Duval County Public Schools' Benefits
frequently asked questions
2009-2010 General Open Enrollment FAQs
Q. Who should participate
in Open Enrollment?
A. This is a Changes Only Enrollment. You may
meet with an Enrollment Counselor to review and discuss
your benefit options or you may visit the self-enroll
website by logging onto
www.myFBMC.com .
Q. What will happen to my
current benefits if I do not meet with an Enrollment
Counselor or log onto
www.myFBMC.com during Open Enrollment?
A. Your benefits and tier levels will remain the
same with the exception of medical coverage. Your
medical coverage will default to the plan you’re
eligible for.
Q. Why should I see an Enrollment
Counselor?
A.
·
Enrollment Counselor can help you
decide which benefit selections could best meet your
needs.
-
Enrollment Counselors can answer
questions that are specific to you and
your benefit needs.
-
Employees, who enroll “Online” and wish
to select a new voluntary benefit or
make a change to their current voluntary
benefit, will be required to schedule an
appointment with an Enrollment Counselor
for the voluntary benefits portion due
to the application requirement. These
Voluntary Benefits include Long Term
Care, Hospital Indemnity, AHL Group
Critical Illness, UNUM Whole Life,
Trustmark Universal Life and Premier
Select Critical Illness (current
Trustmark participants only).
Q. What do I need to bring
to my enrollment appointment?
A. Employees should bring the following to an
enrollment appointment:
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Birthdates
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Social Security Numbers
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Addresses for dependents and
beneficiaries
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Insurance information if any dependent
is covered under another plan.
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For employees wishing to add a dependent
to the plan, appropriate documentation
showing proof of dependency (birth
certificate, adoption decree, marriage
certificate, etc.) will be required.
Q. Can I make a change to
my benefits once I have completed my enrollment?
A. Yes, an employee has 14 days (Supersede
Period) to make changes after their enrollment.
Q. What if I have a family
status change that requires me to add a family member or
drop a family member from my benefit coverage after Open
Enrollment ends, can I make a change?
A. Yes, a change can be made if it meets the
qualifying events listed on page 14 and 15 of your
Reference Guide. All qualifying family status changes
outside of the Open Enrollment period must be completed
within 30 days of the qualifying event.
Q. When does my benefit
coverage end?
A. Group health plans and flexible benefits will
continue until the last day of the month in which
termination occurs, unless the terms of your contract
have been completed. If the terms of the contract have
been completed, benefits will continue until the end of
the plan year (September 30, 2010), provided that all
necessary contributions have been made.
Q. Are there any changes
being made to the medical benefit plans this year?
A. No. The medical plan you’re eligible for will
continue to be based on the Non-Bargaining or Collective
Bargaining Unit you’re represented by:
DCPS Blue A
– Administrators, Exempt, and Employees represented by
School Maintenance Employee Association (School
Maintenance Employee Association represents all
maintenance employees even if you aren’t a dues paying
member of that Collective Bargaining Union.)
-
In-Network Office Visit Co-pay - $10
-
In-Network Deductible: Individual - $300
/ Family - $600
-
In-Network Out-of-Pocket Max: Individual
- $2,500 / Family - $5,000
-
Out-of-Network Out-of-Pocket Max:
Individual – Individual - $3,250 /
Family - $6,500
-
Emergency Room Co-pay: $250
-
Rx Coverage: Generics - $7 / Preferred
Brand - $30 / Non-Preferred - $55 /
Specialty - $55 Mail Order: Generics -
$14 / Preferred Brand - $60 /
Non-Preferred - $110
-
Routine Eye Exams, Infertility
Treatments, and Massage Therapy are not
covered under the medical plan
DCPS Blue C
– Employees represented by DTU (Teachers,
Paraprofessionals, UOPD), AFSME, LIUNA, and JSA (even if
you aren’t a dues paying member of that Collective
Bargaining Union.)
-
In-Network Office Visit Co-pay - $15
-
In-Network Deductible - Individual -
$0.00 / Family - $0.00
-
In-Network Out-of-Pocket Max –
Individual - $2,500 /Family - $5,000
-
Out-of-Network Out-of-Pocket Max:
Individual – Individual - $3,250 /
Family - $6,500
-
Emergency Room Co-pay: $250
-
Rx Coverage: Generics - $7 / Preferred
Brand - $25 / Non-Preferred - $40 /
Specialty - $55 Mail Order: Generics -
$14 / Preferred Brand - $50 /
Non-Preferred - $80
-
Routine Eye Exams, Infertility
Treatments, and Massage Therapy are not
covered under the medical plan
Q. Are there any changes
to the Medical Expense Flexible Spending Account (MFSA)?
A. No. The employer contribution amount you
receive is based on the Non-Bargaining or Collective
Bargaining Unit you’re represented by. The funds
contributed into your MFSA are designed to be utilized
towards the annual deductible and any other medically
necessary, out-of-pocket expenses not covered by your
insurance plans.
DCPS Blue A
– The employer contributions to your Medical Expense
Flexible Spending Account will total $500 (employee-only
coverage) and an additional $300 (dependent/family unit
coverage)
DCPS Blue C
– The employer contributions to your Medical Expense
Flexible Spending Account will total $450 (employee-only
coverage) and an additional $300 (dependent/family unit
coverage)
Q. Will I receive new
medical ID cards?
A. Yes, you will receive a new BCBSFL Medical ID
Card.
Q. What if I need to see a
medical provider before I receive my new medical
insurance ID card?
A. If you need to see a medical physician before
you receive your new ID cards and after the start of the
new plan year (10/1/09), you may use your current ID
card or you may contact BCBS Customer Service for
assistance.
Q. What is the main number
for BCBS Customer Service?
A. The dedicated Customer Service telephone
number for DCPS employees is 1-800-664-5295.
Q. What are the BCBS
Customer Service hours?
A. 8:30 am – 6 pm Mon – Thurs, 9 am – 6 pm Friday
Q. Will I need to select a
Primary Care Physician (PCP) if I have Blue Cross Blue
Shield of Florida?
A. No. You will not be assigned a PCP from the
BCBS Provider network.
Q. Will I need a referral
to see specialists?
A. No. DCPS Blue A and DCPS Blue C are both Open
Access Plans. Referrals are not required.
Q. Is there a change in
the network of providers I am allowed to see at the
In-Network benefit level?
A. No. BlueOptions NetworkBlue Providers
are In-Network. Traditional Network Providers are
Out-of-Network.
Q. Is Mayo Clinic
In-Network or Out-of-Network?
A. Mayo Clinic and Mayo Hospital are
Out-of-Network. If you continue to see physicians at the
Mayo Clinic and/or Mayo Hospital, your claims will be
processed at the Out-of-Network benefit level.
Q. What is the best method
for me to validate a provider’s network status?
A. The best method to validate a provider’s
network status is to go online: www.bcbsfl.com and click
on Find a doctor or hospital.
Q. What is the difference
between the calendar year and plan year?
A. The calendar year is January 1- December 31.
The plan year is October 1 – September 30.
Q. What is a deductible?
A. A deductible is a set amount of money that a
member must pay for covered medical services each
calendar year before covered services are paid by the
plan.
Q. What expenses are
subject to the deductible?
A. All medical expenses, other than co-payments,
including hospital charges (both inpatient and
outpatient), surgery charges (both inpatient and
outpatient), skilled nursing care, hospice care, X-ray
and lab fees that are done at the facility.
Q. If I met my deductible
earlier this calendar year, will I have to meet it again
once the new plan year starts on October 1, 2009?
A. No. If you met the calendar year deductible
prior to October 1, 2009, you will not have to meet a
new deductible during this calendar year.
Q. What medical expenses
are applied to the out-of-pocket maximum?
A. Deductibles, co-insurance and medical
co-payments are applied to the out-of-pocket maximum.
Prescription drug co-payments are not applied toward the
out-of-pocket maximum.
Q. If I met the
Out-of-Pocket Maximum earlier this calendar year, will I
have to meet it again once the new plan year starts on
October 1, 2009?
A. No. If you met the Out-of-Pocket Maximum prior
to October 1, 2009, you will not have to meet a new
Out-of-Pocket Maximum this calendar year.
Q. Is there a carryover of
the deductible and/or out-of-pocket maximum?
A. No. Any deductible met in October through
December 2009 will not carry over to the 2010 calendar
year. Out-of-Pocket Maximums met in October through
December 2009 will not carry over to the 2010.
Q. Is the Deductible and
Out-of-Pocket Maximum based on a calendar year or plan
year?
A. The Deductible and Out-of-Pocket Maximum are
both based on a calendar year.
Q. What is the Usual,
Customary, and Reasonable (UCR) charge and how does it
affect me?
A. The UCR is established by Blue Cross Blue
Shield of Florida using the average medical fees charged
within a given zip code area. If you are using
in-network services, all eligible charges will be
covered. However, if you elect to access medical
services out of the network, all charges that exceed the
UCR rates are your responsibility and you will be
balance billed by the medical provider. This will
significantly increase your out-of-pocket costs.
Q. Where can I go to
receive a colonoscopy at the lowest out of pocket
expense?
A. If you go to a participating ambulatory
surgical center to receive a colonoscopy, you will pay a
total of $70 ($35 co-pay for the facility + $35 co-pay
for the physician services).
|
Participating
Ambulatory Surgical
Centers:
|
|
Jacksonville Beach
Surgery Ctr.
3316 3rd St.
S. Jacksonville Beach,
FL
(904) 247-8181
|
Jacksonville Ctr.
for Endoscopy
4800 Belfort Rd.
Jacksonville, FL
(904) 265-4801 / (904)
387-6750
|
Jacksonville
Surgery Ctr.
7021 AC Skinner Pkwy
Jacksonville, FL
(904) 281-0021
|
|
Medical Partners
Surgery Ctr.
4545 Emerson St.
S. Jacksonville, FL
(904) 399-2600
|
Parkside Surgery
Ctr.
2731 Park St.
Jacksonville, FL
(904) 389-1077
|
Plaza Surgery
Center, LTD
6138 Kennerly Rd. Ste.
101
Jacksonville, FL
(904) 208-4120
|
Q. Is there a new pharmacy
benefit provider?
A. Yes. Medco Health Solutions is the
Pharmacy Benefit Manager for DCPS as of July 1, 2009.
Q. What is the contact
information for Medco Health Solutions?
A. The toll-free number to reach Medco is
1-866-544-6950. Website:
www.medco.com
Q. Are there changes to
the pharmacy benefits?
A. Yes. Effective October 1, 2009, DCPS
will participate in Medco’s Medication Step-Therapy
Program.
Q. What is Medication
Step-Therapy?
A. Medication Step Therapy (Step Therapy) is a
program especially for people who take prescription
drugs regularly — that is, for an ongoing condition like
arthritis, asthma, stomach problems or high blood
pressure. It provides the safe, effective and most
appropriate treatment you need while keeping your costs
as low as possible. The program moves you along a
well-planned path, with your doctor approving your
medications.
Q. To whom does
Step-Therapy apply?
A. Step Therapy only affects NEW
prescriptions or prescriptions that you have not filled
in the previous 60 days. Using samples from the doctor
does not count as taking a medication consistently.
Q. How can I find out if my medication is
included in the Step-Therapy Program?
A. You can find out which medications are
included in the Step-Therapy Program by contacting Medco
Customer Service at 1-866-544-6950. |
