Rate Sheet

Directory

Health Options

  • PPO HDHP/HSA Gold BlueOptions 03161
  • PPO Gold BlueOptions 03359
  • HMO Gold BlueCare 47
  • PPO HDHP/HSA Gold BlueOptions 03160
  • 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

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.

PPO HDHP/HSA Gold BlueOptions 03161

PPO Gold BlueOptions 03359

PPO HDHP/HSA Gold BlueOptions 03160 (Employee Ony)

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 Lakeview Center, 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.

 

Florida KidCare Health and Dental Insurance

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.

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 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 call 1-800-726-5603.

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.

SUPPLEMENTAL | Allstate Supplemental Health Insurance

SUPPLEMENTAL | Aflac Critical Care Protection

SUPPLEMENTAL | Aflac Cancer

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 | Ameritas Dental Low Plan

Ameritas Dental Low Plan (.pdf)

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.

OPTIONAL | Ameritas Dental High Plan

Ameritas Dental High Plan (.pdf)

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.

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

2023 VSP Vision Plan Brochure (.pdf)

2024 VSP Vision Plan Brochure (.pdf)

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 in-network 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.

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.

2023 EyeMed Vision Plan Brochure (.pdf)

2024 EyeMed Vision Plan Brochure (.pdf)

Life Options

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.

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 $14.95 per month
  • $10,000 for $29.90 per month
  • $25,000 for $74.75 per month
  • $50,000 for $149.50 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

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. The state requires that employees contribute 3% and employer portion is determined by the state each July.

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. The state requires that employees contribute 3% and employer portion is determined by the state each July.

FRS Investment Plan Beneficiary Form (.pdf)

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 PSC Human Resources Department.

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 $14.95 per month*
  • $10,000 for $29.90 per month*
  • $25,000 for $74.75 per month
  • $50,000 for $149.50 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 and $10,000 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:

Retirement Savings Annuity Plans

  • Contact your plan provider to update your beneficiary information.

Benefit Documents & Forms

Health

Beneficiary

Optional Plans

Retirement Savings Annuity Payroll Deduction

FICA and Special Pay Plan Accounts

Privacy Policy