COUNTY OF ORANGE 2010 Option Transfer and Open Enrollment October 1, 2009 - October 30, 2009 The following are frequently asked Questions and Answers regarding your benefits. If you have specific questions, please do not hesitate to contact the Benefits Unit at Risk Management, 615-3600, for answers. 1. Q. What is Option Transfer? 1. A. Option Transfer is the County�s open enrollment period, during which you can make changes to your benefits without any special reasons, or �qualifying events�. These benefits include: Medical Dental Vision Flexible spending plans (Health FSA and Dependent Care) Medical Buy Out Determine the coverage you (and all your eligible family members) will need for the new plan year, and request those changes during October. All approved requests will become effective January 1st of the coming year. (New enrollees: do not use your cards or benefits until that date.) 2. Q. What changes can I make during Option Transfer? 2. A. You can: Enroll in coverage if you are not already enrolled Remove some of your dependents from your Family coverage Remove all dependents from your Family coverage and downgrade to Individual Add additional dependents to your existing Family coverage Upgrade your Individual coverage to Family by adding dependents Remember: You can voluntarily remove eligible dependents but you must remove all ineligible dependents, as of the date each dependent lost eligibility. 3. Q. Who are my eligible dependents? 3. A. Your spouse to whom you are legally married Your unmarried children under 19 years of age: natural child legally adopted child stepchild who depends on you for financial support (supporting documentation may be required) a child for whom you have legal custody (requires additional documentation) Your financially dependent full-time student dependent age 19 to 25 (proof required) Your disabled dependent child (requires additional documentation) 4. Q. Can I cover my spouse if we are separated? 4. A. A separated spouse can be an eligible dependent if you choose to enroll him/her. 5. Q. Can I cover my ex-spouse if I am required to continue health benefits after the divorce? 5. A. Under no circumstance can you keep an ex-spouse on your coverage following a divorce. Continuation coverage under COBRA, or other alternate coverage must be at your or your ex-spouse�s expense. 6. Q. Will these changes I�m requesting cost me more money? 6. A. The cost of your medical health coverage (your Employee contribution) is determined by the bargaining unit under which you work. For employees who contribute to the cost of medical coverage covered under CSEA, Managerial/Confidential, OCCC Faculty and OCCC Staff/Chair, the 2010 contributions are capped at $875 for Individual coverage and $1,650 for Family coverage. This means that for the Empire Plan, depending on the finalized rate, you could pay less, but you would pay no more than $33.65 per pay period for Individual coverage, or $63.46 per pay period for Family coverage. Keep in mind that if you select the alternate plan, and that plan has higher premiums than the Empire Plan, you will also have to pay the difference, or the excess premium. Employees covered under DSPBA, COBA, and Superior Officers� contracts continue at current contribution rates, until notified otherwise. The cost of Family Dental and Family Vision can be found on page 11 of this brochure. 7. Q. Could my request for changes be rejected during Option Transfer? 7. A. All requests for changes to your benefits, along with the required supporting documentation, must be reviewed to determine the eligibility of each dependent. Only persons who meet Orange County�s dependent definition can be covered, and all dependents must submit proof of that relationship. If you cannot provide the supporting documents � marriage certificate, Social Security card, birth certificate, or other required proof of eligibility your request could be delayed or denied. In addition, if you are under a court order to provide your dependent with medical, dental and vision coverage, you can not request to remove the dependent unless you can provide proof that the order has been lifted, or the dependent no longer fits Orange County�s dependent definition. 8. Q. What if I don�t submit any applications during the open enrollment period? 8. A. Health, Dental, Vision - If you submit no requests for changes to your health, dental, or vision coverage, the coverage you now have will continue for next year. Flexible Spending Accounts - If you do not submit a request for the New Plan year, your current enrollment in either the Health Flexible Spending Account or the Dependent Care Account, or both, will end December 31st of this year. You must submit a new enrollment form if you want to continue in one or both of these flexible spending accounts. Medical Buy-Out � PLEASE NOTE THIS IMPORTANT CHANGE: If you are covered by the following contracts or classifications � CSEA (County and OCCC) Managerial/Confidential Management Plan OCCC Faculty OCCC Staff and Chair and are enrolled in the 2009 Medical Buy Out, you are no longer required to submit a new application to continue in the Buy Out for the 2010 Plan Year. (Unless you submit a health plan enrollment application, your Buy Out will continue.) If you are covered by COBA, DSPBA, or Superior Officers� contracts, and are enrolled in the Medical Buy Out for 2009, and want to continue in the Medical Buy Out beyond December 31, 2009, you must submit a new Buy out application for the 2010 Plan Year. (A 2010 Medical Buy Out application will be sent to your home address.) 9. Q. What will I need to submit to make changes during this open enrollment? 9. A. For each plan you want to enroll in, or make changes to, you must submit a completed, signed and dated form. Originals please; no faxes or photocopies will be accepted. If you want to remove an otherwise eligible dependent or dependents for January 1, you will list his/her name on the form. If you need to remove an ineligible dependent to update your record, you will list the name, and the Date the dependent was last eligible (for example, a child who last attended school in May 2009). If you are adding a dependent to your coverage, you must submit the required documents along with your completed, signed and dated application. One set of documents is all that is required for any number of changes. If these documents are already on file at Risk, you do not need to submit them again. If you are not certain, you can call the Benefits Unit and someone will check your file. 10. Q. How do I get the forms I need to make changes? 10. A. Health, dental and vision transaction forms as well as Section 125 enrollment forms can be accessed by going to the Orange County Portal. Changes to your Empire Plan health coverage? Use the Empire Plan Form PS503.1 Changes to your Dental coverage? Use the Orange County Self-Insured Dental Transaction Form Changes to your Vision coverage? Use the Orange County Self-Insured Vision Transaction Form Want to enroll in the Medical Flexible Spending or Dependent Care Account? Use the Section 125 Enrollment Form (2010) Want to enroll in the Medical Health Insurance Buyout for 2010? Use the Request to Decline and Waive Medical Health Insurance 2010 form 11. Q. What happens if my HMO costs more than the Empire Plan? 11. A. In the event that the cost of your HMO exceeds the cost of the Empire Plan, you will be required to pay your employee contribution, if any, in addition to the difference between the cost of the two plans (the excess premium). (Refer to Question #6.) 12. Q. Why can�t I change my benefits anytime I want? 12. A. During a Plan Year (January 1-December 31), your benefits cannot be changed at will. There are numerous laws, rules, and regulations that govern how benefits are administered. If you cannot document a qualifying event that would permit a change or addition in your coverage, you cannot make changes during a Plan Year. However, certain life events may allow you to add new dependents, while other events REQUIRE you to delete dependents that are no longer eligible. 13. Q. What are some �qualifying events� that would allow me to add a dependent mid- year? 13. A. Some qualifying events would be: marriage, birth or adoption of a child, obtaining legal guardianship of a child, or a return to full-time student status of your 19 to 25 year old dependent. REMEMBER, YOU MUST NOTIFY RISK MANAGEMENT WITHIN 30 DAYS. 14. Q. Can I add a new dependent at any time after he or she becomes eligible? 14. A. There are rules and regulations that require you to promptly notify the Benefits Unit if you want to add newly acquired dependents following a marriage, birth or adoption, return to student status, or involuntary loss of other coverage. All requests for coverage must be made within 30 days of the event. Failure to request coverage within this 30 day period may delay or prevent your request from being processed until the next annual open enrollment. 15. Q. What do I have to do to remove an ineligible dependent? 15. A. First of all, report the loss of eligibility within 30 days of the event. All requests to remove ineligible dependents, whether non-students ages 19 to 25, step-children who you are no longer supporting, or an ex-spouse, must be submitted on signed and dated change forms (health, dental, vision, as the case may be). For loss of student status: The date your dependent last attended school on a full-time basis is required. (The Empire Plan has changed the way it terminates eligibility of students leaving school before graduation; contact the Benefits Unit for more information.) For a divorce: You must supply a photocopy of the first and last page of the decree to verify names, the document filing date, and the ex-spouse�s current or last known address. 16. Q. What can happen if I don�t report a loss of a dependent�s eligibility? 16. A. There can be consequences to you, your dependent and your Department. For your dependent - your enrolled dependents have certain rights under COBRA and HIPAA laws. The date of the event dictates the date an ineligible dependent must be terminated from your coverage. If your dependent loses eligibility, as in the case of divorce, death, non-student dependents over age 19, you should contact this office within 30 days. If you wait more than 60 days, the dependent loses his/her right to COBRA coverage. For you � Refunds of employee contributions will be considered from the date you notify Risk Management. In addition, if the dependent uses your card after eligibility ends, you could be billed for all expenses incurred after that date. And keep in mind, use of a membership card after eligibility ends is considered fraud. For your Department - You may, or may not, contribute toward the cost of medical, family dental and family vision coverage, but it is important to keep in mind that when you no longer have any eligible dependents (spouse and/or children) neither you, nor your Department, should be paying for Family coverage. However, as long as one dependent�s name appears on your enrollment records, the coverage being purchased is Family coverage, regardless of that dependent�s actual eligibility. When you do not report the loss of your last dependent, your Department is paying thousands of dollars for coverage that cannot be used. 17. Q. How do I get a new or additional Empire Plan card? 17. A. You, the employee, must complete a Request for Empire Plan Card; sign and date the form and return it to Risk Management. This form can be obtained from the County�s Intranet, by calling the Benefits Unit at Risk Management or the Human Resources office at Orange County Community College. 18. Q. How do I get a new or additional card from my HMO? 18. A. You must request your card from your HMO directly. 19. Q. Why don�t I receive all the brochures and literature that my co-workers receive from our insurance companies? 19. A. If your address is not kept current, you may not receive all the information that you need from your insurer or benefits administrator. You must change your address through your Department Timekeeper; once the Benefits Unit is notified of the new address, your health and dental/vision providers are notified. 20. Q. Why is my child, who is no longer eligible for my coverage, still listed as my dependent? 20. A. It is your responsibility to notify the Benefits Unit, in writing, when any dependent loses eligibility for your coverage. Each year, the Empire Plan sends out Benefits Statements listing all dependents on your record. If you failed to update and send back that form, or did not submit a transaction form removing the dependent, or did not respond to any questionnaires from Risk Management, then the dependent�s name will remain on your record. Please read the important notice, at the front of this brochure, regarding the NYSHIP Dependent Eligibility Verification Project. 21. Q. I�ve had family coverage for years, and all of a sudden I am being asked to provide information on my dependents. Why now? 21. A. If you enrolled your dependents years ago, no supporting documents such as marriage and birth certificates were necessary, as is required today. When you request changes to your file, the Benefits Unit reviews it, and if documents are missing, we will ask you to supply them. Risk Management must verify initial eligibility of each dependent. Once enrolled, it is your responsibility to keep your record up to date. However, that has not happened in many cases, and this is the reason the Empire Plan is conducting the Dependent Eligibility Project. To avoid any delays in enrollment or payment of claims, always respond promptly to requests from this office, your health plan, or any of the payer components. 22. Q. Is there anything I need to know or do if I�ll soon be retiring with my health benefits? 22. A. If neither you nor your dependent is currently Medicare eligible, you will notice few, if any, differences in the way the Empire Plan pays claims when you first leave active employment. However, if you are already eligible for Medicare, or if your spouse, either by age or disability, is already eligible for Medicare, you must make sure to enroll in Medicare Parts A and B and have it in effect for the month following your retirement. If you have a Medicare eligible dependent based on disability rather than age, you should contact either the Benefits Unit at Risk Management or OCCC Human Resources, as the case may be, to notify us of this fact. If you have specific questions, please feel free to contact the Benefits Coordinator at Risk Management, 615-3600. 23. Q. What is a Section 125 Flexible Benefit Plan 23. A. The County of Orange and Orange County Community College each offer Section 125 Plans. Enrollment questions regarding the County�s Plan should be addressed to OC Risk Management. OCCC employees should address their questions to OCCC Human Resources. Orange County Government Section 125 Flexible Benefit Plan (for Active County of Orange benefits eligible employees only) This plan was established under Section 125 of the Internal Revenue Code, to help you pay for certain expenses using pre-tax dollars. Pre-tax contributions are not subject to federal, FICA, state and local taxes. (If you live in Pennsylvania, however, state and local taxes are not excluded.) These pre-tax contributions do not affect New York State Retirement System benefits. Under the Plan, all employee contributions for health, family dental and family vision are taken on a pre-tax basis unless you instruct the Benefits Unit that you do not want to participate. Your current election will continue unless a change form is filed during this open enrollment period. The regulations that govern cafeteria plans are very technical and complex, and many special rules under COBRA and HIPAA must also be considered. If, during the plan year, you think you have experienced a qualifying event that would allow a change in your benefits elections, and therefore your pre-tax contributions, please contact the Benefits Unit to discuss your status change. (Claims filing deadline for a plan year is March 31 of the following calendar year.) 24. A. What is a Health Flexible Spending Account? 24. Q. The Health Flexible Spending Account, also known as Health FSA or Med Flex, is a medical reimbursement plan funded by your tax-free contributions. Enrolling in the Health FSA allows you to set aside money on a pre-tax basis to pay for medical, dental and vision expenses that cannot be reimbursed through insurance or any other arrangement. Examples of Health FSA expenses are deductibles, eyeglasses and orthodontics. This is a voluntary program. You can enroll for a minimum of $300, up to a maximum of $3,000 per year. During this open enrollment period, you should think about the out of pocket expenses you will have for yourself and your eligible dependents for the coming year. After your Health FSA becomes effective January 1, you cannot make changes in your account unless you have a qualifying change in status that would allow a corresponding and consistent change to occur. There are specific reasons for which a change can be allowed. You will be requested to complete a Change in Circumstance Form, and provide acceptable documentation of the change in circumstances. This is an IRS rule that must be followed. PLAN WISELY and do not over pledge. You must use this money during the Plan Year or you will lose it. You cannot get it back, and you cannot roll it over to the next year. This �Use it or Lose it� rule is part of the Plan design. Technical questions can be answered by calling Fitzharris, our third party claims administrator, at 1-800-635-5651, ext. 140. The Flexible Spending Accounts Enrollment Form is available on the County Intranet or through Risk Management. Your current FSA enrollment, if any, terminates December 31st. This benefit is not automatically renewed. You must apply for the new Plan Year. Please complete the attached Orange County Government Section 125 Flexible Benefit Plan form. Return to Risk Management before the deadline. Claims filing deadline for a plan year is March 31 of the following year. 25. Q. What is the Dependent Care Assistance Program � DCAP? 25. A. The Dependent Care Assistance Program, or DCAP, is another voluntary flexible spending account funded by your pre-tax salary contributions. This account helps you reduce taxes and increase your disposable income by paying dependent care expenses with pre-tax dollars. This program is available to employees who have dependents under age 13, handicapped children, or adult parents who need care to allow you and your spouse to continue working. Like the Health FSA, the DCAP Plan Year is January 1st - December 31st. The DCAP only reimburses expenses that have been incurred during the coverage period. Unlike the health FSA, you must put the money in before getting it out. You must have sufficient contributions in your account to cover the amount you are requesting for reimbursement. There must be adequate claims substantiation (the employee must provide the name, address of the caregiver, caregiver�s tax ID, or Social Security number for an individual.) You cannot carry over any unused contribution. The same �Use it or Lose it� rule applies to the DCAP, in accordance with federal regulations and Plan design. The annual minimum contribution is $300. There is a statutory limit on the amount of expenses that can be paid pre-tax under a DCAP. The maximum contribution, set by the IRS, is $5,000 (or $2,500 if married and filing separate returns). You will need to decide whether you will claim the Dependent Care Tax Credit for eligible dependent care expenses. You may want to talk to your tax preparer to assist you with this decision. This benefit is not automatically renewed. If you are currently enrolled in the Dependent Care Assistance Program (DCAP) it will terminate December 31st. You must apply for the coming Plan Year. To enroll in one, or both of the flexible spending accounts, (Health FSA or DCAP), complete the Flexible Spending Account Enrollment Form, and return to Risk Management by the deadline. All of the components of the Section 125 Flexible Benefit Plan operate under Internal Revenue Service rules. Therefore, once you have elected participation, you may not change your deduction(s) during the Plan Year unless you experience a qualifying event, as allowed by IRS regulations. You must contact Risk Management to discuss mid-year changes. You will be required to complete a Change of Status form and provide acceptable proof of the qualifying event. If you experience a change of status, contact the Benefits Unit with your questions and for further instructions. 26. Q. What are my health plan options? 26. A. Emblem Health and the Empire Plan will be offered for the coming year. GHI will not be offered. Consult the applicable union contract to determine your bi-weekly contribution for medical coverage enrollment. Keep in mind that if the cost of Emblem Health exceeds that of the Empire Plan, the difference (the excess premium) will be the responsibility of the enrollee. Risk Management will report rate information updates as soon as they become available. PLEASE CONSIDER ALL YOUR HEALTH CARE NEEDS, AND THAT OF YOUR ENROLLED DEPENDENTS, WHEN MAKING YOUR HEALTH PLAN CHOICE FOR 2010. Emblem Health Emblem Health is a new health insurance option that has resulted from the merger of GHI and HIP. It is similar to current GHI coverage. Although the Emblem Health provider network is not identical to that of GHI HMO, it is larger, and Risk Management has been advised that 93% of GHI HMO providers participate. The list of Emblem providers can be found on the Emblem Health website at www.emblemhealth.com. Office visit co-pays are $20, ER co-pay $50, generic drugs $0, preferred brand $30, and non-preferred brand $50. (A copy of the 2009 Formulary is available at Risk Management.) There is no Out-of-Network coverage. If you are interested in enrolling in Emblem Health, contact Risk Management (or OCCC Human Resources) for an enrollment packet and application. The Empire Plan, NYSHIP (New York State Health Insurance Program) The Empire Plan is a specially designed health insurance program available only to public employees. The Empire Plan is not an Empire Blue Cross Blue Shield Plan. However, the Empire Plan contracts with other insurance carriers to pay claims. The following claims are paid by: Hospital claims are paid by Empire Blue Cross Blue Shield. Doctor visits and lab charges are paid by United HealthCare. Mental health and substance abuse claims are paid by Value Options. Prescriptions are paid by MEDCO. For general information, copies of the current The Empire Plan At A Glance are available through Risk Management or OCCC Human Resources. The brochure helps explain the Empire Plan payer components. You may also look on the NYSHIP web site www.cs.state.ny.us (Employee Benefits, Employees and Retirees of Participating Agencies (PA), Core Plus). If you are thinking of leaving your HMO and enrolling in the Empire Plan, please contact the Benefits Unit with any questions, since there are differences in the way an HMO and the Empire Plan work. When you choose doctors or providers of services that participate with the Empire Plan, you will only have to pay the co-pay(s), and the doctor accepts what the Empire Plan pays as payment in full. Office Visit co-pays $20, ER co-pay $60, generic drug $5, preferred brand $15, non-preferred brand $40. Empire Plan has Out-of-Network coverage. 27. Q. What is the Medical Health Insurance Buy-Out option? 27. A. Employees who are eligible for medical coverage and are actively employed at work are eligible for the Medical Health Buy-Out Option. How do I leave County medical coverage and enroll in the Buy-Out? The Medical Health Insurance Buy Out option is effective from January 1 through December 31 of each year. You must apply for this Buy Out Option by completing the Request to Decline and Waive Medical Health Insurance Coverage. You must provide detailed information regarding the alternate coverage under which you will be covered during the buyout period. (The alternate coverage cannot be health coverage provided by government assistance programs.) If you are enrolled in County provided medical coverage, Risk Management will terminate your current coverage at the end of the calendar year. How do I continue the Medical Health Plan Buy-Out for the next year? As Question and Answer #8 explain, if you are CSEA, Managerial/Confidential, Management Plan, OCCC Faculty, or OCCC Staff and Chair, your current Buy-Out will automatically be continued for 2010 unless you submit a health plan enrollment application. If you have the 2009 Buy Out and are covered by DSPBA, COBA, or Superior Officers� contracts, the Buy-Out option must be renewed during Option Transfer. It is not renewed for you. If you want to continue the Buy-Out option for the coming year, complete the Request to Decline and Waive Medical Health Insurance Coverage that has been mailed to your home address; return to Risk Management before the deadline. How do I leave the Buy Out and enroll in medical coverage? If you want to enroll in medical coverage, complete an enrollment form for either Emblem Health or the Empire Plan, and return it to Risk Management before the deadline. (Please remember to include any supporting documents that are required to verify eligibility of your dependents, if enrolling.) What if I need to get out of the Buy Out during the Plan Year? You will not be able to re-enter a medical health plan during the year unless you experience a qualifying event. (It would not be a qualifying event if you find that your alternate coverage is not as good as the coverage you instructed this office to terminate. However, if your spouse loses his/her job and health coverage, that loss would be a qualifying event which would allow you to enroll in coverage for yourself and your dependents.) If you experience an involuntary loss of coverage during the period of the Buy-Out, you must contact the Risk Management Benefits Unit (or OCCC Human Resources) immediately to discuss health plan options, and to complete the required Request to Resume Medical Health Insurance Coverage. (You must also be able to supply acceptable documentation of the loss of coverage.) If you want the Buy-Out option but are also planning to retire during the coming year, contact the Benefits Coordinator to discuss your particular situation. Buy-Out payments are issued by the Orange County Payroll Department in the month following the end of each quarter. Orange County Self-Insured Dental and Vision Plans You can enroll or make changes to your dental and vision coverage by using separate dental and vision transaction forms. Make sure you complete the form(s) accurately; list all eligible dependents you want covered, with proper names, dates of birth and Social Security numbers. Remember, if you are adding dependents for the first time, (or if documents for dependents are not currently on file at Risk Management) you must supply required proofs of eligibility. Plan brochures, provider lists, and claim forms are readily available by accessing the Intranet or contacting Risk Management. As an important reminder: the deadline for submitting dental and vision claims for a Plan Year is March 31st of the following calendar year. It is YOUR responsibility to ensure that claims are sent to Fitzharris before the claims filing deadline. Claims received after the deadline will not be considered for payment. 28. Q. Can you tell me about our dental coverage? 28. A. The Orange County Self-Insured Dental Plan is funded by the premiums that you and your Department pay. Your Department pays the total cost of your Individual coverage. Family coverage for Groups 718 OCCOBA and 755 OCDSPBA will cost $16.55 per payroll. Family coverage for Groups 723 CSEA/Management Plan, 768 Superior Officers, 719 OCCC Faculty and 722 OCCC Staff and Chair will cost $17.07 per payroll. If you do not submit a change form, your dental coverage will remain the same as it is now. 29. Q. Can you tell me about our vision coverage? 29. A. The Orange County Self-Insured Vision Plan is funded by the premiums that you and your Department pay. Your Department pays the total cost of your Individual coverage. Family coverage will cost you $1.96 per payroll. If you do not submit a change form, your vision coverage will remain the same as it is now. 30. Q. Who or what is Fitzharris? 30. A. Fitzharris and Company Incorporated, is the claims administrator for the County�s dental and vision programs. Fitzharris works for Orange County; it is not the insurer. Fitzharris pays claims based on the scheduled of benefits allowances. If you have questions regarding a claim, you should call the toll free number at 1-800-321-1336. 6 11