatient Surgery/Non-hospital/Hospital

$50/$100 $15/$50

RxTier 1 $0 $5 N/A

Tier 2 $10 $30 N/A

Tier 3 $60 $60 N/A

Tier 4 33% 33% N/A

Tier 5 N/A N/A N/A

Coverage Gap Applies Applies Applies

If you would like more information about the Humana Group Medicare Advantage Plans or to receive a complete pre-enrollment plan guide, call Humana at 1-800-824-8242, TTY 711, 8 a.m. - 8 p.m. ET, seven days a week.

Humana Medicare Advantage Plans(See chart for available Medicare Advantage Plans by county of residence.)



EDIC

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Benefit Cigna Leon CaresMedical HMOAnnual Deductible $0Annual Out-of-Pocket $6,700Hospital Admit $0Office Visit $0Emergency Care $0Outpatient Surgery $0

RxTier 1 $0Tier 2 $0Tier 3 33%Tier 4 33%Tier 5 33%Coverage Gap AppliesIf you would like more information about the Cigna Leon Medical Center Health Plans or have questions, please call Cigna Leon Medical Center Health Plans Member Services, at 305-229-7543 or toll-free 1-866-266-8917 or, for TTY users, 711, from 8 a.m. - 8 p.m., seven days a week.

Cigna Leon Medical Center Health Plans - Leon Cares (HMO)(See chart for available Medicare Advantage Plan by county of residence.)

Benefit Group Plus C Group POS B (HMO - POS) SunSaver Plan (HMO-POS)

Medical In-Network In-Network Out-of-Network


Annual Deductible $0 $0 $0 $0 $0

Annual Out-of-Pocket $2,000 $3,000 $6,000 $4,500 N/A

Inpatient Hospital Care

$250 per admission

$150/Day to 5 Days


N/A


$0/$20 $0/$25 20% $0/$40 N/A/20%$2,500 limit

Emergency Care $50 $50 $50 $75 $75

Outpatient Surgery $125 $150 20% $225 N/A

RxTier 1 $2 $2 N/A $2 N/A

Tier 2 $5 $5 N/A $5 N/A

Tier 3 $25 $45 N/A $45 N/A

Tier 4 $45 $90 N/A $90 N/A

Tier 5 $90 33% N/A 33% N/A

Tier 6 $0 $0 $0

Coverage Gap No Gap Coverage for Tiers 1, 2 & 6

N/A Coverage for Tier 6

N/A

If you would like more information about the Florida Hospital Care Advantage Plans or have questions, please call Florida Hospital Care Advantage Member Services, at 1-855-882-6467, from 8 a.m. - 8 p.m., seven days a week.

Florida Hospital Care Advantage Plans(See chart for available Medicare Advantage Plans by county of residence.)

MYFSRBC.ORG | 21


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Benefit Medicare Choice

MedicalMiami Dade County Broward County

HMO HMO

Annual Deductible $0 $0


Inpatient Hospital Care$0/ Day 1 - 5 Days

$55/Day 6 - 20 Days$0/Day 21 - 90 Days

$0/ Day 1 - 5 Days$80/Day 6 - 20 Days$0/Day 21 - 90 Days


Primary - $0Specialty $5 - $40

Primary - $0Specialty $10 - $40


Outpatient Surgery - Non-hospital/Hospital

$75/$175 $75/$200

Rx

Tier 1 $0 $0

Tier 2 $3 $7

Tier 3 $40 $40

Tier 4 $75 $75

Tier 5 33% 33%

Coverage Gap Applies Applies

If you would like more information about the AvMed Medicare Advantage Plan or have questions, please call an AvMed Benefits Consultant at 1-800-835-6137, or for TTY users, 711, from October 1, 2016 - February 14, 2017, from 8 a.m. - 8 p.m., 7 days a week, and February 15, 2017 - September 30, 2017, from 8 a.m. - 8 p.m., Monday-Friday 8 a.m. - 8 p.m., seven days a week.

AvMed Medicare Advantage Plan (HMO)(See chart for available Medicare Advantage Plan by county of residence.)


FSRBC | MeDICaRe sUPPleMenT PlansM

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MEDICARE SUPPLEMENT INSURANCE PLAN (MEDIGAP)

While Medicare pays for many health care services and supplies, a supplement plan is an add-on to your Medicare Part A and Part B and offers extra coverage to pay for expenses not covered by Medicare.

Information to Consider in a Medicare Supplement Insurance Plan:

• You must be enrolled in Medicare Part A and Part B.

• You should apply for a Prescription Drug Plan when you apply for a supplement plan to avoid incurring extra fees.

• You pay a monthly premium in addition to your direct payment to Medicare.

• You and your Medicare-eligible spouse or dependent must each buy your own policy.

MEDICARE PART D PRESCRIPTION DRUG PLANS

Medicare Supplement Plans offered through the FSRBC do not cover most prescription drugs. A Medicare Part D Prescription Drug Plan will help cover your prescription drug costs. There are several levels of coverage available to meet your needs. Contact the carrier(s) below to receive more information.

Note: You must apply for a Prescription Drug Plan when you are first eligible for Medicare to avoid a late enrollment fee.

Supplement and Prescription Drug Plans (PDP) are available nationwide. Contact the carriers listed below to receive more information.

Supplement Plan Options

MYFSRBC.ORG | 23

MeDICaRe sUPPleMenT Plans | FSRBC

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Supplement Plans and Prescription Drug Plans (PDP) carrier contact information. Medicare Supplement Plans

Plan A

UnitedHealthcare®

1-877-776-1466, (TTY 711)

You can request an enrollment kit from United Healthcare® to be

mailed to you.Plan F*

Plan N*

Medicare Part D Prescription Drug Plan

Saver Plus Plan

UnitedHealthcare®

1-877-776-1466, (TTY 711) You can request an enrollment

kit from United Healthcare® to be mailed to you.

Preferred Plan

Comprehensive PDP

Premier Plan


FSRBC | MeDICaRe PaRT D Plan PResCRIPTIon DRUG benefITsM

EDIC

ARE

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RIPT

ION

DRU

G B

ENEF

ITS

benefits Plan a Plan f Plan nPart A Coinsurance plus 365 additional hospital days after Medicare benefits end Hospital Costs √ √ √

Part B (Medical) Coinsurance or Copayment √ √ Copay1

Blood (First Three Pints) √ √ √

Hospice/Respite Care Coinsurance or Copayment √ √ √

Skilled Nursing Facility Care Coinsurance √ √

Part A Deductible √ √

Part B Annual Deductible √

Part B Excess Charges √

Foreign Travel Emergency Care2 80% 80%

1 - Plan pays Part B coinsurance or copayment except for an insured copay of up to $20 for each doctor’s office visit and up to $50 for each emergency room visit (emergency room copay waived if admitted as inpatient).2 - Beneficiaries must pay a separate deductible for a foreign travel emergency ($250 per year) and a lifetime maximum benefit of $50,000 applies.

AARP® PlanMedicare Supplement Plan Benefits

MYFSRBC.ORG | 25

MeDICaRe PaRT D Plan PResCRIPTIon DRUG benefITs | FSRBC

MED

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Medicare Part D Plan Prescription Drug BenefitsUnitedHealthcare® MedicareRx Plan

Medicare RX Saver Plus Plan

Medicare RX Preferred Plan

Comprehensive Plan

Premier Plan

Deductible $400.00 $0 $0 $0

Initial Coverage Period

Tier 1 $1 - $2 $2 - $4 $10 $7

Tier 2 $2 - $5 $15 - $20 $45 $30

Tier 3 $17 - $30 $36 - $47 $75 $60

Tier 4 30% - 35% 40% - 50% 33% $75

Tier 5 25% 33% N/A N/A

Gap

Tier 1 51% 51% $10 $7

Tier 2 51% 51% 40% $30

Tier 3 40% 40% 40% $60

Tier 4 40% 40% 40% $75

Tier 5 40% 40% N/A N/A

Catastrophic

Tier 1 Greater of $3.30 or 5%

Greater of $3.30 or 5%



Tier 2Greater of

$8.25 or 5%Greater of

$8.25 or 5%Tier 3



Tier 4

Tier 5 N/A N/A

Monthly Premium $32.90 $72.00 $115.00 $304.23


FSRBC | GlossaRY of TeRMsLE

ARN

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Benefit period - A benefit period begins the day you’re admitted as an inpatient in a hospital or (Skilled Nursing Facility) SNF and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.Coinsurance - An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent).Copayment - A set amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. Cost Sharing - An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. Deductible - The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.Drug list - A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. This list is also called a formulary.Excess charge - When the amount a doctor or other health care carrier is legally permitted to charge Original Medicare is higher than the Medicare-approved amount, the difference is called the excess charge.Generic drug - A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. Initial coverage limit - The copayment or coinsurance you pay for each covered drug once you’ve met your yearly deductible until you reach your plan’s out-of-pocket maximum (or initial coverage limit). You’ll then enter your plan’s coverage gap (also called the “donut hole”).

In-network - Doctors, hospitals, pharmacies, and other health care carriers that have agreed to provide members of a certain insurance plan a discounted price if they use an in-network carrier. Network - The facilities, carriers, and suppliers your health insurer or plan has contracted with to provide health care services.Out-of-network - Many Medicare Advantage plans provide the choice of in and out of network carriers. In some cases, out-of-pocket costs may be higher for an out-of-network benefit.Out-of-pocket costs - Health or prescription drug costs that aren’t covered by Medicare or other insurance.Penalty - An amount added to your monthly premium for Part B or a Medicare drug plan (Part D) if you don’t join when you’re first eligible. You pay this higher amount as long as you have Medicare. Pharmacy network - Pharmacies that have agreed to provide members of certain Medicare plans with services and supplies at a discounted price. In some Medicare plans, your prescriptions are only covered if you get them filled at network pharmacies.Prior authorization - Approval that you must get from a Medicare drug plan before you fill your prescription in order for the prescription to be covered by your plan. Your Medicare drug plan may require prior authorization for certain drugs.Service area - The geographic area where a health insurance plan accepts members (if the plan limits membership based on where people live). Tiers - Groups of drugs that have a different cost for each group. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.

MYFSRBC.ORG | 27

GlossaRY of TeRMs | FSRBC

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In the non-medical benefits section of this guide, you will find important information about additional benefits that are valuable for retirees.

Please review this section of the Benefits Guide thoroughly as it contains important information regarding all of the non-medical Benefits available to you. This information will help you choose the benefits and coverage that best suit your needs and your budget!

Non-Medical BenefitsThe FSRBC and your School District are making valuable Benefits like dental and vision coverage available to you; these options may no longer be available directly from your School District. Additional options include IT Technical Support plans, ID Theft Protection plans, a Hearing Aid benefit, Pet Insurance*, and Pet RX. A Non-Medical Benefits Enrollment Form* is included in the back of this guide to help you enroll in non-medical plans.

With the FSRBC, you have the security of knowing you will have the coverage you need, so that you can truly enjoy The Benefits of Aging.

*Nationwide Pet Insurance has an individual enrollment process. Don’t forget to mention FSRBC when you enroll!

IT’S TIME TO LEARN MORE - ABOUT NON-MEDICAL BENEFITS!


FSRBC | DenTal PlansD

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The Florida School Retiree Benefits Consortium (FSRBC) is pleased to offer you the choice of five dental plans provided by Humana. The HumanaDental® Plans have you covered for any circumstance. Whether you simply need routine dental care or unexpected dental treatment, you know what to expect with HumanaDental.

• Broad network access• No claims to file on DHMO• No annual maximums (HD205 and

HS195 Plans)

Make dental visits a priorityOne of the first lines of defense in overall health is dental care. Regular dental cleanings can help manage problems throughout the body, such as heart disease, diabetes and stroke. The HumanaDental Plan enables you to take better care of your teeth, and you’ll pay less for your dental care doing so.

HumanaDental® offers two DHMO Plans and three PPO Plans. Please review each of the plans information carefully to determine which plan will best suit your dental care needs:

• Low PPO Plan• Medium PPO Plan• High PPO Plan• Low DHMO Plan• High DHMO Plan

Dental HMO benefitsAfter you enroll in a plan and receive your Humana member identification (ID) card, you can manage your plan information on your personal home page on HumanaDental.com.

• You have the freedom to select any participating general dentist as your primary care dentist. To select a dental carrier from our network, simply visit HumanaDental.com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1-800-233-4013.

• Life without claim forms! With the HumanaDental Prepaid Plans (Low DMHO Plan and High DHMO Plan) you pay your dentist directly, when applicable.

• Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service.

• You must live in Florida to enroll in

the Humana DHMO Plan.

Questions?Check out HumanaDental.comCall 1-800-233-4013, Monday through Friday, 8 a.m. to 6 p.m.(TDD: 1-800-325-2025).Or visit: www.myfsrbc.org/2017

Dental Plans

MYFSRBC.ORG | 29

DenTal Plans | FSRBC

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Monthly Rates Humana Low DHMO Plan HD205 Humana High DHMO Plan HS195Retiree $9.75 $15.83Retiree + 1 $19.31 $31.34Retiree + Family $34.32 $55.71

Rate Chart

* Services marked with a single asterisk (*) also require separate payment of laboratory charges, not to exceed $200. The laboratory charges must be paid to the plan dentist in addition to any applicable copayment for the service.

HD205 DHMO: Specialist services: Should members need a specialist, (i.e. endodontist, oral surgeon, periodontist, pediatric dentist), they may be referred by a participating general dentist, or members can self-refer to any participating specialist. For HD plans, and benefits for procedures not listed on the schedule, members may receive up to a 25 percent discount by visiting certain participating specialists.

ADA Code Services

Humana DHMO PlansLow DHMO

Plan HD205

High DHMO Plan

HS195OFFICE VISIT COPAY PER VISIT (normal visiting hours) $0 $0

D120 PERIODIC ORAL EVALUATION-ESTABLISHED PATIENT $0 $0D150 COMPREHENSIVE ORAL EVALUATION $0 $0D330 PANORAMIC RADIOGRAPHIC IMAGE $0 $0D272 BITEWINGS - TWO RADIOGRAPHIC IMAGES $0 $0D1110 PROPHYLAXIS - ADULT $0 $0D2140 AMALGAM - ONE SURFACE - PERMANENT $5 $0D2330 RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR $30 $0D2391 RESIN-BASED COMPOSITE – ONE SURFACE, POSTERIOR $45 $30D2392 RESIN-BASED COMPOSITE – TWO SURFACES, POSTERIOR $55 $45D2740 CROWN - PORCELAIN/CERAMIC SUBSTRATE $270* $245*D2752 CROWN - PORCELAIN WITH SEMIPRECIOUS METAL $270* $245*D3310 ENDODONTIC THERAPY, ANTERIOR TOOTH $110 $100D3330 ENDODONTIC THERAPY, MOLAR $250 $210D4341 PERIODONTAL SCALING & ROOT PLANING-4 OR MORE TEETH $55 $50D5110 COMPLETE DENTURE - MAXILLARY $375* $325*D6240 PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL $270* $245*D6242 PONTIC - PORCELAIN FUSED TO NOBLE METAL $270* $245*D6750 CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL $270* $245*D6752 CROWN - PORCELAIN FUSED TO NOBLE METAL $270* $245*D7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT $0 $5D7210 SURGICAL REMOVAL OF ERUPTED TOOTH $40 $30

NUMBER OF ADA CODES COVERED UNDER PLAN 315 337

In-Network Benefits

HS195 DHMO: Specialist services: Should members need a specialist, (i.e.,endodontist, oral surgeon, periodontist, pediatric dentist), they may be referred by a participating general dentist, or members can self-refer to any participating specialist. For HS plans, copayment amounts are applicable when treatment is performed by participating specialists. Visit HumanaDental.com to find a participating specialist.


FSRBC | DenTal PlansD

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Benefits

Low PPO Plan Medium PPO Plan High PPO Plan

In-NetworkOut-of-

Network* In-NetworkOut-of-

Network* In-NetworkOut-of-

Network*Plan Identification

Humana Vol. PPO 100/70/50 INFS

Humana Vol. PPO 100/80/50 INFS

Humana Vol. TRP 100/80/50 MAF

Annual Maximum $800 per person per year $1,250 per person per year $2,000 per person per year

Annual Deductible

$50/person to max $150

for Basic or Major Services

$100/ person to max $300 for Basic or Major Services

$25/person to max $75 for Basic or Major Services

$50/person to max $150

for Basic or Major Services

$50 per person to max $150 for Basic or Major

Services

Diagnostic and Preventive Services

100% 100% 100% 80% 100% 100%

Basic Services 70% 70% 80% 60% 80% 80%Major Services 50% 50% 50% 40% 50% 50%Out of Network Allowance

* Coverage based on negotiated contracted fees for the Preferred

Carrier Network.

* Coverage based on negotiated contracted fees for the Preferred Carrier

Network.

* Coverage based on usual, customary, and

reasonable fees.

Monthly RatesHumana Low

PPO PlanHumana Medium

PPO PlanHumana High

PPO PlanRetiree $29.10 $34.28 $40.62Retiree + 1 $57.93 $58.86 $80.89Retiree + Family $75.49 $84.18 $105.04

In-Network Benefits

Rate Chart

PPO Indemnity PlansThe PPO Indemnity Plans are similar to traditional dental insurance plans. You do not have to pre-select a primary dentist. When you need dental services, simply make your appointment with any dentist. For maximum benefits, select a dentist from Humana’s extensive PPO network. PPO dentists have agreed to accept a discounted fee for services. When you receive treatment from a participating PPO dentist, your share of the cost will be reduced. Once services are performed, you or your dentist must file a claim form in order to receive reimbursement.

Your claim will be paid based on your plan’s Schedule of Benefits. The plan will pay a percentage of the eligible charges, up to the plan’s annual maximum limit for benefits subject to the plan’s limitations and exclusions.

For more information on this product visitwww.myfsrbc.org/2017

MYFSRBC.ORG | 31

vIsIon Plans | FSRBC

VIS

ION

PLA

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The FSRBC is pleased to offer you the choice of two vision plans provided by Davis Vision.

Davis Vision PlanHealthy eyes and clear vision are an important part of your overall health and quality of life. Your vision plan helps you care for your eyes while saving you money by offering:Paid-in-full eye examinations, eyeglasses and contacts!

• Frame Collection: Your plan includes a selection of designer, name brand frames that are completely covered in full.1

• Contact Lens Collection: Select from the most popular contact lenses on the market today with Davis Vision’s Contact Lens Collection.1

• One-year eyeglass breakage warranty included on plan eyewear at no additional cost!

FOR MORE INFORMATION AND HOW TO LOCATE A NETWORK CARRIER

For more details about the plan, just visit the Open Enrollment section of our member site at www.davisvision.com/Open-Enrollment/ and enter Client Code: 4951 or call 1-877-923-2847.

VALUE FOR DAVIS VISION MEMBERS

A comprehensive benefit ensuring low out-of-pocket cost to members and their families. Our goal is 100 percent member satisfaction.

CONVENIENT NETWORK LOCATIONS

A national network of credentialed preferred carriers throughout the 50 states.

FREEDOM OF CHOICE

Access to care through any of our network of independent, private practice doctors (optometrists and ophthalmologists) or retail partners such as: Visionworks, Costco, Sam’s Club, Walmart, For Eyes, and others.

Value-Added Features:• Replacement contacts through Davis

Vision contact lens replacement service, saving both time and money.

• Laser Vision Correction discounts of up to 25 percent off the carrier’s usual & customary fees, or 5 percent off advertised specials, whichever is lower.

Coverage level Monthly Rates Option I Option IIRetiree $6.17 $7.01Retiree + 1 $11.11 $12.62Retiree + Family $17.28 $19.63


FSRBC | vIsIon PlansV

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Benefits Plan OptionsFrequency – Once Every: Option I Designer Option II Designer

Exam inclusive of Dilation (when professionally indicated)

12 Months 12 Months

Spectacle lenses 12 Months 12 MonthsFrames 24 Months 12 MonthsContact Lens Evaluation, Fitting & Follow-up Care 12 Months 12 MonthsContact Lenses (in lieu of eyeglasses) 12 Months 12 MonthsCopayment

Exam $10 $5Spectacle Lenses $15 $15Contact Lens Evaluation, Fitting & Follow-up Care $01 $01

Eyeglass Benefit – Frame

Non-Collection Frame Allowance (Retail): Up to $130 OR

Up to $180 Allowance2

Plus a 20% discount on any overage3

Up to $130 OR

Up to $180 Allowance2

Plus a 20% discount on any overage3

Davis Vision Frame Collection/4 (in lieu of Allowance):Fashion Level Included IncludedDesigner Level Included IncludedPremier Level $25 copay $25 copayEyeglass Benefit – Spectacle Lenses & Lens Options Member Charges

Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx)

Included Included

Tinting of Plastic Lenses Included IncludedScratch-Resistant Coating Included IncludedPolycarbonate Lenses (Children5/ Adults) $0/$30 $0/$30Ultraviolet Coating $12 $12Anti-Reflective (AR) Coating (Standard / Premium / Ultra)

$35/$48/$60 $35/$48/$60

Progressive Lenses (Standard / Premium / Ultra6) $50/$90/$140 $50/$90/$140High-Index Lenses $55 $55Polarized Lenses $75 $75Plastic Photosensitive Lenses $65 $65Scratch Protection Plan: Single Vision / Multifocal Lenses

$20/$40 $20/$40

In-Network Benefits

1. Copayment applies to Collection Contact Lenses only.2. Enhanced Allowance of $180 available only at all Visionworks locations nationwide. Cannot be combined with any

other discounts or offers.3. Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.4. Collection is available at most participating independent carrier offices. Collection is subject to change. Collection

is inclusive of select torics and multifocals.5. Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with

prescriptions +/- 6.00 diopters or greater.6. Category includes digital free-form progressive lenses.

MYFSRBC.ORG | 33

vIsIon Plans | FSRBC

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1. Copayment applies to Collection Contact Lenses only.2. Enhanced Allowance of $180 available only at all Visionworks locations nationwide. Cannot be combined with any

other discounts or offers.3. Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.4. Collection is available at most participating independent carrier offices. Collection is subject to change. Collection

is inclusive of select torics and multifocals.5. Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with

prescriptions +/- 6.00 diopters or greater.6. Category includes digital free-form progressive lenses.

Service With Davis VisionEye Examination $40Single Vision Lenses $40Bifocals/Progressive Lenses $60Trifocal Lenses $80Lenticular Lenses $100Elective Contact Lenses $105Medically Necessary CL $225Frame $50

Out-of-Network Benefits

Please send all Out-of-Network Claims to:Vision Care Processing Unit P.O. Box 1525 Latham, NY 12110


Benefits Plan OptionsFrequency – Once Every: Option I Designer Option II Designer

Contact Lens Benefit (in lieu of eyeglasses)

Non-Collection Contact Lenses: Materials Allowance

Up to $130 Plus a 15% discount on

any overage3

Up to $130 Plus a 15% discount

on any overage3

Evaluation, Fitting & Follow-Up Care – Standard & Specialty Lens Types

15% Discount3 15% Discount3

Collection Contact Lenses3 (in lieu of Allowance): MaterialsDisposable 4 boxes/multi-packs 4 boxes/multi-packsPlanned Replacement 2 boxes/multi-packs 2 boxes/multi-packsEvaluation, Fitting & Follow-up Care Included IncludedMedically Necessary Contact Lenses (with prior approval)• Materials, Evaluation, Fitting & Follow-up Care Included


FSRBC | HeaRInG benefITH

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Hearing Aid Plans

Life’s getting louder.® Thanks to the cranked up volume ofmodern life, hearing loss is becoming a major health problem.Freedom to Choose: You have the freedom to choose any hearing carrier to receive benefits.

This plan provides access to EPIC, the largest ENT and Audiologist network in the country. The advantage of seeking services through an EPIC carrier Includes:

• No claims to be filed for the member!• 30-60 percent discounts for all major

hearing aid Technology manufacturers (as low as $495)

• Open product selection and no off brand or private label products

• Hearing wellness program• EPIC Customer Service line 9 a.m.-9p.m. ET• Leasing program availability

Hearing Exam: A full audio metric hearing exam is covered at 100 percent through EPIC carriers once every benefit period. This comprehensive exam is also available if you chose not to use EPIC with reimbursement up to $75 per benefit period.Hearing Aid Maintenance: You are also eligible for 100% of hearing aid maintenance up to $40 per benefit period. Maintenance covers batteries, service contracts, fittings, ear molds and repairs.No Deductibles: Hearing exams, hearing aids and hearing aid maintenance are all deductible-free.Hearing Aid Lease Benefit: In addition to this insured benefit, members have access through EPIC to a separate Hear TEK Leasing program to make hearing aid benefits more affordable. While members can use both the insured benefit and also the leasing benefit, the SoundCare plan does not coordinate benefits with the leasing plan. Please see the detailed Hear Tek brochure and FAQ for more information, or contact any EPIC carrier for more details.

Increasing Hearing Benefits: The hearing aid benefit is progressive, rewarding you with benefits that increase over time based on your enrollment effective date.If you require a hearing aid, your FSRBC plan covers 50 percent of the hearing aid cost per ear up to the annual benefit amount.Once you use your hearing aid coverage at any level, you become re-eligible for benefits at the top level, after five years, as long as there is no break in coverage. A reduced benefit may be available after three years if your hearing suffers deterioration the current aids can’t correct.

Increasing Hearing Aid Maximum BenefitsYear 1 Year 2 Year 3

Comprehensive, full audio metric hearing exam100%

up to $75 perbenefit period

100% up to $75 perbenefit period


Hearing Aid Maintenance(batteries, repairs, service contracts, ear molds)




Hearing Aids30-60% EPICdiscount onhearing aids.

30-60% EPICdiscount onhearing aids

30-60% EPICdiscount onhearing aids

No insuredbenefit in Year 1 for hearing aids.

Insured benefitprovides 50%,up to $400 perear, per benefitperiod for anycarrier

Insured benefitprovides 50%,up to $800 perear, per benefitperiod for anycarrier

SoundCare®

Monthly Rates (effective through 12/31/2017)Retiree only $8Retiree & Spouse $16Retiree & Child(ren) $12Retiree & Family $20

MYFSRBC.ORG | 35

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Protect and preserve your ability to hear. Take advantage of the Ameritas SoundCare benefits available through the FSRBC.

How to use your Soundcare benefits.1. Call 877-359-8346 to speak to a SoundCare customer service representative. We’ll offer you

the option of working with an EPIC Hearing Health Care counselor to help make finding and receiving care easier. Your SoundCare benefits are the same whether you opt to use EPIC or not.

If you choose not to use EPIC:2. Select a carrier of your choice and make

an appointment with them directly.3. Visit ameritas.com to obtain a claim form.

• click on the Individuals and Families tab

• click on Forms under Existing Customers, Dental/Vision/Hearing

• you will find the Hearing GC393 form within the Claim Forms dropdown menu

4. Take the claim form with you to your hearing carrier. You complete Part 1 of the form and your carrier completes Part 2.

5. You or your hearing Carrier must send the claim form to: Ameritas Life Insurance Corp. Claims Office P.O. Box 82520 Lincoln, NE 68501 Fax 402-467-7336

6. You are responsible for paying any remaining balance due directly to your carrier after your SoundCare benefits have been applied.*

* Insurance benefits for hearing aids are not payable

until the expiration of a 45-day trial period. The trial period is required by state mandate unless the member signs a waiver stating they are with their hearing aids.

Eyewear and Rx savings: Save up to 15% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide by presenting your Ameritas savings card. Members can also save on prescriptions for your family (even your pets) at Walmart or Sam’s Club pharmacies. You’ll get hundreds of generic prescriptions for only $4.00, plus up to 40% off all other generics and 10-15% off most brand-name prescriptions. These savings arrangements are not insurance and are no additional cost to your planpremium. Access your savings cards by creating a secure member account at Ameritas.com.

Questions?SoundCare customer service representatives are available Monday-Thursday 7:00am to 12:00am and Friday 7:00am to 6:30pm (CST) to answer your questions or help you find an EPIC carrier. Please call 877-359-8346.


If you choose to work with EPIC:2. An EPIC hearing counselor will help

you to locate an alliance carrier in your area, then EPIC will send you a packet of information.

3. Once you are evaluated by the EPIC carrier, the carrier will coordinate your care directly with EPIC.

4. You will not need to complete or submit any claim forms. EPIC will submit the claims directly to Ameritas for you, including for the ordering of your hearing devices.*

5. EPIC can typically offer you substantial cost savings on your hearing devices. You are responsible for paying any remaining balance due directly to the EPIC carrier after your SoundCare benefits have been applied.


FSRBC | TeCH sUPPoRT PlansIT

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The FSRBC is pleased to offer two technology support options through IT Please. IT Please is a whole-home technology support program that gives members unlimited 24/7/365 remote support access via the Internet, chat, or phone, for everything from virus removal and wireless network troubleshooting to gaming console setup.

Unlimited Support Plan• Unlimited remote support• On-site support (up to 50

percent off retail rates)• Self-help solution library• Best practices assessment• Computer protection software

Unlimited Plus Support Plan• Unlimited remote support• On-site support (up to 50

percent off retail rates)• Self-help solution library• Best practices assessment• Computer protection software• Secure data backup (100GB)

Product Details• 24/7 Remote Technical Support

Experienced and qualified technicians are standing by 24/7 to instantly resolve your technical issue. Technicians will utilize cutting edge technology to fix your computer over the Internet.

• On-site Support (at an additional cost) We have over 14,000 technicians that can be dispatched to your home or office as soon as the same business day.

• Antivirus Software BitDefender Total Security will protect you from viruses, Trojans, spyware and other malicious software.

• Online Data Backup Our data backup service provides secure, enterprise-class remote data backup solutions.

• Self-Help Database Our self-help database contains over 120,000 use solutions to common computer problems.

• Best Practices Assessment You will receive an online analysis of your computing environment and recommendation to improve performance and security.

Your Monthly RatesUnlimited Support Plan $10.00

Unlimited Plus Support Plan $14.00

MYFSRBC.ORG | 37

TeCH sUPPoRT Plans | FSRBC

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• Desktop/laptop hard drive install• Desktop I/0 gaming card install

configuration• Software install and configuration• Basic digital imaging (photo)

training• Digital music training (setup sold

separately)• Data or document recovery• Virus removal and performance

optimization

Systems Supported• Windows 10• Windows 8 • Windows 7• Windows Vista• WindowsXP• Windows 2000• Windows ME• Windows 98• Windows NT• Windows 95• Mac OS• LINUX

System Utilities Supported• BitDefender• AVG Anti-Virus• Norton Clean Sweep• Partition Magic• Norton Utilities• Dr. Solomon’s• Norton Anti-Virus• Windows Themes• WinZip• Lavasoft•


Technologies Supported• Desktop and laptop• Computers (PC and Mac)• Smartphones and PDAs• Digital Cameras• Printers/Scanners• Routers• Modems• Mass Storage Devices• Gaming Consoles

Software Supported• Microsoft 365• Adobe Acrobat• Adobe Photoshop• Lotus• SmartSuite• Open Office• Microsoft Office (Excel, Word,

Project, Access, etc.)• Windows Media Player• Quicken• Corel Office Suite• QuickBooks

Services Supported• Data transfer and backup • Broadband/DSL install• Network (wireless or wired) install

or troubleshooting• VOlP install• Audio and video component

installation• PDA/Blackberry install or

troubleshooting • Off-site data backup install and

configuration• Desktop/laptop setup and

configuration• Desktop/laptop memory upgrade

and install• Desktop/laptop CD or DVD drive

install


FSRBC | ID THefT PRoTeCTIon PlansID

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The FSRBC is pleased to offer two identity theft protection options through ID Commander.

Premium Protection PlanRestoration:• Full-service identity restoration• 24/7 lost wallet assistance• $1 million insurance policy• Identity safety resource center

Detection:• Internet surveillance monitoring and

alerts• Social security monitoring and alerts• Change of address monitoring and

alerts

Ultimate Protection PlanRestoration:• Full-service identity restoration• 24/7 lost wallet assistance• $1 million insurance policy• Identity safety resource center

Detection:• Internet surveillance monitoring and

alerts• Social Security monitoring and alerts• Change of address monitoring and

alerts• Court/criminal monitoring and alerts• Sex offender monitoring and alerts• Payday loan monitoring and alerts

Protection:• Computer Detection Software

Identity theft is the fastest growing crime in America, with an identity stolen once every four seconds. ID Commander, a leader in proactive identity theft protection, uses a variety of industry-leading tools to help protect you from the growing crime of identity theft:• Advanced Identity Monitoring and

Alerts• $1 Million Identity Theft Insurance

Policy, with $0 deductible• Full-service Identity Restoration• 24/7 Lost Wallet Assistance• Award-winning Computer Protection

Software

ID Commander’s comprehensive identity theft protection plans are available to both individuals and families, with complete access to benefits the moment membership begins. The ID Commander Family Protection Plan provides a truly managed household program and empowers individual family members with the tools and data they need to proactively manage the health and well-being of their identities.

If the worst happens, and you become the victim of identity theft while covered by ID Commander, we will restore your identity and any related credit accounts to pre-theft status. No limits, no fine print, no “service guarantee.” In addition, if you suffer any covered out-of-pocket expenses as a result of a breach, you’re covered by a real insurance policy that will put money in your hands for qualified losses.Take command of your future with ID Commander – sign up today!

Plan Premium UltimateIndividual $ 7.00 $10.50Family $15.00 $22.50

MYFSRBC.ORG | 39

ID THefT PRoTeCTIon Plans | FSRBC

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P R E M I U M U LT I M AT E Exceptional protection Our most comprehensive at a great price protection package

PLAN FEATURES

IDENTITY INSURANCE

IDENTITY THEFT PROTECTION RESOURCE CENTER

24/7 LOST WALLET ASSISTANCE

INTERNET SURVEILLANCE MONITORING & ALERTS

SOCIAL SECURITY MONITORING & ALERTS

CHANGE OF ADDRESS MONITORING & ALERTS

COURT AND CRIMINAL RECORDS MONITORING & ALERTS

NON-CREDIT LOAN MONITORING & ALERTS

SEX OFFENDER MONITORING & ALERTS

ANTI-VIRUS / ANTI-SPYWARE SOFTWARE

ANTI-PHISHING, ANTI-SPAM SOFTWARE

SOFTWARE FIREWALL

DIGITAL VAULT

DIGITAL FILE SHREDDER

1 Member must provide a Social Security Number in order for the SSN Trace functionality to monitor SSN activity.

FULL-SERVICE IDENTITY THEFT RESTORATION SERVICES

Note: Email address is required to receive notifications.



FSRBC | PeT InsURanCe PlansPE

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The FSRBC is pleased to offer three pet insurance options through Nationwide.Nationwide is the leading pet insurance carrier of pet health insurance.With comprehensive plans designed to protect you financially when the unexpected occurs, affordable coverage from Nationwide allows you to focus on providing optimal healthcare for your pet rather than worrying about the cost of treatment. You can be reimbursed for veterinary expenses such as surgeries, diagnostic tests, hospitalization, prescriptions, vaccinations and more.

HOW TO ENROLL

Once you’ve decided on which plan best protects your pet, visit: www.petinsurance.com/fsrbc or call 877-738-7874 and mention FSRBC to receive your discount.

AVAILABLE PLANS The following plans are available for both dogs and cats:

Major Medical Plan - Comprehensive covers accidents, illnesses & hereditary conditionsIf you want a safety net for big vet bills, this is the dog and cat insurance plan you’re looking for. It’s our most comprehensive protection, with our highest level of benefits.

• Our most popular plan• $250 annual deductible• Covers accidents, illnesses,

procedures, X-rays and more• Chronic condition coverage included• Freedom to use any vet, anywhere• Benefits renew in full each year• Limited hereditary coverage after the

first year• Includes 24/7 access to Vet HelplineSM

($150 value)

Pet Wellness Basics - Economical Covers Accidents & IllnessesRoutine pet care plan that gives you cash back.

• No deductible• Freedom to use any vet, anywhere• Covers prescription flea control• Covers vaccinations• Includes 24/7 access to Vet HelplineSM

($150 value)

Major Medical Plan + Wellness$250 annual medical deductible

• $250 maximum annual wellness benefit

• Covers accidents and injuries• Illnesses• Cancer• X-rays• Surgeries• Hereditary coverage• Vaccinations, exams, flea/heartworm,

and more• Freedom to use any vet, anywhere• Includes 24/7 access to the Vet

HelplineSM ($150 value)


Discountcode:

FSRBC

MYFSRBC.ORG | 41

PeT DIsCoUnT Plan | FSRBC

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PETplus is a wholesale online pricing club that will save retirees money on all prescriptions and preventatives including flea and tick preventatives, heartworm preventatives, and dietary supplements. PETplus is available at a low cost per month.

Participant Benefit from:

SAVINGS ASK-A-VET HELPLINE CONVENIENCE

• 100% Savings Guarantee • Access to veterinary specialist 24/7 via email, chat or phone

• PETplus will get the prescription script; no need to call or ask the vet

• Flea & Tick Preventatives • You can easily save between $300 - $800 a year on avoidable vet visits

• Free delivery always, no restrictions

• Rx Medications • Fewer vet visits • Convenient Rx pick up at local pharmacies nationwide

• Vitamins & Supplements • This service alone is valued at $150 a year

• Heartworm Products• Specialty/Rx Food

Is PETplus insurance?No! With PETplus, retirees get wholesale pricing on prescriptions, preventatives and other products which are almost never covered by insurance. It’s instant savings without any paperwork.

Are there any exclusions?No, there are absolutely no exclusions. Retirees can enroll any type of dog or cat.

When can retirees start using their membership?Immediately! All participating retirees will receive instructions how to activate their online account before the benefit start date. Just login to the PETplus account, register pets, and start shopping immediately.

Plan Premium Single Pet $4.50 Multiple Pets $8.50

CATEGORY SAMPLE PRODUCTS

AVERAGE VETERINARY

PRICE

PETPLUS WHOLE SALE

Prescriptions Rimadyl 100mg 30 caplets $64

$40 Save $288/

year

Heartworm Preventatives

Heartguard Plus Chewables 6 monthsupply for up to 25lbs

$42 $23Save $38/year

Flea & Tick Preventatives

FrontlinePlus 6 month Supply for 35-88lbs

$104 $58 Save $92/year

Prescription Diet Foods

Hill’s prescription Diet Canned Dog Food 12/13oz cans

$54$36

Save $221/year


Brought to you by Pet Assure Corp


FSRBC | bIllInGBI

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GBILLING

The Billing section of this book describes the choices you have in deciding how to pay for the plans you have selected.

When deciding on a payment method, you may want to consider each method and ask the following:

Florida Retirement System (FRS):

Q: Do you have sufficient funds in your FRS retirement account to cover the payments?

A: Yes. If you are able, having your premium payments deducted from your FRS account is a highly recommended, hassle-free method to pay for your coverage selections.

Automated Clearinghouse (ACH) Payment:

Q: Do you travel often?

A: Yes. If FRS is not an option and you travel frequently or are often busy, ACH payments offer the convenience of being automatically deducted from your personal bank account.

Direct Billing

Q: Do you have multiple accounts and wish to vary your payment methods from month-to-month?

A: Yes. With Direct Billing, you will receive a monthly statement that detail your balance due and includes a voucher to mail in with your payment that will last throughout the plan year. If you choose this option, please always send the statement voucher in with your premium payment.

MYFSRBC.ORG | 43

bIllInG | FSRBC

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Payment and BillingYou have three options to pay the premiums for the plans you select:

FLORIDA RETIREMENT SYSTEM (FRS) DEDUCTION (RECOMMENDED)Your premium payments can easily be deducted from your FRS retirement account. FRS deductions are taken one month prior to the month of coverage. For example, your January premiums will be deducted in December. If you choose this method, FBMC requires a completed and signed FRS Insurance Payroll Deduction Authorization Form (included in this package). Until FRS deductions begin (in 6 to 8 weeks if you are completing this form with us for the first time), you must pay by personal check or money order.You can access the details of your FRS pension including all deductions by registering and logging on to http://www.DMS.myflorida.com/. You can also call 1-844-377-1888.

Note: Your monthly retirement benefit must be sufficient to cover the entire premium deduction – partial payments cannot be deducted.

AUTOMATED CLEARING HOUSE (ACH) PAYMENTYou have the option of setting up electronic payments through your personal bank account. If you choose this method of payment, the amount deducted will automatically be updated any time there is a change to your benefit elections. Be sure you notify your bank each time premium costs change to ensure your coverage continues. FBMC requires a completed and signed Direct Debit (ACH) Form, which is included in this package. ACH deductions are withdrawn from your bank account one month prior to the month in coverage. In addition, ACH payments will automatically withdraw any outstanding premium balances from prior months so your premiums are paid-to-date and ensures that your coverage remains active.

Note: All premiums must be paid by the due date. ACH deductions occur on the 22nd of the month before the benefit month: For example, deduction for your September benefits occur on August 22nd, etc.

DIRECT BILL (PERSONAL CHECK OR MONEY ORDER PAYMENT)Premium payments can be submitted by personal check or money order directly to FBMC. If you choose this payment method, payment coupons to send in with your premiums. All premiums must be paid by the due date. A monthly statement at the beginning of each month showing your total balance due, and includes a payment voucher.Note: Premium payments are due on the first of the benefit month. Payments must be received by the due date indicated on the monthly statement to avoid cancellation of benefits.

REFUNDSIf you are having premium payments deducted from your FRS retirement benefit or from your personal bank account (ACH) and are owed a refund, your refund will be completed as soon as verification is received that your deduction has changed. Refunds are processed once a month and mailed no later than the 15th of the following month.

INCREASES IN PREMIUMSIf you have a change in coverage that results in an increase in the premium to be deducted from your FRS retirement benefit, you may need to pay the difference by check or money order until your deductions are flowing correctly. FBMC will automatically deduct up to $100.00 in additional funds from your pension check if that will result in your account being paid-to-date. If your total outstanding balance exceeds $25.00, you will receive a statement requesting a payment by check. Funds must be received by the due date on the statement in order to avoid cancellation of your benefits.


FSRBC | ToolsLE

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Just the facts. The next few pages contain:

FBMC’s Privacy Statement:

• We will never share your information with anyone.• We protect your personal information - health or otherwise.• We only collect the information we need to provide you with

the best service.

Directory:

• Medicare contacts for applying for Part A and Part B.• Non-Medical Benefits contacts to learn details about each

type of benefit.• Medicare Advantage and Supplement Plan carriers so

you can request information and take a personal Needs Assessment.

MYFSRBC.ORG | 45

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FBMC Privacy Statement This statement applies to products administered by FBMC Benefits Management, Inc. FBMC takes your privacy very seriously. As a carrier of products and services that involve compiling personal-and sometimes, sensitive-information, protecting the confidentiality of that information has been, and will continue to be, a top priority of FBMC. This Privacy Statement explains how FBMC handles and protects the personal information we collect. Please note that the information we collect and the extent to which we use it will vary depending on the product or service involved. In many cases, we may not collect all of the types of information noted below. Note this Privacy Statement is not meant to be a Privacy Notice as defined by the Health Insurance Portability and Accountability Act (HIPAA), as amended.

FBMC’s privacy statement is as follows: I. We collect only the customer information necessary to consistently deliver responsive services.FBMC collects information that helps serve your needs, provide high standards of customer service, and fulfill legal and regulatory requirements. The sources and types of information collected generally vary depending on the products or services you request and may include:Information provided on enrollment and related forms - for example, name, age, address, Social Security number, e-mail address, annual income, health history, marital status, and spousal and beneficiary information. Responses from you and others such as information relating to your employment and insurance coverage. Information about your relationships with us, such as products and services purchased, transaction history, claims history, and premiums. 1. Information from hospitals, doctors, laboratories and other companies about your health condition, used to process

claims and prevent fraud.

II. Under Federal Law you have certain rights with respect to your protected health information.You have rights to see and copy the information, receive an accounting of certain disclosures of the information and, under certain circumstances, amend the information. You also have the right to file a complaint with your Employer or with the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.

III. We maintain safeguards to ensure information security. We are committed to preventing unauthorized access to personal information. We maintain physical, electronic, and procedural safeguards for protecting personal information. We restrict access to personal information to those employees, insurance companies, and service carriers who need to know that information to provide products or services to you.

IV. We limit how, and with whom, we share customer information.We do not sell lists of our customers, and under no circumstances do we share personal health information for marketing purposes. With the following exceptions, we will not disclose your personal information without your written authorization. We may share your personal information with insurance companies with whom you are applying for coverage, or to whom you are submitting a claim. We will share personal information of VISTA 401(k) participants with the plan’s recordkeeper. We also may disclose personal information as permitted or required by law or regulation. For example, we may disclose information to comply with an inquiry by a government agency or regulator, in response to a subpoena, or to prevent fraud. If you no longer have a customer relationship with us, we will still treat your information under our Privacy Policy, the words “you” and “customer” are used to mean any individual who obtains or has obtained an insurance, financial product or service from FBMC that is to be used primarily for personal or family purposes.

Notice of Administrator’s CapacityThis notice advises insured persons of the identity and relationship among the contract administrator, the policyholder and the insurer:1. Contract Administrator. FBMC Benefits Management (FBMC) has been authorized by your employer to provide

administrative services for your employer’s insurance plans offered within your benefit program. In some instances, FBMC may also be authorized by one or more of the insurance companies underwriting the benefits to provide certain services, including, but not limited to: marketing; billing and collection of premiums; and processing insurance claims payments. FBMC is not the policyholder or the insurer.

2. Policyholder. This is the entity to whom the insurance policy has been issued; the employer is the policy holder for group insurance products and the employee is the policyholder for individual products. The policyholder is identified on either the face page or schedule page of the policy or certificate.

3. Insurer. The insurance companies noted herein have been selected by your employer, and are liable for the funds to pay your insurance claims.

If FBMC is authorized to process claims for the insurance company, we will do so promptly. In the event there are delays in claims processing, you will have no greater rights to interest or other remedies against FBMC than would otherwise be afforded to you by law. FBMC is not an insurance company.

Compliance and Legal


FSRBC | DIReCToRYLE

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Medicare Carrier ContactsAvMedEnrollment & Premium ServicesP.O. Box 569004Miami, FL 33256-9942Enrollment Telephone number: 1-800-835-6137Post enrollment for Member Engagement Center:1-800-782-8633www.avmed.org

Cigna Leon

Leon Medical Center Health Plans - Leon Cares (HMO)Customer Service1-866-266-89177 days a week, 8 a.m. - 8 p.m.

www.cigna.com

Health First Medicare Plans

6450 U.S. Hwy. 1

Rockledge, FL 32955Customer Service 1-800-716-77377 days a week, 8 a.m. - 8 p.m.www.myhfhp.org

Florida Hospital Care Advantage

1425 W. Granada Blvd. Suite 4Ormond Beach, FL 32174

Customer Service 1-855-882-64677 days a week, 8 a.m. - 8 p.m.www.myfhca.org

Humana Medicare Enrollment

Enrollment Telephone number: 1-800-824-8242 (TTY 711)

Seven days a week, 8am-8pm ESTCustomer Telephone number (post-enrollment): 1-866-396-8810 (TTY 711)

Monday-Friday, 8am-9pm ESTP. O. Box 14330Lexington, KY 40512www.humana.com

UnitedHealthcare®

Customer Service (for all plans)1-877-776-14667 days a week, 8 a.m. - 8 p.m. ETEnrollment materials for UHC Medicare Supplement Plan should be returned to:UnitedHealthcare® Enrollment DivisionP. O. Box 105331Atlanta, GA 30348-5331Enrollment materials for UHC Part D Prescription Plan or Medicare Advantage Plan should be returned to:UnitedHealthcare® Enrollment DepartmentP.O. Box 29675Hot Springs, AR 71903 or Fax to: 501-262-7070

www.uhcretiree.com

MYFSRBC.ORG | 47

DIReCToRY | FSRBC

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Vision

Davis VisionClient Code# 4951Customer Service 1-877-923-2847Mon - Fri, 8 a.m. - 11 p.m. ET. Sat - 9 a.m. - 4 p.m. ET.Sun - 12 p.m. - 4 p.m. ET.www.davisvision.comDental

Humana DentalCustomer Service 1-800-233-4013Mon - Fri, 8 a.m. - 6 p.m.www.humanadental.com

Hearing Benefits AmeritasCustomer Service877-359-8346Mon.-Thurs. 7 a.m. - 12 a.m. CST.Fri. 7a.m. - 6 p.m. CST.

www.ameritas.comIdentity Theft Protection

ID CommanderMembership Services 1-855-592-7941Mon - Fri, 9 a.m. - 6 p.m. ET.

www.idcommander.comTechnology Support

ITPleaseMembership Services 1-888-384-7935Mon – Fri, 9 a.m. - 6 p.m. ET.

www.itplease.comPet InsuranceNationwideMembership Services1-877-738-7874Mon - Fri, 5 a.m. - 7 p.m. PT.Sat 7 a.m.- 3:30 p.m. PT.

www.petinsurance.com/fsrbcPet RxPETplus1-866-893-0306M-F: 9am - 6pm ET.Sat: 9am - 5pmSun: 9am - 3pm

www.petplus.com/hr

Non-Medical Benefits - Carriers Administrative ContactsFBMC Benefits Management, Inc.Retiree and Direct Bill Department

P.O. Box 10789Tallahassee, FL 32303Fax Number: 1-866-836-9943Email: [email protected]

(Contract Administrator) Service Center1-855-44FSRBC (1-855-443-7722)Mon - Fri, 7 a.m. - 7 p.m. ET.www.myfsrbc.orgFlorida Retirement System (FRS)Bureau of Retirement Calculations1-888-738-2252Enrollment Section1-877-377-3675www.myfrs.comMedicare1-800-MEDICARE (1-800-633-4227)www.medicare.govSocial Security 1-800-772-1213SocialSecurity.gov

Your School District and the FSRBC look forward to providing you access to high quality benefits, tailored especially for retired participating School District

employees, aged 65 or older.

Retiree Benefits

Plan year January 1, 2017 - December 31, 2017

Open for addition forms Reference Guide

To enroll in Voluntary Benefitsplease complete this form and return it to

FBMC Benefits Managementin the enclosed envelope.

To have your premium automatically deducted from your bank account each month, please complete this form and

return it to FBMC Benefits Management in the enclosed envelope.

To have your premium automatically deducted from your Florida Retirement System (FRS)account each month, please complete this

form and return it to FBMC BenefitsManagement in the enclosed envelope.

© 2016 FBMC Benefits Management, Inc.

P.O. Box 10789 • Tallahassee, Florida 32302-2789Service Center 1-855-44FSRBC (1-855-443-7722)www.myFSRBC.org

BENEFITS MANAGEMENT

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