Open Enrollment Dates: Monday, October 23 - Thursday, November 9, 2017

Dental Options

  • Health Waiver Dental Vision Plan
  • OPTIONAL | Dental Low Plan
  • OPTIONAL | Dental High Plan

Disability Options

  • OPTIONAL | Short and Long Term Disability Package

Health Options

  • Blue Options PPO Plan 3562
  • Blue Care HMO Plan 10
  • Health Waiver Dental Plan
  • COBRA
  • Retirees Group Health Insurance
  • Employee Assistance Program
  • Wellness
  • OPTIONAL | Flexible Spending Account (FSA)
    • Health Care FSA
    • Dependent Care FSA
  • SUPPLEMENTAL | Cancer Care
  • SUPPLEMENTAL | Accident Indemnity Advantage
  • SUPPLEMENTAL | Critical Care and Recovery
  • SUPPLEMENTAL | Hospital Advantage

Life Options

  • Basic / AD&D
  • SUPPLEMENTAL |  AD&D Life
  • Dependent Life
  • Retirees Group Life

Retirement Options

  • Pension
  • Investment
  • SCORP
  • DROP
  • SUPPLEMENTAL | Retirement
  • Retiree Group Health
  • Retiree Group Life

Vision Options

  • Health Waiver Dental Vision Plan
  • OPTIONAL | Ameritas | EyeMed ViewPointe® Plan
  • OPTIONAL | Ameritas | VSP Focus Plan

Privacy Statement

Florida College System Risk Management Consortium, FCSRMC, acting as the covered entity and Pensacola State College, acting as the plan sponsor, have undertaken fiduciary duties to the plan. A covered health plan includes a group health plan, which is defined as an employee welfare benefit plan under ERISA. This may include hospital and medical benefit plans, vision plans, health flexible spending accounts and employee assistance plans.

It is the policy of FCSRMC and PSC that appropriate physical safeguards will be in place to reasonably safeguard protected health information from any intentional or unintentional use or disclosure that is in violation of the HIPAA Privacy Rule. These safeguards will include physical protection of premises and personal health information, technical protection of PHI maintained electronically and administrative protection. These safeguards will extend to the oral communication of personal health information.

Health Insurance

Pensacola State College offers an HMO and a PPO plan to choose from. When comparing plans be sure to review the schedule of benefits carefully. Once you have selected a plan, be sure to inform yourself with the plan selected. The Health Plan Schedule of Benefits contains valuable information you will need to know before receiving health care services.

Your cost-share amounts will vary depending upon the provider you choose, the type of services you receive, and the setting in which the services are rendered. Make sure to verify a provider’s in-network participation status prior to receiving health care services.

To verify a provider’s specialty or participation status, you may contact the local FloridaBlue office or access the most recent provider directory by logging in to FloridaBlue.com.

Blue Options PPO Plan 3562

Annual Deductible Annual Max Out-of-Pocket Co-Pay Office Visit/ Urgent Care Emergency Room Services
Individual: $500
Family: $1,500
In-Network: $5,000 per person
Family $10,000
Primary care visit $25
Specialist visit $40
Urgent Care $35
Emergency Room $100 Copayment +
20% Coinsurance

PPO Plan 3562 Rx Plan

Pay a flat co-pay for each class of medication. Generic prescriptions through the mail order program is the least expensive option. The mail order program allows the member to get a 3-month maintenance supply for the price of 2 months.

Benefit Description Retail 30-Day Supply Mail-Order 90-Day Supply
Preferred Generic $15 $30
Preferred Brand Name $45 $90
Non-Preferred Prescription $65 $130

Blue Care HMO Plan 10

Annual Deductible Annual Max Out-of-Pocket Co-Pay Office Visit/ Urgent Care Emergency Room Services
$0 In-Network: $5,000 per person
Family $10,000
Primary care visit $25
Specialist visit $40
Urgent Care $35
Emergency Room $50 Copayment

 

 

HMO Plan 10 Rx Plan

Pay a flat co-pay for each class of medication. Generic prescriptions through the mail order program is the least expensive option. The mail order program allows the member to get a 3-month maintenance supply for the price of 2 months..

Benefit Description Retail 30-Day Supply Mail-Order 90-Day Supply
Preferred Generic $15 $30
Preferred Brand Name $45 $90
Non-Preferred Prescription $65 $130

Blue Options PPO Plan 3900 – Adjuncts

Pensacola State College offers eligible adjunct employees healthcare coverage based on the Affordable Care Act passed by the federal government beginning January 1, 2015.

Eligible adjunct employees must average 30 hours per week during the “look back” period used to determine eligibility. The “look back” period, refers to the prior year the coverage was offered. Employees who are eligible for healthcare coverage through the college will receive a notification to enroll in the coverage, the coverage offer is for 12-months.

Download the Blue Options PPO Plan 3900 Benefit Booklet.

If you have any questions, please contact your Benefits Administrator, Erandi Sanchez-Perez, ext. 1772, or via email esanchez-perez@pensacolastate.edu Building 7, Room 715G

Additional Health Options

COBRA

A participating member of the college’s health plan can continue the group health plan benefits, through the Consolidated Omnibus Budget Reconciliation Act (COBRA), for a limited period of time under certain life qualifying events in which the coverage under the plan would otherwise end. A participating member with a COBRA qualifying event will receive a COBRA notice in the mail following the event.

Employee Assistance Program

Pensacola State College Employee Assistance Program, provided through Baptist Health Care, benefits employees, spouses, and dependent children. Three free counseling sessions are available for those who may need professional assistance in handling various types of personal and/or family issues. Appointments are kept confidential and names of those who seek counseling are not provided to PSC.

Counseling appointments may be made by calling Baptist Health Care at 850.469.2383, or 1.800.528.8955.

Health Waiver, Dental Vision Plan

The Health Waiver, Dental Vision Plan is only available to those who waive health insurance coverage.

Retirees Group Health Insurance

Retiree group health insurance options are available at the time of retirement. Coverage cannot be reinstated if declined.

Blue Medicare Plan

To be eligible to enroll in this plan, you and you’re eligible dependent must be entitled to Medicare Part A (Hospital Services), enrolled in Medicare Part B ( Physician care and Medical services) and identified as an eligible group plan participant.

Some of the few advantages with this plan are:

  • Predictable co-payments/coinsurance;
  • Prescription drug coverage with protection through the “coverage gap” for generic drugs and more, based on the plan’s benefits;
  • Increased savings when you use mail-order pharmacy; Mail-order available for 90-day supply for an amount equal to two monthly co-payments;
  • Large provider and pharmacy networks, no referrals needed for specialists and the freedom to choose in-network or out-network providers; and
  • User-friendly tools, information and services to help you make the best decisions with your healthcare dollars.

To enroll in this benefit complete the enrollment form and return it to you group benefit administrator, Erandi Sanchez-Perez, by the enrollment deadline or within 30 days from your Medicare-eligible start date.

If you have pre-enrollment questions, please contact Member Services at 1-800-926-6565 and enter extension 89724.

Wellness

Redeem up to $175.00 in rewards by working towards wellness goal with the FloridaBlue Wellness Program.

The FloridaBlue Wellness Program was developed to help employees work toward their wellness goal. Employees can redeem up to 700 points for a total of $175.00 to shop for rewards (merchandise or gift cards); just 100 points could earn you a $25 reward.

In addition to individual employee incentives, Pensacola State College could qualify for a monetary award based on participation in the annual health screening event starting at $5,000 (monetary award will be used to fund other wellness initiatives and provide additional incentives to wellness program participants).

PROGRAM DATES
The Wellness Program runs from January 1 – December 31.

ELIGIBILITY
Full-time employees and their dependents may participate in the free onsite annual health screening (dates to be determined). Only full time employees with a Florida Blue health plan qualify to participate in the incentive program.

WELLNESS GOALS

  • Personal Health Assessment
    Earn 40 points completing the online PHA and learn why it is important to make health choices. The PHA wellness score represents your health overall status in the short-term future. A higher number predicts a better overall health status.
  • My Health Assistant
    Earn 25 points for each goal set online through floridablue.com and 45 points for each goal achieved. The different health goals are Nutrition, Weight Loss, Exercise, Stress Management, Maintaining a Positive Mood, and Quitting Tobacco Products.
  • Health Trackers
    Earn 10 points and track your blood pressure, cholesterol, stress level, and weight by utilizing the health trackers online through floridablue.com.
  • Member Resources
    Earn up to 20 points using the medical cost-estimators which helps determine cost of procedures prior to medical visits. (To access the Cost Estimators – Log on to floridablue.com, click Tools and Compare Medical Cost).
  • Health Screening
    Earn up to 320 points by participating in the annual health screening event (dates to be determined).Employee and covered spouse and/or dependents, age 18 or over, are invited to participate. There is no cost to attend. The screenings give a great opportunity to detect early diseases or conditions in people that may already look or fell well. All full-time employees are encourage to participate whether covered or not by the college’s Florida Blue health insurance plan.
  • Wellness Workshops
    No current workshops.
  • Gym Reimbursement
    Qualify to earn up to $150 reimbursement for an annual gym membership when earning at least 100 points for visiting a participating gym facility. Please refer to the Blue Rewards Checklist and the List of Participating Gyms.

QUESTIONS
For questions regarding the program or how to access or redeem your points, please contact Erandi Sanchez at ext. 1772, or email esanchez-perez@pensacolastate.edu. You may also contact Blue Rewards toll free at 1-888-476-2227, or email BlueRewardsInquiry@bcbsfl.com.

 

Wellness Incentive Program (.pdf)
Blue Rewards Checklist (.pdf)
My Health Assistant FAQs (.pdf)
Next Steps Program Flyer (.pdf)
Mobile App Flyer (.pdf)
BlueRewards and WebMD Video (video)

OPTIONAL | Flexible Spending Account (FSA)

The Flexible Spending Account (FSA) allows you to set aside a certain amount of money on a pretax basis, increasing your spending power and tax savings.

When calculating your annual reimbursement amount, take into consideration the services to be provided during the upcoming plan year for you and your dependents.

FSA is an annual benefit and does not rollover year to year. Employees are required to sign up and designate their amount every year during open enrollment.

To access your account go to www.myflexonline.com or contact Custom Benefits at (352) 369-9453.

Health Care FSA

This account reimburses you up to $2,550 for healthcare expenses not covered by insurance. Reimbursement includes individual and dependent expenses for medical, prescription, dental, and vision out of pocket costs.

Certain expenses such as vitamins, supplements, weight-loss programs, massage therapy, and over-the-counter items do require a doctor’s prescription or letter of medical necessity to be cover.

For a list of all eligible expenses, please review the IRS Publication 502.

Flexible Spending Account Brochure

Enroll For Flexible Spending Account

Dependent Care FSA

This account reimburses you up to $2,500 or $5,000 if married and filing jointly for eligible children and adults daycare expenses. Reimbursement includes daycare centers, preschool and before/after school care.

Eligible dependents must be:

  • A child under the age of 13, or
  • A child, spouse or other dependent that is physically or mentally incapable of self-care and spends at least eight hours a day in your household.

SUPPLEMENTAL | Cancer Care

SUPPLEMENTAL | Accident Indemnity Advantage

SUPPLEMENTAL | GIM (Hospital Indemnity) plan design and Claim form

SUPPLEMENTAL | Critical Care and Recovery

SUPPLEMENTAL | Hospital Advantage

 

Dental Options

Pensacola State College offers the choice of two dental plans which includes coverage for preventive, basic, and major dental work. Both plans offer Out-of-Network coverage and both plans participate in the dental rewards programs, which allows the member to carry over part of the unused annual maximum benefit to next calendar year.

Health Waiver, Dental Vision Plan

The Health Waiver, Dental Vision Plan is only available to those who waive health insurance coverage. The Dental/Vision Plan option was designed as an alternative plan for employees with other adequate health insurance and is an employer-paid benefit for employees only.

OPTIONAL | Dental Low Plan

$50 Individual per Calendar Year for Basic and Major Care

$150 Family per Calendar Year for Basic and Major Care

 

Benefit                        In-Network                Out-Network                            

Preventative              100%                          100%

Basic                          80%                             50%

Major                          50%                             25%

Annual Maximum     $1,250                         $1,000

Allowance                 Discounted Fee           Discounted Fee

 

Dependent Eligibility Requirements include:

  • Legal Spouse
  • Each child through the end of the calendar year in which they turn age 30, for whom the insured or the insured’s spouse, is legally responsible.
  • The child must be dependent upon the employee for support and either living in the household or is a full or part-time student.
  • Each child age 30 or older who is totally disabled or becomes totally disabled while insured as a dependent.

Ameritas 1-800-487-5553
Ameritas.com

 

Dental Low Plan Highlight (.pdf)

 

OPTIONAL | Dental High Plan

HIGH Plan                      

Deductible      $50 Individual per Calendar Year for Basic and Major Care

$150 Family per Calendar Year for Basic and Major Care

 

Benefit                        In-Network                Out-Network                            

Preventative             100%                        100%

Basic                         80%                          80%

Major                         50%                          50%

Annual Maximum     $1,500                      $1,500

Allowance                 Discounted Fee       90th Usual & Customary

 

Dependent Eligibility Requirements include:

  • Legal Spouse
  • Each child through the end of the calendar year in which they turn age 30, for whom the insured or the insured’s spouse, is legally responsible.
  • The child must be dependent upon the employee for support and either living in the household or is a full or part-time student.
  • Each child age 30 or older who is totally disabled or becomes totally disabled while insured as a dependent.

Ameritas 1-800-487-5553
Ameritas.com

Dental High Plan Highlight (.pdf)

 

Vision Options

Health Waiver, Dental Vision Plan

The Health Waiver, Dental Vision Plan is only available to those who waive health insurance coverage. The Dental/Vision Plan option was designed as an alternative plan for employees with other adequate health insurance and is an employer-paid benefit for employees only.

OPTIONAL | Ameritas | VSP Focus® Plan

Ameritas Vision Plan Options: Vision Care Benefit Brochure

VSP Doctor Directory 
VSP Provider Choices

VSP Choice Network. 25 provider locations within 25 miles of zip code 32504. For added convenience, 8 of them offer evening and weekend appointments.

Online in-network options. Eyeconic.com is VSP’s innetwork online eyewear store – which means you won’t have to pay the full price now, then wait to be reimbursed later. Your vision benefits will be applied directly to your online order.

Additional frame allowance. When you select a frame from one of the 34 featured frame brands, you’ll get an extra $20 to spend, on top of your plan frame allowance.

Non-prescription sunglasses. Ask your VSP doctor about possibly using your VSP frame benefit for non-prescription sunglasses.

Exclusive member extras. Members can take advantage of more than $2,500 in special offers leading from industry brands such as Nike and Sharper Image at VSP.com.

Laser vision surgery. Your maximum out-of-pocket per eye is $1,800 for LASIK, $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure.

Additional VSP savings:

  • 20% off remaining frame balance
  • 20-25% off non-covered lens options such as UV coating & polycarbonate promotion price
  • 20% off non-covered complete prescription glasses
  • 15% off LASIK and PRK laser surgery retail price or 5% off promotion price

OPTIONAL | Ameritas | EyeMed ViewPointe® Plan

EyeMed ViewPointe, emphasizes in quality care and convenient service that fits in with employees busy lifestyles. EyeMed network includes the choice between independent and retail providers. Advantages of retail chains are same-day service, evening and weekend hours and walk-in appointments.

EyeMed Network 
EyeMed Network Directory

Life Options

Basic / AD&D

College-provided Group Term Life Insurance (no cost to employee): $50,000.00 

Employee Life and Accidental Death & Dismemberment (AD&D) Insurance

Employee earning $15,000-$49,999 annually – $50,000
Employee earning $50,000-$74,999 annually – 75,000*
Employee earning $75, 000+ annually – $100,000*

* in accordance with the law, Pensacola State College can only pay premiums on life insurance up to $50,000. Employees may contribute the required amount to have the level of coverage above $50,000

  • Accelerated living benefits
  • Waiver of premium is available to qualified employees who have been totally disabled for six months while insured
  • 24-hour coverage
  • Paid for injury which results in accidental death, dismemberment, or loss of sight

Coverage Information (.pdf)
“What would you do?” Flyer
(.pdf)
UNUM Life Planning (.pdf)
UNUM Travel Assistance (.pdf)
UNUM Work Life Balance Flyer (.pdf)

Dependent Life

Dependent Life Insurance Coverage is available for all eligible dependents for $3.16 per month.

Spouse:  $20,000
Child:     $10,000 / $500 (under 6 months)

  • Your lawful spouse, including a legally separated spouse. You may not cover your spouse as a dependent if your spouse is enrolled for coverage as an employee.
  • Your unmarried children from 14 days but less than age 19.
  • Your unmarried children age 19 or over but under age 25 if they are full-time students at an accredited school.

Coverage Information (.pdf)

Retirees Group Life

Retirees have the option to participate in one of the four retiree basic group life insurance options. Retiree group basic life insurance options are available at the time of retirement. Coverage cannot be reinstated if declined.

Life Coverage Options

  • $5,000 for $11.80 per month
  • $10,000 for $23.60 per month
  • $25,000 for $59.00 per month
  • $50,000 for $118.00 per month

Benefit Reduction: Coverage amounts reduce 35% at are 65 and 50% at age 70, additional 25% reduction at age 75+. There is no reduction for the $5,000 policy.

Life Insurance Enrollment Form

Life Insurance Beneficiary Form

SUPPLEMENTAL | AD&D Life

Supplemental Life and Accidental Death & Dismemberment (cost is .277 per thousand of coverage per month)

  • Up to 3 times employee’s salary with a minimum of $1,000 and a maximum of $500,000 (as elected by the employee)
  • Accelerated living benefits
  • Waiver of premiums is available to qualified employees who have been totally disabled for six months while insured
  • 24-hour coverage
  • Paid for injury which results in accidental death, dismemberment, or loss of sight

Coverage Information (.pdf)

Disability Options

OPTIONAL | Short and Long Term Disability Package

Have you thought about what would happen to your earning potential if you were to become totally disabled? You will be faced with the financial burden of daily living expenses, in addition to immediate and long-term debt, without means to cover those obligations.

Group Voluntary Disability Insurance is a relative inexpensive way to provide for your family and loved ones in the event you are disabled by protecting your biggest asset – your ability to earn a paycheck. This type of benefit is offered through your employer, and paid for through the convenience of payroll deductions.

Short and Long Term Disability Package (.pdf)

Retirement

Pension

The Pension Plan is part of the Florida Retirement System. It’s a traditional retirement plan designed for longer service employees, with a vesting period requirement of eight years of service. The guaranteed retirement monthly benefit is based on the employee’s age, salary and years of service, among other factors. Employee contribution is 3% of annual salary, College contribution is 7.52%.

FRS Pension Plan Beneficiary Form (.pdf)

Investment

The Investment Plan is part of the Florida Retirement System. This plan is a portable retirement plan designed for mobile employees. The vesting period requirement is only one year of service. The retirement benefit amount is based on contributions, investment returns and account fees, among other things that contribute to the account growth. Employee contribution is 3% of annual salary, College contribution is 7.52% out of which you will only receive 3.3%.

FRS Investment Plan Beneficiary Form (.pdf)

SCORP

The State College Optional Retirement Program (SCORP) is an option only for faculty and certain administrators. A full-time employee who chooses to participate in the SCORP will withdraw from the Florida Retirement System (FRS). Pensacola State College will contribute 5.15%* of the identified full-time employee’s salary and the employee will contribute 3.00%* pre-tax to the SCORP selected vendor, for a total of 8.15%*.

SCORP vendors include TIAA-CREF, Valic and Metlife. Full-time employees who choose this option will have 90 days from their date of hire to make this election.

For more information about either plan, please call MyFRS Financial Guidance Line at 1-866-446-9377 to talk with a financial planner.

*Contributions are determined by the FRS each year and are subject to change.

DROP

The Deferred Retirement Option Program (DROP) was implemented July 1998. An eligible participant may retire and instead of receiving his/her monthly benefit, the amount will be paid into the employee’s DROP account, which earns interest. The employee continues to work for the College up to the date in which the participant’s DROP period ends.

Retirees Group Health Insurance

Retiree group health insurance options are available at the time of retirement. Coverage cannot be reinstated if declined.

Blue Medicare Plan

To be eligible to enroll in this plan, you and you’re eligible dependent must be entitled to Medicare Part A (Hospital Services), enrolled in Medicare Part B ( Physician care and Medical services) and identified as an eligible group plan participant.

Some of the few advantages with this plan are:

  • Predictable co-payments/coinsurance;
  • Prescription drug coverage with protection through the “coverage gap” for generic drugs and more, based on the plan’s benefits;
  • Increased savings when you use mail-order pharmacy; Mail-order available for 90-day supply for an amount equal to two monthly co-payments;
  • Large provider and pharmacy networks, no referrals needed for specialists and the freedom to choose in-network or out-network providers; and
  • User-friendly tools, information and services to help you make the best decisions with your healthcare dollars.

To enroll in this benefit complete the enrollment form and return it to you group benefit administrator, Erandi Sanchez-Perez, by the enrollment deadline or within 30 days from your Medicare-eligible start date.

If you have pre-enrollment questions, please contact Member Services at 1-800-926-6565 and enter extension 89724.

2017 Retiree Rate Sheet

Retirees Group Life

Retirees have the option to participate in one of the four retiree basic group life insurance options. Retiree group basic life insurance options are available at the time of retirement. Coverage cannot be reinstated if declined.

Life Coverage Options

  • $5,000 for $11.80 per month
  • $10,000 for $23.60 per month
  • $25,000 for $59.00 per month
  • $50,000 for $118.00 per month

Benefit Reduction: Coverage amounts reduce 35% at are 65 and 50% at age 70, additional 25% reduction at age 75+. There is no reduction for the $5,000 policy.

Life Insurance Enrollment Form

Life Insurance Beneficiary Form

Life Change Event

Pensacola State College pre-tax benefits are governed by IRS guidelines. Once open enrollment ends or 31 days from hire enrollment date expires you are only allowed to make changes to your pre-tax benefits if you experience a qualifying change in status event. Change in status is outlined by the Internal Revenue Services to allow you to adjust your benefit elections as needed.  The benefit changes must be in relation to your qualifying change in status event.

You must report your change in status qualifying event within 30 days. Otherwise, the change in status event will not be valid and you will have to wait until the following open enrollment period to submit your changes.

Changes in Status Qualifying events include the following:

  • Marriage
  • Divorce or Legal Separation
  • Birth of a Child, Adoption, Legal Guardianship
  • Qualified Medical Support Order
  • Death of a child or dependent
  • Change in job status or reduction of hours resulting in loss of coverage
  • Unpaid leave of absence for employee and spouse
  • Or, any other circumstance where individual, spouse or dependent lose coverage

Updating Your Beneficiary Information

Beneficiary designations to your life insurance, retirement account, deferred compensation plans, and/or special pay plan account should be evaluated when you experience a life change event. However, you may change your beneficiaries anytime during the year. Below is the information and beneficiary forms needed to update your information: