Employee Benefits

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 Beneficiary Designation Form
• Coverage Home and Away

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:

 

2021 HSA Contribution Limits	2021 HSA Employer Contribution
Individual $3600	Individual $500
Family $7,200	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

Annual Deductible	Annual Max Out-of-Pocket	Co-Pay Office Visit/ Urgent Care	Emergency Room Services
Individual: $600 Family: $1,800	In-Network: $6,000 per person Family $12,000	Primary care visit $35 Specialist visit $50 Urgent Care $35	Emergency Room $150 Copayment + 20% Coinsurance

• Summary of Benefits and Coverage
• Schedule of Benefits
• Coverage Home and Away

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

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 $35 Specialist visit $50 Urgent Care $50	Emergency Room $100 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

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.

• Summary of Benefits and Coverage (.pdf)

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.

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)

BY Strides Checklist (.pdf)
Next Steps Program Flyer (.pdf)

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 roll over year to year. Employees are required to sign up and designate their amount every year during open enrollment.

To access your account go to http://www.eaglesbenefits.com/ or contact Custom Benefits at 1800-726-5603.

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

Technology & Resources Handout

Dependent Care FSA

This account reimburses you up to $2,750 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.

• Allstate Cancer Brochure
• Low Option Plan
• Cancer and Specified Rider
• Policy

• Allstate GIM1 High/Low Handout
• GIM Claim Form

 

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)

$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)

 

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       90^th 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)

 

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 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

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

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 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 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 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)

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)

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%.

FRS Pension Plan Beneficiary Form (.pdf)

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%.

FRS Investment Plan Beneficiary Form (.pdf)

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.

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.

• MetLife
• Retiree Rate Sheet
• Retiree College Amenity Benefits
• Seniors Preventative Care Guidelines
• Annual Notice of Prescription Drug Coverage and Medicare

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.