Rate Sheet
Directory
Health Options
- Blue Options PPO Plan 3766
- Blue Care HMO Plan 55
- 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
Dental Options
- Health Waiver Dental Vision Plan
- OPTIONAL | Dental Low Plan
- OPTIONAL | Dental High Plan
Disability Options
- OPTIONAL | Short and Long Term Disability Package
Benefits Summary Booklet
Life Options
- Basic / AD&D
- SUPPLEMENTAL | AD&D Life
- Dependent Life
- Retirees Group Life
Retirement Options
- Annual Retirement Benefits Guide
- 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.
Health Saving Account (HSA) / PPO 5190.5191
HSAs ARE AN EASY WIN
An HSA paired with an HSA-qualified health plan (PPO 5190/5191) allows you to make tax-free contributions to an FDIC-insured savings account. Balances earn tax-free interest and can be used to pay for qualified medical expenses. HSA-qualified health plans typically cost less than traditional plans and the money saved can be put into your HSA.
HSAs empower savings:
- HSA members will receive an annual initial employer contribution to help offset the deductible (employer contributions vary depending on the coverage level).
- HSA members may contribute to their account on a pretax basis.
- HSA funds earn tax-free interest.
- HSA funds used for qualified medical expenses are tax-fee.
- HSA funds can be invested for increased tax-free earning potential.
- Unlike flexible spending accounts (FSAs), the entire HSA balance rolls over each year and remains yours even if you change health plans, retire or leave your employer.
- SBC PLAN 05191 HSA Family
- Schedule of Benefits HSA Family
- SBC PLAN 05190 HSA Single
- Schedule of Benefits HSA Single
- HSA Condition Care
- HSA Pre-tax Contribution Payroll Deduction Form
- HSA Beneficiary Designation Form
- Coverage Home and Away
- HSA Powerpoint (.pdf)
- Winning with an HSA
- HSA FAQs
Fund your HSA through pre-tax payroll deductions. To take full advantage of tax savings and to build a reserve for the future, it is suggested that you maximize your contributions as set by the IRS:
2020 HSA Contribution Limits | 2020 HSA Employer Contribution |
Individual $3,550 | Individual $500 |
Family $7,100 | Employee + 1 $1,000 |
(55 and older, catch-up limit $1,000) | Employee + Family $1,500 |
HSA Eligibility
- Be covered ONLY by an HSA-qualified health plan.
- Not be eligible for any other health coverage (including Medicare, Tricare, or any other traditional health plan).
- Not participate in a Flexible Spending Account (including through a spouse).
- Not claimed as a dependent on someone else’s tax return
Blue Options PPO Plan 3766
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 3766 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 three-month maintenance supply for the price of two-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 55
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 |
- Summary of Benefits and Coverage (.pdf)
- Schedule of Benefits (.pdf)
- Coverage Away From Home (.pdf)
HMO Plan 55 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 three-month maintenance supply for the price of two-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 3900 Schedule of Benefits.
If you have any questions, please contact the Benefits Administrator.
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.
- Dental / Vision Plan with Rates (.pdf)
- Coordination of Benefits (.pdf)
- Benefit Plan Overview and Summary (.pdf)
- Dental Certificate of Coverage (.pdf)
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.
If you have pre-enrollment questions, please contact Member Services at 1-800-926-6565 and enter extension 89724.
Wellness
BY Strides Checklist (.pdf)
Next Steps Program Flyer (.pdf)
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 Plan Low Option
SUPPLEMENTAL | GIM (Hospital Indemnity) plan design and Claim form
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.
- Dental / Vision Plan with Rates (.pdf)
- Coordination of Benefits (.pdf)
- Benefit Plan Overview and Summary (.pdf)
- Dental Certificate of Coverage (.pdf)
- Ameritas Dental Brochure (.pdf)
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.
- Dental / Vision Plan with Rates (.pdf)
- Coordination of Benefits (.pdf)
- Benefit Plan Overview and Summary (.pdf)
- Dental Certificate of Coverage (.pdf)
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.
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
The Standard Beneficiary Form (.pdf)
The Standard Enrollment and Change Form (.pdf)
The Standard Evidence of Insurability (EOI) Form (.pdf)
The Standard Life Services Toolkit (.pdf)
The Standard Travel Assistance (.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.
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.
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 8.47%.
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 8.47% out of which you will only receive 3.3%.
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.
Retirement | Supplemental Information
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 PSC Human Resources Department Tammy Henderson or Davieda Grierson in Benefits, 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.
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 65% at age 65, 50% at age 70, and an additional 25% reduction at age 75+.
Life Insurance Enrollment Form
Life Insurance Beneficiary Form
*The $5,000 life insurance policy will not reduce at any age.
Life Event Change
Pensacola State College pre-tax benefits are governed by IRS guidelines. Once open enrollment ends or 30 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:
- Group Policy Life Insurance (.pdfs)
- FRS Investment (.pdfs)
- FRS Pension (.pdfs)
- Special Pay Plan Account (Retirees and DROP members only)
- Retirement Savings Annuity Plans
- Contact your plan provider to update your beneficiary information.