RETIREE BENEFITS - scgov.net

This information is being provided to assist you in understanding your benefit options. Sarasota County Government’s (SCG) Employee Health and Benefits Program offers a variety of valuable resources designed to help you and your family maintain optimal physical, emotional and financial health. Using these resources is one of the keys to your well-being and success.

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RETIREEBENEFITS

All in one.One ID card for medical, pharmacy and dental.

2022 RETIREE BENEFITS

scgov.net (keyword benefits)

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Dear Sarasota County Government Retiree,

On behalf of our entire team, we hope you are safe and in good health. The past year or so has been challenging, and we are feeling very optimistic for the future of benefits.

We are again pleased to share that for the third consecutive year, there will be no premium contribution changes for the 2022 Plan Year and no plan changes. As we announced early this summer, the only change is that Aetna will be our provider for medical, dental, and pharmacy beginning in January. With this one change comes two conveniences. First, you will have one ID card for all three coverages. Second, one customer service line with customer service representatives that know us and our plans.

Open Enrollment for our 2022 benefits program will be held Oct. 1-31. For our retirees this is not a mandatory open enrollment which means you do not need to log into Workday or return the enclosed form unless you need to make a change.

We will be hosting two retiree meetings this year to make sure you get all your questions answered. Those meetings will be held:

• Thursday, Sept. 23, 10:00–11:30 a.m. Jacaranda Library, 4143 Woodmere Park Blvd., Venice

• Friday, Sept. 24, 1:00–2:30 p.m. Administration Building, Board Chambers, 1660 Ringling Blvd., Sarasota

Please note: CDC guidelines will be followed. Social distancing and masks are highly encouraged.

The informational online expos featuring all our vendors will be held again this year the week of October 4th. For your convenience, we will be emailing the calendar of events to you in mid-September. The email will provide directions on how to access the virtual meetings. If your email has changed or you would like to provide us with your email, please do so by sending updates to [email protected].

Similar to last year, we are recommending all retirees obtain your annual flu vaccine through either your primary care physician or your pharmacy. Clinical recommendations for people 65 years and older indicate the following:

Those who are 65 years and older should ask their pharmacy or personal physician for the high-dose, Fluzone vaccine. The high-dose Fluzone is covered on both the pharmacy and medical plans. High-dose Fluzone is a higher dose influenza vaccine specifically formulated for those who do not make a strong immune response with the regular dose vaccine.

We look forward to seeing you soon and as always, please contact us with any questions or service needs at [email protected] or by calling 941-861-5236.

Sincerely

Susan S. Forness Manager, Employee Health and Benefits

A LETTER FROM THE MANAGER OF EMPLOYEE HEALTH AND BENEFITS

https://www.scgov.net/government/human-resources/employee-health-and-benefits

mailto:AskBenefits%40scgov.net?subject=



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2022 RETIREE ENROLLMENT/CHANGE FORM

NAME

SOCIAL SECURITY NUMBER DATE OF BIRTH

STREET

CITY

STATE ZIP

PHONE

EMPLOYED FROM TO

OPTION 1I, the undersigned, elect to CANCEL all coverage.

OPTION 2I, the undersigned, desire to make at least one coverage change. I understand I must indicate each desired coverage and that my elections cannot be changed again (with the exception of a change in family status) until the next annual Open Enrollment. I elect the following coverage, payable on a monthly basis:

PLEASE NOTE: If you are currently not enrolled in one of the medical plans you cannot add medical coverage. In addition, if you are not currently enrolled in one of the dental plans, you cannot elect to add dental coverage.

MEDICAL PLANS

POS II RATES AHF RATES

RETIREE ONLY $709.02/Month $513.41/Month

RETIREE AND CHILD(REN) $1,579.35/Month $1,143.57/Month

RETIREE AND SPOUSE $1,772.57/Month $1,283.49/Month

FAMILY $2,056.17/Month $1,488.83/Month

DEPENDENTS 26-30 $709.02/Month $513.41/Month

2022 Retiree Enrollment/Change Form continues on next page.

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2022 RETIREE ENROLLMENT/CHANGE FORM continued

DENTAL PLANS VISION PLAN

PPO RATES DMO RATES VISION RATES

RETIREE ONLY $40.85/Month $16.03/Month $6.44/Month

RETIREE AND CHILD(REN) $83.73/Month $28.46/Month $12.41/Month

RETIREE AND SPOUSE $83.73/Month $28.36/Month $12.66/Month

FAMILY $98.03/Month $36.75/Month $21.92/Month

DEPENDENTS 26-30 Not eligible Not eligible Not eligible

If electing family coverage for any plan, please complete this section:

NAME RELATIONSHIP


NAME RELATIONSHIP


NAME RELATIONSHIP


SIGNATURE DATE

RETURN TO: Sarasota County Government1660 Ringling Blvd., 4th FloorSarasota, Florida 34236or fax to 941-861-5825

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MEDICAL PLAN INFORMATION

The chart below is a general overview of the SCG medical plan options. For complete details, refer to the appropriate plan documents located online at scgov.net (keyword benefits). Plan documents may supersede benefits found below.

Benefits and

Services

Aetna Choice POS II Aetna Health Fund (AHF)

In Network Out of Network* In Network Out of Network*

Health Fund

SCG Contribution: $500 Individual $1,000 Family

(Contributions are prorated if enrolled after Jan. 1)

Annual Deductible

$600 Individual

$1,200 All Family Tiers

$1,200 Individual


$1,750 Individual


$3,500 Individual


AnnualOut-of-Pocket

Maximum

$2,500 Individual


$5,000 Individual


$3,500 Individual


$7,000 Individual


• Health Fund dollars decrease your out-of-pocket expenses • Prescriptions count toward deductible/max out-of-pocket

*Members may also be responsible for any additional amounts that were not payable under the plan.

Preventive Care Covered at 100%

Routine preventive screenings

Plan pays 100% based on U.S. Preventive Services Task Force guidelines.(Preventive services do not reduce Health Fund.)

Adult physical

One per year; note that you no longer have to wait 12 months between physicals.

Colonoscopy or sigmoidoscopy Once every three years.

Dermatology exam Once every 12 months.

Flu vaccine Annually

Gynecological exam Once every 12 months.

Mammogram, screening

or diagnosticOnce every 12 months, 35 years or older.

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Benefits and

Services



Preventive Care Covered at 100% continued

Dexascan Bone density screening (recommended annually after age 65).

Pediatric physical Once every 12 months, more frequently for 3 years or younger.

Pneumonia vaccine Up to two doses as prescribed by your physician.

Shingles vaccine Once, 50 years or older.

Tetanus Tdap or TD

Physician Office Visits

Primary care physician $25 co-pay After deductible,

you pay 40%After deductible,


you pay 40%

Aexcel specialist $35 co-pay Not available After deductible,

you pay 10% Not available

Lab/diagnostic imaging $35 co-pay

After deductible, you pay 40%



Enhanced clinical review

(subject to pre-certification

requirements)


Emergency Care

Urgent care $75 co-payAfter deductible,



you pay 40%Emergency room $300 co-pay

Hospital Services

Inpatient hospital





Outpatient hospital

Inpatient maternity

MEDICAL INSURANCE INFORMATION continued

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Benefits and

Services



Prescription Drugs

Retail(30-day supply)

• $9 Generic

• 20% Formulary brand ($35 min/ $70 max co-pay)

• 40% Non-formulary brand ($50 min/ $100 max co-pay) Out-of-network

not available

• $9 Generic

• 20% Formulary brand ($35 min/ $70 max co-pay)

• 40% Non-formulary brand ($50 min/ $100 max co-pay) Out-of-network

not available

Mail order(31-90 day

supply)

• $22.50 Generic

• 20% Formulary brand ($87.50 min/ $175 max co-pay)

• 40% Non-formulary brand ($125 min/ $250 max co-pay)

• $22.50 Generic

• 20% Formulary brand ($87.50 min/ $175 max co-pay)

• 40% Non-formulary brand ($125 min/ $250 max co-pay)

Mental Health Services

Inpatient After deductible, you pay 20% After deductible,



you pay 40%Outpatient $35 co-pay

Alcohol/Drug Abuse Services

Inpatient After deductible, you pay 20% After deductible,



you pay 40%Outpatient $35 co-pay

Other Services

Convalescent facility





Home health care

(120 visits/year)

Hospice - inpatient

Hospice - outpatient

Speech, physical, occupational

therapy


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Benefits and

Services



Spinal manipulation/

chiropractic (20 visits/year)





Acupuncture (up to 20

visits/year)


Out-of-network not available


Out-of-network not available

Durable medical equipment

Deductible waived,

you pay 20%


Deductible waived,

you pay 20%


Allergy testing $40 co-pay After deductible,



you pay 40%

Allergy injections $5 co-pay After deductible,



you pay 40%

Ambulatory services





Hearing aid benefit

$1,500 benefit one time every five years. This benefit is unique to Sarasota County members.

Family Planning

Infertility treatment

Specialist co-pay

Member cost share based on type and

place of service


Member cost share based on type and

place of service

Comprehensive infertility services

Specialist co-pay

Not covered


Not covered

Coverage includes maximum lifetime benefit of $30,000.

Remember: If the doctor or medical facility you visit is not in Aetna’s network, you may be able to receive out of network benefits; however, it will cost you more.


Premium Comparison (per month)

POS II AHF

Retiree $709.02 $513.41

Retiree and child(ren) $1,579.35 $1,143.57

Retiree and spouse $1,772.57 $1,283.49

Family $2,056.17 $1,488.83

Dependents ages 26-30 (see Page 7) $709.02 $513.41

MEDICAL INSURANCE PREMIUMS

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Which plan is right for me?

If your medical expenses are low to average, consisting primarily of routine care and an occasional doctor’s visit, you’ll pay less in monthly premiums for the Aetna Health Fund.

If you have a chronic condition or upcoming surgery planned, the POS II offers a lower out-of-pocket maximum to keep your expenses down. Remember that your Aetna Health and Benefits Professional can help you decide which plan is best for you.

HOW TO REDUCE YOUR PREMIUMS FOR 2023Sarasota County offers a program that encourages healthy preventive steps you may take to help maintain your health, while reducing your medical insurance premiums by $30 a month (single coverage) or $60 a month (family coverage). See the details on to learn how you can save in 2023.

DEPENDENT COVERAGE Sarasota County offers benefits to you and your eligible family members. Extended family members, such as grandchildren, are not eligible for coverage unless you are their legal guardian or have adopted them. You may also cover your grandchildren if you are covering their eligible parent (your eligible dependent) and your grandchild is under 18 months of age.

Type of Dependent Requirements

Your spouse Must be your legal spouse. Ex-spouses are not eligible, even if court-ordered.

Your children:

• Biological

• Adopted

• Stepchildren

• Children you are required to support under the terms of a Qualified Medical Child Support Order

Up to age 26Ages 26-30 medical only; the eligible dependent must be the insured child by blood or law and must meet the following additional criteria:

1. Less than 30 years of age. 2. Unmarried. 3. Has no dependents. 4. Is a resident of Florida, or if not a resident of Florida, is

enrolled as a full-time or part-time student.5. Is not covered as a named subscriber, insured, enrollee,

or covered person under any other group, student, or franchise health plan or individual health benefits plan, or is entitled to benefits under Medicare.

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DEPENDENT COVERAGE continued

DEPENDENTS AGES 26-30Retirees who elect to cover dependents aged 26-30 will pay the full employer and retiree share of a single-tier premium for the coverage for each dependent. The cost will be $709.02 per pay period per month for the POS II plan and $513.41 per month for the AHF plan. This cost is in addition to the medical premiums for coverage for the remainder of the family. (Dependents aged 26-30 with a qualifying disability may continue to be covered under the retiree’s policy without paying the additional premium.)

AETNA TELADOC TO THE RESCUE!After hours and on weekends, travelling away from home, or any time you want to avoid sitting in a waiting room, Teladoc is a call or click away. Talk to a board-certified doctor by phone or video, 24/7. Teladoc doctors can treat many medical conditions, including:

• Cold and flu symptoms • Skin problems• Urinary tract infections • Allergies• Respiratory infection • Pink eye• Sinus problems

The cost for a Teladoc consult is $25 for POS II members and up to $40 maximum for Aetna Health Fund (AHF) members. Call 1-855-Teladoc (835-2362) or download the Teladoc app on your smartphone.

AETNA HEALTH AND BENEFITS PROFESSIONAL SERVICESYour Health and Benefits Professional can help manage your health-related tasks by:

• Helping you find a high-quality physician, hospital or other health service provider.

• Explaining your benefits and anticipated out-of-pocket costs.• Reviewing your bills to confirm you are paying the correct amount.• Tracking health insurance reward credits offered through the wellness

program to reduce your out-of-pocket expenses.

Contact your Aetna Health and Benefits Professional at 941-861-5273 (KARE) or by email: [email protected].

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REQUIREMENTS FOR THE 2023 MEDICAL INSURANCE PREMIUM REDUCTION PROGRAMThese requirements cover the compliance period from Oct. 1, 2021 – Sept. 30, 2022.

All members and spouses covered under the county’s medical plans must have completed each requirement that pertains to them before Sept. 30, 2022, in order to qualify for the 2023 medical insurance premium reduction program.

2023 PREMIUM REDUCTION AMOUNTS• Single coverage – $30 per month• Family coverage tiers – $60 per month

ALL MEMBERS AND SPOUSESComplete an annual preventive exam/physical and biometric lab screening (preventive lab/bloodwork panel). Compliance will be determined by the medical claims submitted by providers for the required services. NOTE: Please schedule your preventive physical exams early in the year. The county’s medical plans do not require members to wait 365 days between preventive physical exams.

Program requirements Applies toFrequency

(see additional details below)

How compliance is verified

Annual preventive exam/physical

All members and spouses Annually

Claim submitted by physician

to Aetna

Biometric lab screening (preventive lab/bloodwork

panel). Typical biometric lab screening tests include total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides

and fasting glucose.

All members and spouses Annually

Claim submitted by laboratory

to Aetna

Colonoscopy

All members and spouses (male and

female) age 50 and over (as of Oct. 1, 2021)

Every 10 years

Claim submitted by facility to Aetna

Mammogram

All female members and spouses between

the ages of 50-74 (as of Oct. 1, 2021)

Every two years

Claim submitted by facility to Aetna

Gynecological exam

All female members and spouses between

the ages of 21-65 (as of Oct. 1, 2021)

Every three years

Claim submitted by physician

to Aetna

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AETNA PRESCRIPTION COVERAGEEffective 1-1-22, prescription coverage is provided through Aetna. If you are enrolled in a county medical plan, your pharmacy coverage is included in the medical premium.

Prescription Coverage for POS II and AHF

Get your prescription filled at Your responsibility

Network Pharmacy (30-day supply)

• Generic $9

• Brand formulary: 20% co-insurance ($35 minimum and $70 maximum)

• Brand non-formulary: 40% co-insurance ($50 Minimum and $100 Maximum)

Maintenance medications can be filled through CVS Mail Order or any of the

pharmacies listed below.

• Generic $22.50

• Brand formulary: 20% co-insurance ($87.50 minimum and $175 maximum)

• Brand non-formulary: 40% co-insurance ($125 minimum and $250 maximum)

Members who use maintenance medications may use any of the following major pharmacies (CVS, Publix, Walmart, Target, Rite Aid, Walgreens) or CVS Mail Order to fill prescriptions for 90 days. A maintenance medication is one that is taken daily, and most likely, permanently.

Some local pharmacies offer free antibiotics, diabetes and blood pressure medications. Select other pharmacies have low-cost $4 generics.

DENTAL INSURANCEIf you are not currently enrolled in one of Sarasota County’s retiree dental plans, you may not enroll now. Retirees may change plans or cancel coverage, but if you cancel coverage, you will not be eligible to re-enroll in the future.

Which plan is right for me? If your current provider is not in either plan and you do not want to switch dentists, the traditional PPO plan will still pay for out-of-network care (at a reduced benefit level).

If you anticipate you’ll need a large volume of dental work that will exceed the PPO’s $1,750 annual benefit, the DMO plan has no annual maximum benefit amount but may require you to change dental providers.

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DENTAL INSURANCE PREMIUMS

Aetna Dental Premiums (per month)

PPO DMO

Retiree $40.85 $16.03

Retiree and child(ren) $83.73 $28.46

Retiree and spouse $83.73 $28.36

Family $98.03 $36.75

Deductibles, Maximums and Co-pays

PPO DMO

Preventive care 100% covered (if you have not met the $1,750 annual maximum benefit) 100% covered

Deductible $50 $0

Basic 90% or 80% after deductible Co-pay system based on procedure

Major 60% or 50% after deductible Co-pay system based on procedure

Comprehensive orthodontia $1,750 lifetime benefit $2,250 - $2,350

Annual maximum $1,750 No limit

VISION INSURANCE – SUPERIOR VISION

Superior Vision Premiums (per month)

Employee Only $6.44

Employee + Children $12.41

Employee + Spouse $12.66

Employee + Family $21.92

LIFE INSURANCESarasota County will continue to offer a $5,000 retiree life insurance policy through Sun Life for $8.75 per month. You may only elect this policy when you retire. If you are currently retired and did not elect the option at your retirement, you will be unable to elect it now or in the future.

Note: Remember to contact Sarasota County if there is a change in the designated beneficiary for your life insurance. Email [email protected] or call 941-861-5236.

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DEALING WITH LIFE EVENTS Be aware! When a change to your personal or work life impacts your benefits, you have only 31 days to make changes to your benefits, or you must wait until the next open enrollment period. Some coverage begins on the date of the event (e.g., birth or adoption) while other changes take effect on the first of the following month. Log on to Workday to make changes and upload any necessary documentation (i.e. birth certificate).

When one of the following “life events” takes place, you may be able to make mid-year changes to some or all your benefit elections.

MarriageSarasota County offers benefits coverage for spouses (same or opposite sex). The following life events allow you to make a change to your coverage or to switch to your spouse’s benefit plan:

• Marriage or divorce.• Death of your spouse.• Gain or loss of coverage, or change in benefits, for your spouse.

If you add a spouse to your coverage, you will need to submit proof of eligibility. See Page 7 (dependent coverage) for required documentation.

Divorce or death of a spouseDivorce or the death of a spouse affects your benefits coverage. You may drop or add coverage for dependents as well as make changes to your life insurance. NOTE: In the event of divorce, you cannot remove your spouse from your benefit plans until your divorce is final.• Log on to Workday within 31 days of the event to add, change or drop health

care and/or life coverage.• If applicable, change your name and/or address.• Verify or change your beneficiary information for your life insurance.

Birth, adoption and legal custodyIf a child becomes ineligible for coverage, you may change certain benefits without waiting until the next open enrollment period. When you add a dependent to your coverage, you will be required to submit documentation of eligibility. See Page 7 (dependent coverage) for required documentation.

Family life events include:• Birth, adoption, placement for adoption or legal custody of a child.• Change in your childcare costs or provider.• Dependent no longer qualifies for coverage.• Dependent becomes qualified for coverage.• A child becomes eligible at birth, adoption or when you gain custody.

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When you add a new child to your homeLog on to Workday within 31days of the event to add your child to your health plan. Newborns of mothers covered under the plan are automatically covered for 31 days after birth. To continue coverage after 31 days, the newborn information will need to be added to Workday along with a copy of the birth certificate.

PROVIDERS AND RESOURCES CONTACT INFORMATION

Vendor Phone Number Website

Aetna Member Services (Medical, Dental, Pharmacy) 1-877-432-7733 aetna.com

Payflex-Retiree Billing 1-888 678-7835 payflex.com

Sun Life Term Life 1-800-247-6875

Superior Vision 1-800-507-3800 superiorvision.com

Sarasota County Contact

Phone Number Fax Number Email

Employee Health and Benefits 941-861-5236 941-861-5825 [email protected]

Aetna Health and Benefits Professional 941-861-5273 [email protected]

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http://superiorvision.com

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