��AV��Ƶ: Insurance Plans

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Insurance Plans

��AV��Ƶ offers budgeted and eligible non-budgeted employees the opportunity to participate in a selection of voluntary insurance benefit programs.

Marketplace Notice: Please visit for more information, about the Health Insurance Marketplace for employment-based health coverage offered by the state of Florida, should you choose not to enroll through the State Group Insurance Program

Health Insurance
Life Insurance
Dental Insurance
Vision Insurance
Flexible Spending
Post-Tax Insurance
Supplemental Insurance
Quicklinks

Health Insurance

��AV��Ƶ offers the following health insurance coverage:
Preferred Provider Organization | Health Maintenance Organization | Health Investor Health Plan

Health insurance coverage is available to all budgeted faculty, administrative, support, and eligible non-budgeted employees at the ��AV��Ƶ. Employees have 60 calendar days from their hire date to enroll in a State Group Insurance Program health insurance plan. Plan changes are only made during the annual open enrollment period or due to an approved . To enroll in a new plan or make changes to your current health plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

You can also sign-up for a State Group Insurance Program health insurance plan online through or by contacting the People First Service Center at 866-663-4735.

Note:

If you enrolled online or through the People First Service Center, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.
��AV��Ƶ employees whose spouse also works for the State of Florida may qualify for health insurance coverage at a reduced cost. Please refer to the Spouse Program page on the webpage for more information.
All nine-month faculty (who have not elected deferred pay) enrolled in a State Group Insurance Program health insurance plan will have their deductions doubled starting with the first paycheck in February through the first paycheck in May. Refer to the Nine-Month Faculty Benefits page for more information.
- must be satisfied for all dependents upon enrollment into a state plan within the grace period, or dependents could lose coverage. Please be sure to read all People First correspondence as it may relate to keeping active benefits coverage for your dependents.

will manage your prescription benefits like your health insurance company manages your medical benefits. That means helping you get the medication you need and helping you find ways to save. For more information, please call 800-547-9767.

Preferred Provider Organization (PPO)

Standard PPO coverage provides flexibility in choosing both network and non-network providers. The deductibles and coinsurance out-of-pocket costs will be less when visiting an in-network provider. A summary of the Standard PPO plan is below. For complete plan details and a plan comparison chart, please visit the website.

Plan Summary

Insurance Carrier:
Phone Number:

(800) 825-2583

Monthly Premiums:*

Employee Only Coverage:

Employee Contribution: $50.00
��AV��Ƶ Contribution: $763.46
Total Contribution: $813.46

Family Coverage:

Employee Contribution: $180.00
��AV��Ƶ Contribution: $1,651.08
Total Contribution: $1,831.08

Spouse Program Coverage (both spouses must be benefit-eligible, State of Florida employees):

Employee Contribution: $15.00 (per spouse)
��AV��Ƶ Contribution: $1,801.08
Total Contribution: $1,831.08

Notes:

This plan uses a provider network. You will pay less if you use a provider in the plan's network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing).
Please be aware that your network provider may use an out-of-network provider for some services (such as lab work). Check network status with your provider before receiving treatment.

*Premium deductions take place on a biweekly basis. To calculate the amount deducted from your paycheck, divide the employee contribution amount by two. The employee contribution amounts shown above are based on an active, full-time employee. Part-time employee contribution amounts may be higher. Contact the Office of Human Resources at (904) 620-2903 to calculate the employee contribution for a part-time employee.

Network Coverage:	In-Network: (You will pay the least)	Out-of-Network: (You will pay the most)
Annual Deductible:	Employee: $250 Family: $500	Employee: $750 Family: $1,500
Coverage:	United States	Worldwide
Co-Payments:	Primary Care: $15/visit Specialist: $25/visit Hospital: 20% + $250 Per Admission Deductible	Primary Care and Specialist: 40% Coinsurance + amount above allowance Hospital: 40% Coinsurance + $500 Per Admission Deductible + amount above allowance
Prescriptions:	Generic: $7 Preferred brand: $30 Non-preferred brand: $50 (Mail order, 90-day-supply prescriptions also available)	You pay in full, file a claim, and will not get reimbursed the entire amount.

Health Maintenance Organization (HMO)

Standard HMO coverage offers benefits through network providers without deductible or coinsurance out-of-pocket costs. Non-network providers do not provide covered services. A summary of the Standard HMO plan is below. For complete plan details and a plan comparison chart, please visit the website.

Plan Summary

Insurance Carrier:
Phone Number:

877-614-0581

Monthly Premiums:*

Employee Only Coverage:

Employee Contribution: $50.00
��AV��Ƶ Contribution: $763.46
Total Contribution: $813.46

Family Coverage:

Employee Contribution: $180.00
��AV��Ƶ Contribution: $1,651.08
Total Contribution: $1,831.08

Spouse Program Coverage (both spouses must be benefit-eligible, State of Florida employees):

Employee Contribution: $15.00 (per spouse)
��AV��Ƶ Contribution: $1,801.08
Total Contribution: $1,831.08

Notes:

Benefits will be given through an out-of-network provider in the event of a life or limb-threatening emergency.
Referrals are not needed to access specialist services. An employee may self-refer to any physician, specialist or hospital in the network.

Network Coverage:

Network:

Out-of-Network:

Annual Deductible:

None

No coverage for out-of-network**

Coverage:

Open Access

No coverage for out-of-network**

Co-Payments:

Primary Care: $20/visit

Specialist: $40/visit

Hospital: $250/admission

No coverage for out-of-network**

Prescriptions:

Generic: $7

Preferred brand: $30

Non-preferred brand: $50

(Mail order, 90-day-supply prescriptions are available)

No coverage for out-of-network**

Health Investor Health Plan (HIHP)

HIHP high deductible coverage gives you either PPO or HMO coverage at a reduced premium for the trade-off of an increased out-of-pocket cost. A summary of the HIHP high deductible PPO and HMO plan is below. For complete plan details and a plan comparison chart, please visit the website.

Health Investor PPO
Health Investor HMO

Health Investor Health Plan (HIHP) Plan Summary

HIHP PPO

Insurance Carrier:
Phone Number:

(800) 825-2583

Monthly Premiums:*

Employee Only Coverage:

Employee Contribution: $15.00
��AV��Ƶ Contribution: $763.46
Total Contribution: $778.46

Family Coverage:

Employee Contribution: $64.30
��AV��Ƶ Contribution: $1,651.08
Total Contribution: $1,715.38

Spouse Program Coverage (both spouses must be benefit-eligible, State of Florida employees):

Employee Contribution: $15.00 (per spouse)
��AV��Ƶ Contribution: $1,685.40
Total Contribution: $1,715.40

Notes:

A Health Savings Account (HSA) is available and required for HIHP participants. People First will automatically open your HSA account once you enroll in a HIHP account. An HSA is an account owned by the employee, and the employee may use accrued HSA contributions to pay for additional medical expenses that may otherwise not be covered by the health plan. ��AV��Ƶ will contribute $41.66 per month ($500 annually) for employee-only coverage or $83.33 ($1,000 annually) for family coverage for full-time employees.
The employee contribution limit is $3,600/year for single coverage and $7,200/year for family coverage (Limits include the state’s contribution).
Employees ages 55+ may make catch-up contributions of an additional $1000 each year.
The HSA earns interest, and the balance will accumulate year after year tax-free until you use it.
The HSA is yours and will stay with you even after termination. There is no time limit on using the funds.

Network Type:	Network:	Out of Network:
Annual Out-of-Pocket Maximum:	Employee Only Coverage: $3,000 Family Coverage: $6,000	Employee Only Coverage: $7,500 Family Coverage: $15,000
Annual Deductibles:	Employee Only Coverage: $1,500 Family Coverage: $3,000	Employee Only Coverage: $2,500 Family Coverage: $5,000
Medical Care:	20% of the network-allowed amount after the annual deductible is met.	40% of the non-network-allowed amount after the annual deductible is met.
Hospital Stay:	20% of the network-allowed amount after the annual deductible is met.	20% of the non-network-allowed amount and $1,000 admission deductible after the annual deductible is met.
Prescriptions:	Generic: 30% Preferred Brand: 30% Non-Preferred Brand: 50%	Member pays in full and files a claim.

HIHP HMO

Insurance Carrier:
Phone Number:

877-614-0581

Monthly Premiums:*

Employee Only Coverage:

Employee Contribution: $15.00
��AV��Ƶ Contribution: $763.46
Total Contribution: $778.46

Family Coverage:

Employee Contribution: $64.30
��AV��Ƶ Contribution: $1,651.08
Total Contribution: $1,715.38

Spouse Program Coverage (both spouses must be benefit-eligible, State of Florida employees):

Employee Contribution: $15.00 (per spouse)
��AV��Ƶ Contribution: $1,685.40
Total Contribution: $1,715.40

Network Type:

Network Only

Annual Out-of-Pocket Maximum:

Employee Only Coverage: $3,000

Family Coverage: $6,000

Annual Deductibles:

Employee Only Coverage: $1,500

Family Coverage: $3,000

Medical Care:

20% of the contracted rate after the annual deductible is met.

Hospital Stay:

20% of the contracted rate after the annual deductible is met.

Prescriptions:

Generic: 30%

Preferred Brand: 30%

Non-Preferred Brand: 50%

Notes:

A Health Savings Account (HSA) is available and required for HIHP participants. People First will automatically open your HSA account once you enroll in a HIHP account. An HSA is an account owned by the employee, and the employee may use accrued HSA contributions to pay for additional medical expenses that may otherwise not be covered by the health plan. ��AV��Ƶ will contribute $41.66 per month ($500 annually) for employee-only coverage or $83.33 ($1,000 annually) for family coverage for full-time employees.
The employee contribution limit is $3,600/year for single coverage and $7,200/year for family coverage (Limits include the state’s contribution).
Employees ages 55+ may make catch-up contributions of an additional $1000 each year.
The HSA earns interest, and the balance will accumulate year after year tax-free until you use it.
The HSA is yours and will stay with you even after termination. There is no time limit on using the funds.

Life Insurance

��AV��Ƶ offers the following life insurance coverage:

Basic Life Insurance | Optional Life Insurance | Spousal Life | Dependent Life

Life insurance coverage is available to all budgeted faculty, administrative, support, and eligible non-budgeted employees at the ��AV��Ƶ. Employees have 60 calendar days from their hire date to enroll in a State Group Insurance Program life insurance plan. Plan changes are only made during the annual open enrollment period or due to an approved . To enroll in a new life insurance plan or make changes to your current life insurance plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

You can also sign-up for a State Group Insurance Program life insurance plan online through or by contacting the People First Service Center at 866-663-4735.

Note:

If you enrolled online or through the People First Service Center, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.
All nine-month faculty (who have not elected deferred pay) enrolled in a State Group Insurance Program life insurance plan will have their ��AV��Ƶ offers the following life insurance coverage will have their deductions doubled starting with the first paycheck in February through the first paycheck in May. Refer to the Nine-Month Faculty Benefits webpage for more information.

Basic Life Insurance

A free, basic group term life insurance benefit of $25,000 is available to all full-time budgeted employees. Part-time budgeted employees pay pro-rated premiums based on their FTE. Eligible non-budgeted employees pay the full premium.

Plan Summary

Insurance Carrier:
Phone Number:

(888) 826-2756

Monthly Premium:*

Full-Time Coverage:
No cost for full-time employees.
Part-Time Coverage:
Prorated premiums based on FTE.
Eligible Non-Budgeted Coverage:
$3.58

Coverage Amount:

$25,000

Notes:

This insurance only covers the employee.
Full-time budgeted employees are automatically enrolled in Basic Life Insurance.
An accidental death and dismemberment benefit and accelerated death benefit are included.
Death benefits are paid to beneficiaries designated by the employee.
This life insurance is term coverage with no cash value.

*Premium deductions take place on a biweekly basis. To calculate the amount deducted from your paycheck, divide the monthly premium amount by two. The employee premium amounts shown above base on an active, full-time employee. Part-time employee premium amounts may be higher. To enroll in a new plan or make changes to your current Basic Life insurance plan, if eligible, or for information regarding part-time premium deductions, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Optional Life Insurance

Salaried employees enrolled in basic life insurance coverage can also elect additional term life insurance. Medical Underwriting may be required.

Plan Summary

Insurance Carrier:
Phone Number:

(888) 826-2756

Monthly Premium:*

Based on a formula using the employee's annual salary and age.
The employee is responsible for the entire premium.

Coverage Amount:

Optional coverage from 1 to 7 times the employee's annual salary is available with a maximum limit of $1,000,000 of coverage.

Notes:

Your optional life insurance will increase the month before (for coverage for the month of) your birthday when you change age bands. Your optional life insurance premium will change as the result of a change in annual salary on the effective date of the change in salary.
Guaranteed issue coverage gives you the option to purchase life insurance without providing evidence of insurability (EOI). Guaranteed issue coverage may be available during annual open enrollment periods, qualified family status changes, and when first eligible to enroll in your life insurance plan.
If you apply for coverage above the guaranteed amount and are declined due to health reasons, you will still receive the guaranteed amount.
This insurance only covers the employee.
An accidental death and dismemberment benefit and accelerated death benefit are included.
Death benefits are paid to beneficiaries designated by the employee.
This life insurance is term coverage with no cash value.
Minnesota life offers enrolled employees a free simple will preparation service.

*Premium deductions take place on a biweekly basis. To calculate the amount deducted from your paycheck, divide the monthly premium amount by two. The employee premium amounts shown above base on an active, full-time employee. To enroll in a new plan or make changes to your current Optional Life insurance plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Spousal Life

All employees enrolled in basic term life insurance may elect and pay for dependent spouse coverage.

Plan Summary

Insurance Carrier:
Phone Number:

(888) 826-2756

Monthly Premium:

Based on the amount of coverage selected.
The employee is responsible for the entire premium.

Coverage Amount:

$15,000 benefit or $20.000 benefit

Notes:

Dependent spouse coverage is guaranteed issue if elected when the spouse first becomes eligible.
Medical underwriting to elect or increase coverage after the initial eligibility period is required.

*Premium deductions take place on a biweekly basis. To calculate the amount deducted from your paycheck, divide the monthly premium amount by two. The employee premium amounts shown above base on an active, full-time employee. To enroll in a new plan or make changes to your current Spousal Life insurance plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Dependent Life

Plan Summary

Insurance Carrier:
Phone Number:

(888) 826-2756

Monthly Premium:

$.85
The employee is responsible for the entire premium.

Coverage Amount:

$10,000

Notes:

All employees enrolled in basic term life insurance may elect and pay for dependent child coverage.
The benefit for this coverage option is $10,000.
The premium for dependent child coverage is $.85 per month for all eligible children.
Coverage is guaranteed issuance.

*Premium deductions take place on a biweekly basis. To calculate the amount deducted from your paycheck, divide the monthly premium amount by two. The employee premium amounts shown above base on an active, full-time employee. To enroll in a new plan or make changes to your current Dependent Life insurance plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Dental Insurance

��AV��Ƶ offers the following dental insurance plan types:

Indemnity | PPO | Prepaid

Dental insurance coverage is available to all budgeted faculty, administrative, support, and eligible non-budgeted employees at the ��AV��Ƶ. Employees have 60 calendar days from their date of hire to enroll in a State Group Insurance Program dental insurance plan. Plan changes are only made during the annual open enrollment period or due to an approved qualifying status change. To enroll in a new plan or make changes to your current dental plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

You can also sign-up for a State Group Insurance Program dental insurance plan online through or by contacting the People First Service Center at 866-663-4735.

Note:

If you enrolled online or through the People First Service Center, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.
All nine-month faculty (who have not elected deferred pay) enrolled in a State Group Insurance Program dental insurance plan will have their deductions doubled starting with the first paycheck in February through the first paycheck in May. Refer to the Nine-Month Faculty Benefits page for more information.

��AV��Ƶ offers the following dental insurance plan types:

Indemnity Dental Plan

With the indemnity dental options, you may receive care from any dentist. You have a deductible to meet and then pay a part of the cost for the services you receive. A summary of the Indemnity dental plan is below. For complete plan details and a plan comparison chart, please visit the website.

Humana Schedule B Plan Summary

Insurance Carrier:
Phone Number:

(866) 879-3630

Plan Name:

Monthly Premiums:*

Employee Only: $14.74
Employee + Spouse: $21.96
Employee + Child(ren): $23.30
Employee + Spouse + Child(ren): $37.10

Annual Deductibles:

$50 per person, 3 per family

Annual Maximum:

$1,000 per person

Notes:

Receive care from any dentist
Annual deductible must be met before benefits are paid
Part of the cost of care must be paid

Indemnity with PPO Dental Plan

With the indemnity dental options, you may receive care from any dentist. You have a deductible to meet and then pay a percentage of the cost for the services you receive. A summary of the plan can be found below. Complete plan details and a plan comparison chart can be found on the website.

Ameritas Indemnity with PPO Plan Summary

Insurance Carrier:
Phone Number:

(877) 721-2224

Plan Name:

Monthly Premiums:*

Employee Only: $46.50
Employee + Spouse: $86.24
Employee + Child(ren): $98.20
Employee + Spouse + Child(ren): $141.80

Annual Deductibles:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

$2,000 per person

Notes:

Receive care from any dentist
Annual deductible must be met before benefits are paid
Part of the cost of care must be paid
Orthodontia benefits available

MetLife Indemnity with PPO Plan Summary

Insurance Carrier:
Phone Number:

(844) 222-9104

Plan Name:

Monthly Premiums:*

Employee Only: $51.92
Employee + Spouse: $96.04
Employee + Child(ren): $107.32
Employee + Spouse + Child(ren): $155.80

Annual Deductibles:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

$2,000 per person

Notes:

Receive care from any dentist
Annual deductible must be met before benefits are paid
Part of the cost of care must be paid
Orthodontia benefits available

Sun Life Indemnity PPO Plan Summary

Insurance Carrier:
Phone Number:

(800) 277-2300

Plan Name:

Monthly Premiums:*

Employee Only: $43.55
Employee + Spouse: $83.61
Employee + Child(ren): $98.83
Employee + Spouse + Child(ren): $130.35

Annual Deductibles:

Network:

$50 per person, 3 per family

Non-Network:
$50 per person, 3 per family

Annual Maximum:

Network:

$2,000 per person

Non-Network:
$1,500 per person

Notes:

Receive care from any dentist
Cost is lower when using network dentists
Annual deductible must be met before benefits are paid
Percentage of the cost of care must be paid
Orthodontia benefits available only to dependents under 19
Includes indemnity benefits

PPO Dental Plans

With the PPO Dental plan, you may choose to receive care from any dentist although your cost is lower when you use network dentists. You have a deductible to meet and then pay part of the cost for the services you receive. A summary of the plan can be found below. Complete plan details and a plan comparison chart can be found on the website.

Ameritas Preventive PPO Plan Summary

Insurance Carrier:
Phone Number:

(877) 721-2224

Plan Name:

Monthly Premiums:*

Employee Only: $27.98
Employee + Spouse: $52.92
Employee + Child(ren): $56.64
Employee + Spouse + Child(ren): $82.96

Annual Deductibles:

Network:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Non-Network:

Employee: $50:
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

Network:

$1,000 per person

Non-Network:
$1,000 per person

Notes:

Receive care from any dentist
Cost is lower when using network dentists
Annual deductible must be met before benefits are paid
Percentage of the cost of care must be paid
No coverage for Type III: Major Services

Ameritas Standard PPO Plan Summary

Insurance Carrier:
Phone Number:

(877) 721-2224

Plan Name:

Monthly Premiums:*

Employee Only: $38.60
Employee + Spouse: $72.32
Employee + Child(ren): $80.96
Employee + Spouse + Child(ren): $117.88

Annual Deductibles:

Network:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Non-Network

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

Network/Non-Network

$1,500 per person

Notes:

Receive care from any dentist
Cost is lower when using network dentists
Annual deductible must be met before benefits are paid
Percentage of the cost of care must be paid
Orthodontia 12 Month Waiting Period may apply

MetLife Preventive PPO Plan Summary

Insurance Carrier:
Phone Number:

(844) 222-9104

Plan Name:

Monthly Premiums:*

Employee Only: $25.08
Employee + Spouse: $46.38
Employee + Child(ren): $51.84
Employee + Spouse + Child(ren): $75.24

Annual Deductibles:

Network/Non-Network:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

Network/Non-Network:

$1,000 per person

Notes:

Receive care from any dentist
Cost is lower when using network dentists
Annual deductible must be met before benefits are paid
Percentage of the cost of care must be paid

MetLife Standard PPO Plan Summary

Insurance Carrier:
Phone Number:

(844) 222-9104

Plan Name:

Monthly Premiums:*

Employee Only: $36.60
Employee + Spouse: $67.72
Employee + Child(ren): $75.66
Employee + Spouse + Child(ren): $109.86

Annual Deductibles:

Network/Non-Network:

Employee: $50
Employee + Spouse or Employee + Child(ren): $100
Family: $150

Annual Maximum:

Network/Non-Network:
$1,500 per person

Notes:

Receive care from any dentist
Cost is lower when using network dentists
Annual deductible must be met before benefits are paid
Percentage of the cost of care must be paid
Orthodontia 12 Month Waiting Period may apply

Prepaid (HMO) Dental Plans

With prepaid dental plans you must use in-network providers. These plans do not have a deductible and cover most preventive care at no charge. You pay a specific dollar amount for other care you receive. A summary of the plan can be found below. For complete plan details and a plan comparison chart can be found on the website.

Sun Life Prepaid (HMO) Plan Summary

Insurance Carrier:
Phone Number:

(800) 277-2300

Plan Name:

Monthly Premiums:*

Employee Only: $14.93
Employee + Spouse: $25.17
Employee + Child(ren): $33.26
Employee + Spouse + Child(ren): $43.54

Annual Deductibles:

Annual Maximum:

Notes:

Pays benefits only when using network providers
No deductibles
Pay a specific dollar amount for care received
Orthodontia benefits available

Cigna Prepaid (HMO) Plan Summary

Insurance Carrier:
Phone Number:

(800) 244-6224

Plan Name:

Monthly Premiums:*

Employee Only: $24.01
Employee + Spouse: $47.31
Employee + Child(ren): $56.41
Employee + Spouse + Child(ren): $72.06

Annual Deductibles:

Annual Maximum:

Notes:

Pays benefits only when using network providers
No deductibles
Pay a specific dollar amount for care received
Orthodontia benefits available

Humana HD205 (HMO) Plan Summary

Insurance Carrier:
Phone Number:

(866) 879-3630

Plan Name:

Monthly Premiums:*

Employee Only: $12.64
Employee + Spouse: $21.20
Employee + Child(ren): $23.00
Employee + Spouse + Child(ren): $32.98

Annual Deductibles:

Annual Maximum:

Notes:

Pays benefits only when using network providers
No deductibles
Pay a specific dollar amount for care received
Orthodontia benefits available

Vision Insurance

Vision insurance coverage is available to all budgeted faculty, administrative, support, and eligible non-budgeted employees at the ��AV��Ƶ. Employees have 60 calendar days from their date of hire to enroll in a State Group Insurance Program vision insurance plan. Plan changes are only made during the annual open enrollment period or due to an approved qualifying status change. To enroll in a new plan or make changes to your current vision plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

You can also sign-up for a State Group Insurance Program vision insurance plan online through or by contacting the People First Service Center at 866-663-4735.

Note:

If you enrolled online or through the People First Service Center, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.
All nine-month faculty (who have not elected deferred pay) enrolled in a State Group Insurance Program vision insurance plan will have their deductions doubled starting with the first paycheck in February through the first paycheck in May. Refer to the Nine-Month Faculty Benefits page for more information.

��AV��Ƶ offers the following vision insurance plan types:

Vision/Exam + Materials

Caring for your eyes is a very important part of your overall health and wellness. That's why the State offers you competitive vision coverage at affordable rates. You have access to one of the largest vision networks in the United States, with more than 108,000 access points with independent optometrists and ophthalmologists and national retail locations—and every one accepts new patients. A summary of the vision plan is below. For complete plan details and a plan comparison chart, please visit website..

Vision Insurance Plan Summary

Insurance Carrier:
Phone Number:

(800) 939-5369

Monthly Premiums:

Employee Only: $6.96
Employee + Spouse: $13.74
Employee + Child(ren): $13.60
Employee + Spouse + Child(ren): $21.36

Frequency:

Eye Exams: Every 12 months

Lenses: Every 12 months

Frames: Every 24 months

Co-Payments:

Eye Exams: $10.00

Lenses: $10.00

Frames: $10.00

Notes:

Includes exams and materials.
You will be able to use your benefits at some of the top names in eye care, including LensCrafters®, Pearle Vision® and Target Optical® in addition to the many independent optometrists and ophthalmologists.
Members receive a 10% discount off UCR charges at preferred LASIK provider locations and pay no more than $1,800 per eye for the Conventional LASIK procedure and $2,300 per eye for Custom LASIK.

Flexible Spending

The state offers three reimbursement accounts (FSAs) that can provide tax breaks on predictable out-of-pocket costs. For more information, visit website and check out the Savings and Spending Accounts and review the Guide at the bottom of the . The is also available to help you decide if the reimbursement accounts are beneficial for you.

If you have a high deductible HMO or PPO plan (HDHP), learn more about opening a (HSA).

Chard Snyder is the administrator for all savings and spending accounts.

Carryover

For the healthcare FSA and limited purpose FSA, December 31 is the last day to incur claims for the current plan year, and you must submit all claims by April 15 of the following plan year. If you have funds remaining at the end of the current plan year, a maximum of $570 will carry over to the next plan year while any funds in excess of $570 will forfeit.

Note:

The carryover does not apply to the dependent care FSA. For the dependent care FSA, the grace period to use funds ends March 15 of the next plan year and you must submit all claims by April 15 of the next plan year. Otherwise, you will lose any remaining money.

Flexible Spending Account Plan Summaries
Type	Healthcare FSA:	Dependent Care FSA:	Limited Purpose FSA:
Employee Contribution Limits	$60 to $2,850 in pretax dollars	$60 to $5,000 in pretax dollars ($2,500 if you're married filing separate tax returns)	$60 to $2,850 in pretax dollars
Use For:	Out-of-pocket medical, prescription, dental, vision and over-the-counter medication expenses not paid by insurance or reimbursed from any other source.	Care for children under the age of 13 or a dependent age 13 and older who live with you at least 8 hours a day and who need supervised care, such as an elderly parent or spouse with a disability.	Out-of-pocket dental, vision and over-the-counter medication expenses not paid by insurance or reimbursed from any other source. Not available for medical expenses.
When is Money Available?	The total amount of your annual election is available January 1 (for open enrollment) or on your enrollment date (for new hires or if you have an appropriate Qualifying Status Change (QSC) event).	Money is added to your account after each payroll deduction. You may use only the amount you have in your account at the time.	The total amount of your annual election is available January 1 (for open enrollment) or on your enrollment date (for new hires or if you have an appropriate Qualifying Status Change (QSC) event).
Submitting Claims	December 30 of each year is the last day to incur claims for the current plan year, and you must submit all claims by April 15 of the following year. Otherwise, if you have funds remaining at the end of the current year, a maximum of $570 will carry over to the next plan year, while any funds in excess of $570 will forfeit.	March 15 of each year is the last day to incur claims for the previous plan year, and you must submit all claims by April 15. Otherwise, you lose any remaining money.	December 30 of each year is the last day to incur claims for the current plan year, and you must submit all claims by April 15 of the following year. Otherwise, if you have funds remaining at the end of the current year, a maximum of $570 will carry over to the next plan year, while any funds in excess of $570 will forfeit.

Important considerations to consider before making your FSA choices.

Post-Tax Insurance

Post-tax insurance plans are available to all faculty, administrative and support staff employees at the ��AV��Ƶ. Employees have 60 calendar days from their date of hire to enroll in post-tax insurance plans. Some insurance plans allow plan changes throughout the year while others only allow changes during an open enrollment period. To enroll in a new post-tax insurance plan or make changes to your current post-tax insurance plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Enrollment forms may be mailed in or faxed to (904) 620-2742 if an appointment is not needed.

Note:

If you mailed or faxed your enrollment forms, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.

Post Tax Insurance Plan Summary
Name:	Plan Summary	Insurance Providers:
Long Term Disability:	Long-term disability replaces 60% of your income tax-free to a maximum of $15,000 per month. For complete plan details, please visit the website or contact one of the representatives on the participating investment companies web page. NOTE: This plan will not cover any disability that results from a pre-existing condition in the first 12 months after the effective date of coverage.	Phone: (800) 330-6115
Long Term Care:	Long-term care insurance provides coverage to individuals who are unable to perform at least two activities of daily living or to someone who has severe cognitive impairment. This coverage may be used to cover expenses relating to care in a skilled nursing facility or home-based care.	Phone: (800) 330-6115
Level Term Life Insurance:	Level Term Life Insurance is the least expensive form of life insurance available. Underwritten by Symetra Life Insurance Company. This plan features easy payroll deduction, competitive pricing, predictable premiums, customized and portable coverage.	Phone: (800) 330-6115
Whole Life Insurance:	Whole Life Insurance with Mass Mutual offers three important guarantees: Guaranteed Death Benefit, Guaranteed Level Premium and Guaranteed Increase in cash value. This plan features easy payroll deduction, predictable premiums and portable coverage. Employees may apply for up to $250,000 in coverage. Spouses and children can also be insured.	Phone: (800) 330-6115
Legal Insurance:	Legal insurance provides assistance with adoptions, wills and trusts, real estate, administrative hearings, attorney office work and matrimonial matters, among other things.	Phone: (800) 356-5297

Supplemental Insurance

Supplemental insurance coverage is available to all faculty, administrative, and support staff employees at the ��AV��Ƶ. Employees have 60 calendar days from their date of hire to enroll in supplemental insurance plans. Plan changes can be made only during the annual open enrollment period or as a result of an approved qualifying status change. To enroll in a new plan or make changes to your current health plan, if eligible, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team.

Enrollment forms may be mailed in or faxed to (904) 620-2742 if an appointment is not needed.

Notes:

If you mailed or faxed your enrollment forms, please contact the Office of Human Resources at (904) 620-2903 and ask to speak with a member of the Benefits and Retirement team so that the premium deductions are set up on a per pay period basis to avoid any premium payment delinquencies that may cause your plan to become inactive.

Capital Insurance has developed updated portals for New and Existing/Retiring employees:

- New employee pre-tax benefit packet that includes all of the Aflac, Cigna, MetLife, and Humana benefits forms.
- Retirement Benefits Packet that guides and enables exiting and retiring employees to continue any insurance plans they may currently have with Capital Insurance Agency.

Supplemental Insurance Plan Summary
Benefit Summary:	Insurance Providers:	Contact
Accident Insurance:	Help you pay the following types of expenses when injured during a covered accident: Expensive medical treatment for broken bones and dislocations, or physical therapy Crutches, wheelchairs or other medical aids you may need as a result of your accident Copayments and deductibles	Phone: (888) 899-4135
Cancer Insurance:	Depending on the plan you choose, supplemental benefits for: Cancer diagnosis and treatment, including certain screening tests Procedures and treatments you may require to care for your cancer	(through Capital Insurance Agency) Phone: (800) 780-3100 Phone: (888) 899-4135
Disability Insurance:	Helps supplement your income during short-term disability.	Phone: (888) 899-4135
Hospitalization Insurance:	Deductible Room and board Special hospital facility charges Home health care Daily benefit for hospital confinement	(through Capital Insurance Agency) Phone: (800) 780-3100 (through State Securities) Phone: (800) 277-2300
Intensive Care Insurance:	Daily benefit for confinement in a hospital intensive care or a sub-acute intensive care unit.	(through Capital Insurance Agency) Phone: (800) 780-3100 Phone: (888) 899-4135

Quicklinks

Benefits Forms

Qualifying Status Change

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Insurance Plans

Health Insurance

Preferred Provider Organization (PPO)

Plan Summary

Health Maintenance Organization (HMO)

Plan Summary

Health Investor Health Plan (HIHP)

Health Investor Health Plan (HIHP) Plan Summary

HIHP PPO

HIHP HMO

Life Insurance

Basic Life Insurance

Plan Summary

Optional Life Insurance

Plan Summary

Spousal Life

Plan Summary

Dependent Life

Plan Summary

Dental Insurance

Indemnity Dental Plan

Indemnity with PPO Dental Plan

PPO Dental Plans

Prepaid (HMO) Dental Plans

Vision Insurance

Vision/Exam + Materials

Vision Insurance Plan Summary

Flexible Spending

Carryover

Post-Tax Insurance

Supplemental Insurance

Quicklinks

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