Benefits Guide 12

8/2/2019 Benefits Guide 12

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BeneftsG u i d e

For assistance in English, please call 1.800.342.8017.

Para ayuda en Espaol, llame a 1.800.342.8017.

Siw ta bezwen yon moun ki pale Kreyl ki pou edew,

tanpri rele nan nimewo 1.800.342.8017.

Improving Our Wellness Together 20

12

M - D C P S


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Everyone must enroll this year!

Enrollment Time

Its Benefts Enrollment TimeHealthcare costs represent the second highestexpenditure of funds for M-DCPS after payroll. Inan enrollment of skyrocketing healthcare costs, thediligent efforts of the Superintendent and School Boardmembers, in conjunction with employees, unions and

associations resulted in a plan with rich benets, a no-cost employee-only option, low dependent costs and direct access to specialists.

This is a mandatory enrollment. If you do not-enroll during the OpenEnrollment period, your current benets and those of your dependents

will terminate on MARCH 31, 2012. You will be automatically assignedto Cigna Open Access Plus 20 healthcare (Employee only) coverage andyour current employee-paid benets (including dependent benets)will terminate on 3/31/12.

The premiums and benets design you are selecting at this time arefor the enrollment period of 2/27/12 - 3/9/12 for an effective dateof 4/1/12. You must enroll during this Open Enrollment period if youwould like to select your healthcare and/or exible benets (i.e., Dental,Vision, etc.) or to add or delete or to continue covering your dependents.

NOTE: During this enrollment, all employees represented by BargainingUnits: UTD, AFSCME, DCSMEC, MEP and CEP are eligible to enroll atthis time. All employees represented by other bargaining units (FOP

and DCSAA) cannot enroll at this time. You will be notied when yourOpen Enrollment period occurs.

Current Employee: A current employee is dened as an employee withactive benets.

New Employee: A new employee is dened as an employee withoutactive benets. If you are a new employee hired during this OpenEnrollment period, you must enroll for both plan years. You will receivean e-mail prompting you to enroll online for your benets. You mustenroll online by the due date. Otherwise, you will be automaticallyassigned to Cigna Open Access Plus 20 (Employee only) coverage andStandard Short-Term Disability plan.

All employees must re-enroll for 2012 benets via the Internet. To enroll,log on to www.dadeschools.net. Click on the benets 2012 OpenEnrollment" button. You may access the following: 2012 Employee Benets Guide Provider Directories Benets Web Enrollment Form

The materials contained in this guide do not constitute an insurance certicate or policy. The information provided is intended only to assist in the selection of benets. Final determinationof benets, exact terms and exclusions of coverage for each benet plan are contained in certicates of insurance issued by the participating insurance and posted on the benet Website awww.dadeschools.net.

The School Board of Miami-Dade County, Florida reserves the right to amend or to terminate the Plans described in this guide at any time, subject to the specic restrictions, if any, inthe collective bargaining agreement. In the event of any such amendment or termination, your coverage may be modied or discontinued and the School Board assumes no obligationto continue the benets or coverages described in this guide.

To Enroll Your Dependents: If you are adding new dependents, you will need to enter their

Social Security Numbers on the Web enrollment applicationand you will need to submit dependent eligibility vericationbefore the start of this plan year.

If adding dependents for the rst time, dependent documentationneeds to be provided. If not, your dependents coverage will NOTtake effect on April 1, 2012.

An employees dependent may be covered under the employeeshealthcare plan until the end of the calendar year they reach 26.

To enroll an adult child dependent (ages 26-30), you mustenroll and submit dependent eligibility documentation withyour enrollment form each year. If dependent eligibility is notreceived, your adult child will automatically be cancelled April1, 2012.

This Open Enrollment is for benets effective April 1, 2012 through December 31, 2012.

Opting Out Of Healthcare You may decline Board-Paid Healthcare coverage, provided you are

enrolled in another group healthcare plan. After your enrollment, you will be asked to submit your proof of othe

group coverage. If you do not provide proof of other group healthcare coverage

you will be automatically assigned the Cigna Open Access Plus 20(employee only) healthcare plan, and your dependents will not becovered.

In lieu of Board-Paid healthcare coverage, you will receive $100

per month paid bi-weekly through the payroll system based on youdeduction pay schedule (subject to withholding and FICA) as follows 10-month employees will receive their payment in 20 pay checks 11-month employees will receive their payment in 24 pay checks 12-month employees will receive their payment in 26 pay checks


3/138www.myFBMC.com3

Core Benets The Board provides two healthcare plans: Cigna OAP 20 and Cigna

OAP 10. OAP 20 is at no cost to the employee. OAP 10 does have an

employee cost share determined by the employee's base salary. Pleaserefer to Page 133 for the employee cost share and your dependentcost. (AFSCME employees are only eligible to enroll in OAP 20).

All employees enrolling during the open enrollment of February 27,2012- March 9, 2012 in the OAP 10 for April 1st will have the costshare deducted from the rst 2012 Plan Year payroll on April 6, 2012.

New hires after April 1, 2012, will continue to have their healthcarecoverage effective the day of hire and will start paying for the costshare (only if enrolling in OAP 10) on the rst paycheck followingthe effective date of their healthcare coverage.

The Board will continue to pay a portion of your dependent'shealthcare coverage. The subsidy paid by the School Board is, insome cases, up to 88 percent of the premium.

You are provided with Board-paid Standard Short-Term Disability(STD) coverage.

The School Board provides a Term Life and Accidental Death andDismemberment (AD&D) program with Metropolitan Life InsuranceCompany for all full-time employees. The coverage amount is eitherone or two times your annual base salary rounded up to the next$1,000. Administrators and Condential Exempt employees receivetwo times the annual base salary. All other employees receive onetimes their annual base salary. The minimum benet for employeesrepresented by AFSCME is $10,000. Additional life insurance may bepurchased through payroll deduction to bring maximum benets toan additional one times the amount provided by the School Board.

You will be eligible to increase your coverage to a maximum of vestimes the annual base salary after the rst year of participation in theoptional life program. Evidence of Insurability will be required forany increases in coverage. To nd out more about Board-Paid TermLife and Accidental Death and Dismemberment, contact the MetLifeRepresentative at 305.995.7029.

Healthcare CoverageThe School Board of Miami-Dade County, Florida, is committed toproviding you and your eligible dependents with the highest quality ofbenet selections available. Cigna Open Access Plus (OAP) 10 Employee electing this plan will

continue to pay a cost-share based on their salary band.

Cigna Open Access Plus (OAP) 20 Remains a free-option, no-costfor employee only coverage. Primary Care Physician co-payment remains at $20 per visit. Introduction of the CIgna Care Network (CCN) Specialist, a specialist

designated network that has been identified by Cigna to havedemonstrated the best in management of patient treatment.

Cigna Care Network (CCN) Specialist co-pay at $50 per visit. Non CCN Specialist co-pay at $70 per visit. Minimal pharmacy co-payment increases, services performed at

Emergency Rooms, Urgent Care Centers and Conventional Centerswill continue to be covered after a set co-payment.

Benefts Update

The Open Access Plan does not require the selection of a PrimaryCare Physician or a referral to a specialist.

Outpatient tests/surgeries at non-hospital-afliated facilities remain

at $100 per procedure. Deductible, maximum and/or out-of-pocket and co-insurance wilcontinue to apply only to hospital and hospital-afliated facilities.

Mandatory Prescription Mail Order Program, gives employees theability to manage medications online 24/7, at www.mycigna.comThis program delivers prescribed medications to employee's homefor up to a 90-day supply within a co-pay of two times the tier costsaving time and money.

Durable Medical Equipment (DME) will continue to be covered, adeductible and co-insurance applies. A change in this benet provideemployees a richer benet because once the maximum out-of-pockehas been met, the coverage will be 100 percent.

Dependent Coverage for 2012 Premiums will continue to be based on employee annual base salary

M-DCPS will continue to subsidize the cost or dependent premiumbetween 70 90 percent.

Dependent Social Security numbers are required during OpenEnrollment. If your dependent's Social Security number is noprovided, coverage for the dependent cannot be processed via theon-line enrollment. For additional information, call 1.800.342.8017

Documentation of your dependent's eligibility must be provided

Eligibility Documentation requirements can be found on Pages 24-26 Children may include: natural born children, stepchildren, adopted

children and children for whom you have been appointed legaguardian. Your unmarried children are eligible from birth until the

end of the year in which the child reaches age 26, if the child is: (1)dependent on you for support; or (2) lives in your household; or (3is enrolled full time or part time in an accredited school, college ouniversity. See also Adult Child on Page 27.

Children of your Domestic Partner are eligible for coverage only ithe Domestic Partner is also included in the coverage.

According to IRS (Internal Revenue Service) Section 125 Regulationsall deductions for employee-paid benets for domestic partnecoverage must be taken on a post-tax basis. Additionally, you muspay the tax liability on the monthly contribution (subsidy) the Boardpays on your behalf for any type of Domestic Partner coverageTherefore, the value of these benets will be added to your taxableincome and your W-2 will be adjusted to reect the higher income

level annually. Taxation for the monthly board-paid dependent subsidy contributed

on the employee's behalf for domestic partner coverage, will occuon the last pay statement of each month.

A new dependent tier has been added for employee's covering theichildren and a domestic partner. This new dependent tier allows fothe Board dependent subsidy toward only the domestic partner tobe taxed.



Benefts Update

NOTE: Employees covering a domestic partner and children ofthe domestic partner will continue to be taxed on the full, Board-paid dependent subsidy. Employees covering their own children,

a domestic partner and children of a domestic partner will also betaxed on the entire Board-paid dependent subsidy.

AFSCME - Flex CreditEmployees represented by the AFSCME Union enrolled in Cigna OAP 20will continue to receive a $280 annually of ex credit. This ex creditcan be used to offset the cost of your exible benets.

Flexible Benets Short-Term Disability coverage continues to be provided at no cost

to you. In addition, upgrades to the Short-Term Disability and Long-Term Disability are also being offered.

Miami-Dade County Public Schools will continue to offer a broad

range of high-quality, elective benets at very competitive prices,including: Dental provider MetLife dental is offering MetLife SafeGuard

DHMO, a comprehensive DHMO plan. You will need to chooseyour dental provider at the time you enroll. Your selectedgeneral dentist will refer you directly to a contracted specialtycare provider; no additional referral or pre-authorization fromSafeGuard, a MetLife Company, is required.

This plan offers you the option of selecting a dentist of yourchoice. You are free to choose an In-Network or Out-of-Networkdentist. However, when using an Out-of-Network dentist, thelevel of coverage is reduced and your out-of-pocket expenseswill increase.

MetLife Indemnity Dental Plans continue to be offered. Vision provider, UnitedHealthcare, offers access to both private

practice and retail chain providers that provide quality eye careand materials.

Choose from two Legal plans: The ARAG legal plan and the USLegal plan.

Identity Theft Protection, ID Watchdog, offers identity theftprotection by verication of your identity, monitoring, detectionand resolution of fraud.

Hospital Indemnity coverage Short-Term Disability upgrades Long-Term Disability MetLife Term Voluntary Life insurance MetLife Accidental Death and Dismemberment coverage. Flexible Spending Accounts - NOTE: Current FSA participants'

accounts will not terminate, if you do not re-enroll. Certain Over-the-Counter (OTC) drugs and medicines, except

for diabetes supplies, requires a prescription to qualify for FSAreimbursement. Its important to remember that you can still useyour FSA funds for other eligible medical expenses and prescriptionpurchases at pharmacies. Unaffected OTC items are still reimbursable,as well as affected OTC items with a doctors prescription.

Effective January 1, 2013, the maximum annual contribution amount

for a Medical Expense Flexible Spending Account (FSA) will be$2,500. This change does not affect your 2012 contribution limit. Iyou are contributing more than $2,500 to your 2012 Medical FSA

and expect to incur expenses in 2013, please plan accordingly.Evidence of Insurability (EOI)If you are a current employee who chose not to enroll previously inShort-Term Disability buy up plans or the Long-Term Disability plan, youmust complete an Evidence of Insurability (EOI) form before you areconsidered for coverage. Existing employees currently enrolled in oneof the Short-term buy up plans or Long-term plans must re-enroll duringthis enrollment, if not, your current disability coverage will terminateon 3/31/12 and you will be required to complete a new EOI if enrollingduring the 2013 Open Enrollment.

Current employees electing this benet during the 2012 Open Enrollmenmust complete an EOI form which will be veried by The Hartford. I

your buy up or LTD EOI is approved, the effective date of this benewill be the rst of the month following your rst payroll deduction. Newhires do not need to provide EOI.

NOTE: Your online Open Enrollment Conrmation Notice will reeca $0.00 deduction for this benet, which will change if your EOI isapproved. The deduction will be taken on the last paycheck of the monthafter your approval, which makes your benet effective the rst of thefollowing month after your rst payroll deduction.

EOI forms will be distributed by The Hartford. For any questions, youmay call a Hartford Representative at 1.800.741.4306.

Throughout the Plan Year

Certicate(s) of Coverage for your insurance benets are available toyou online throughout the year. A hard copy of these certicates wilnot be mailed to you automatically. Your Certicate(s) of Coverage aredocument(s) issued by the insurance company for benets registeredwith the State of Florida. These documents are available for the benetyou selected during Open Enrollment or as a new employee. To viewor print a copy of a Certicate of Coverage for any benet, log on towww.dadeschools.net under highlights click on Employee Benets,and then under the M-DCPS New/Current Employees column, click on"Certicates of Coverage." If you prefer to have a hard copy mailed toyour home address, please contact the appropriate insurance companydirectly. Their phone numbers are listed on the M-DCPS website undeImportant Phone Numbers.



Table o Contents

6 Important Phone Numbers and Hours ofOperation

7 Enrollment Checklist8 Benets through the Employee Portal10 How to Enroll Online

FREQUENTLY ASKED QUESTIONS15 Current Employees Open Enrollment Facts17 New Employees Open Enrollment Facts18 Frequently Asked Questions21 Dependent Eligibility24 Dependent Eligibility Documentation

Requirements

25 Domestic Partner EligibilityDocumentation Requirements26 Afdavit of Domestic Partnership27 Adult Child Notice28 Adding/Dropping Dependents During the

Plan Year29 Change in Status Events

HEALTHCARE PLANS

30 Healthcare Q&A

33 OAP 10 - Open Access Plus 10

44 OAP 20 - Open Access Plus 20

55 Healthcare Benets

57 Pre-Certication

59 Guide to Your Explanation ofBenets

62 Prescription Medication Benet63 Declination of Healthcare Coverage

Afdavit64 Florida KidCare

FLEXIBLE BENEFITS

65 Getting FSA Answers

67 Flexible Spending Accounts (FSAs)

69 Medical Expense FSA

71 FSA Worksheets

72 Dependent Care FSA

75 myFBMC Visa CardSM

DENTAL PLANS

77 Dental Comparison Chart

78 SafeGuard Dental DHMO Plans

93 MetLife Dental Indemnity Plan

VISION PLAN

97 UnitedHealthcare Vision Plan

IDENTITY THEFT PLAN

100 ID Watchdog Identity Theft Plan

LEGAL PLANS

102 ARAG Legal Plan

109 US Legal Family Defender

SENIOR LEGAL PLANS

107 ARAG SeniorAdvocateTM

111 US Legal Senior Protector

DISABILITY COVERAGE

114 The Hartford Short-Term Disability116 The Hartford Long-Term Disability

HOSPITAL INDEMNITY COVERAGE

120 Cigna Hospital Indemnity Coverage

VOLUNTARY LIFE INSURANCE

122 MetLife Voluntary Life Insurance

ACCIDENTAL DEATH AND DISMEMBERMENT

124 MetLife (AD&D)

RATES & NOTICES131 Beyond Your Benets132 Creditable Coverage Disclosure Notice133 Rates At-a-Glance



Important Phone Numbers and Hours o Operation

Enrollment Help Line305.995.2777

Enrollment Website24-hours/7 days a week

www.dadeschools.net

Benets InquiryCustomer Care CenterMon - Fri, 7 a.m. - 10 p.m. ET1.800.342.8017

HEALTHCARE PROVIDERCigna24-hours/7 days a week1.800.806.3052www.cigna.com

FLEXPLAN PROVIDERSDental PlansSafeGuard MetLife DHMO PlansCustomer Service/ClaimsMon - Thur, 8 a.m. - 8 p.m. (All Zones)Fri, 8 a.m. - 5 p.m. (All Zones)1.800.880.1800www.metlife.com/mybenets

MetLife Indemnity PlansCustomer Service/ClaimsMon - Thur, 8 a.m. - 8 p.m. (All Zones)Fri, 8 a.m. - 5 p.m. (All Zones)1.800.942.0854www.metlife.com/mybenets

Vision PlanUnitedHealthcare VisionCustomer ServiceMon - Fri, 8 a.m. - 11 p.m. ETSat 9 a.m. - 6:30 p.m. ET1.800.638.3120

Legal PlansARAG Legal Plan Customer CareMon - Fri, 8 a.m. - 8 p.m. ET

1.800.360.5567ARAGLegalCenter.com,Access Code: 10287mdsSeniorAdvocateTM Plan

ARAGMon - Fri, 8 a.m. - 8 p.m. ET1.800.360.5567ARAGLegalCenter.com,Access Code: 10287mds

US LegalFamily ProtectorCustomer Service1.800.356.LAWSAvailable 24/7

www.uslprotects.com/members/family-protector/mdcps

Senior ProtectorCustomer Service1.800.356.LAWSAvailable 24/7www.uslprotects.com/members/family-protector/mdcps

The Short-Term & Long-Term DisabilityPlansHartford Life and Accident Insurance

CompanyCustomer Service 305.995.4889To File a Claim 1.800.741.4306Medical Underwriting 1.800.331.7234www.thehartfordatwork.com

Identity Theft PlanID Watchdog, Inc.Customer Service1.800.970.5182Mon - Fri, 8 a.m. - 6 p.m. (MST)www.idwatchdog.com

Hospital Indemnity CoverageLife Insurance Co. of North America(A Cigna Company)Customer Service/ClaimsMon - Fri, 7 a.m. - 10 p.m. ET1.800.342.8017

Voluntary Life Insurance andAccidental Death and Dismemberment(AD&D)MetLife Voluntary Life ClaimsCustomer Service305.995.7029Mon - Fri, 8 a.m. - 8 p.m. ET1.800.638.6420, option #2

Flexible Spending Accounts &myFBMC Card Visa CardFringe Benets ManagementCompany, a Division of WageWorks*Customer Care Center & myFBMC Card

Activation1.800.342.80171.800.955.8771 (TDD)Mon - Fri, 7 a.m. - 10 p.m. ETwww.myFBMC.comAutomated Services - 24/71.800.865.3262Lost or Stolen myFBMC Card- 24/71.888.462.1909

401(k)VISTA 401(k) PlanP.O. Box 1878Tallahassee, FL 32302-1878Customer Service1.866.325.12781.850.425.8345 (FAX)1.800.213.2310 (IVR)E-mail: [email protected]

OTHER IMPORTANT NUMBERSFor general benet and enrollmentinformation throughout the year

Miami-Dade County Public Schools

The Ofce of Risk and Benets ManagemenAutomated Phone SystemMon - Fri, 8 a.m. - 4:30 p.m. ET305.995.7129305.995.7130305.995.7190 FAX

Ofce of Retirement/Leave/Unemployment305.995.7090

Payroll Deduction ControlAutomated Phone SystemMon - Fri, 8 a.m. - 4:30 p.m. ET

305.995.1655305.995.1644 (FAX)

Life InsuranceMetLife Group Life ClaimsCustomer Service305.995.7029Mon - Fri, 8 a.m. - 8 p.m. ET1.800.638.6420, option #2

Florida KidCare1.888.540.5437www.oridacare.org* Third Party Administrator for the M-DCPS Fringe Benets Program.



Enrollment Checklist

Document PreparationHave the following supporting documentation on hand to help you successfully complete your online enrollment. Use the checklist below to preparefor your open enrollment.

Checklist to Enroll Online

Your M-DCPS Portal Username and Password Your Date of Birth

Your Social Security Number

Beneciaries Name

Beneciaries Relationship

Beneciaries Percentage of Coverage and Contingency

Dependents Name

Dependents Date of Birth

Dependents Relationship

Dependents VALID Social Security Number

You and your dependents Primary Dental Provider (PDP) if selecting the Safeguard DHMO Standard or High Plan

Disable the Pop-Up-Blocker on your computer to allow your Conrmation Notice to display at the end of your enrollment session.

If electing to decline healthcare coverage, proof of other group or state-funded healthcare must be submitted to FBMC. Proof must include theeffective date of group coverage. Otherwise, coverage will be terminated and the employee will automatically be assigned to Cigna OAP 20

employee-only coverage. Proof of dependent eligibility must be submitted to FBMC for all newly added dependent(s). Otherwise, coverage may be terminated for any

dependent whose eligibility has not been veried, claims incurred will not be paid and any premiums deducted will not be automatically issued



www.dadeschools.net

Benets through the Employee Portal

Taxation of Board-Paid BenetsTaxation of monthly Board dependent subsidy toward any type ofdomestic partner coverage occurs every month on the last paycheck

of the month.

Employees enrolled in either medical, dental or vision coverage for adomestic partner or domestic partner and family will have the deductiontaken from the employee's paycheck as a post-tax deduction.

The cost of Board-paid Life Insurance in excess of $50,000 will be taxedon every paycheck.

The taxable benets are:1) The cost of life insurance premiums in excess of $50,000.00,

which are paid/subsidized by the Board.2) The monthly contribution (subsidy) that the Board pays on the

employees behalf for any type of Domestic Partner coverage and/or children of the domestic partner.

Medical Opt OutEmployees who have declined to participate in the Districts medicalinsurance plan (Medical Opt Out) will receive $100.00 per month, basedon the employee's deduction schedule, as follows:

1) 10-month employees will receive their payment in 20 bi-weeklypay checks.

2) 11-month employees will receive their payment in 24 bi-weeklypay checks.

3) 12-month employees will receive their payment in 26 bi-weekly

pay checks.

Employees Returning to Work After aLeave StatusEmployees in a Board-Approved Leave of Absence will be billedfor employee-paid benets in accordance to the type of leave. Thebenets for which you have been billed will be cancelled if paymentis not received by the end of the Grace Period. If an employee returnto work prior to receiving a Grace Period Notice, the premiums duewill be automatically deducted from your bi-weekly check (one reguladeduction plus one arrears) until the full amount of the outstandingpremiums are paid in full.

Viewing your Benets in SAPListed below are steps to view your benets in the new SAP system:

1. Log-on to dadeschools.net, then the employee portal

2. Click on the ERP Tab3. Click on the Employee Self Service tab

4. Click the Benets link

5. Then, click on Participation Overview

6. You may view benets as of a specic period of time by clickingon the box "display your benets as of." Please note, benets prior toNovember 1, 2011, will not be available.



Login to Employee Portal

Step 1: Click onERP Tab

Step 2: ClickEmployee Self Service Tab

Step 3: ClickBenefits Tab

Step 4: Click onDependents/Beneficiary

To add or edit Dependents/Beneficiaries (please note that you are not able to

delete records from SAP).

Steps to Update Beneciaries

www.dadeschools.net

Benefts through the Employee Portal



www.dadeschools.net

How to Enroll Online

Before You Start Your Web EnrollmentPrior to enrolling in your benets online, it is to your advantage to thoroughly review this reference guide. If you are ready to enroll, but needassistance, contact the Enrollment Help Line at 305.995.2777 (to connect to the Fringe Benets Management Company, a Division of WageWorks,

Customer Care Center). Once you have the answers you need, you may begin the enrollment process.

Before you begin your enrollment session it is important for you to disable the "Pop-Up-Blocker" of your computer. If you do not take this step,you will not be able to print your Conrmation Notice at the close of your enrollment session.

Your District Account StatusPrior to accessing your Employee Portal, you need to be aware of thestatus of your District account and the process for accessing Openenrollment information.

Different situations will apply:

1. If you actively used your district account to access the portal or District

e-mail within the past 180 days, NO ACTION IS NECESSARY. Youraccess will remain the same.

2. If you have not used your District account in more than 180 daysto access the portal or District e-mail, your account is inactive. OnFebruary 24, 2012, Information Technology Services (ITS) willreactivate your account. After the reactivation occurs, you will haveaccess using the following login credentials:

Username-YourEmployeeNumber(Example-123456)

Password-Yourbirthmonth(2digits),birthyear(4digits)andyourrstnameinitialandlastnameinitial(Example:011952DG).

3. If you have never used your District account to access the portal oDistrict e-mail, your account is inactive. On February 24, 2012 ITSwill reactivate your account. After the reactivation occurs, you wilhave access using the following login credentials:

Username-YourEmployeeNumber(Example:123456)

Password-Yourbirthmonth(2digits),birthyear(4digits)andyour

rstnameinitialandlastnameinitial(Example:011952DG)

4. For all reactivated accounts, once your account is active and youattempt to sign on, you will be required to change your passwordusing the District's Password Management tool, P-Synch. Instructionfor this process and to reset can be found at http://www.dadeschoolsnet/passwordreset/passReset.asp?lang=en-us.

1How to Log OnLog on to the Miami-Dade County Public Schools homepage

at www.dadeschools.net and click on the following buttons:

2012 Open Enrollment button, then the

log onto the Employee Portal

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4Begin your Open EnrollmentYou will automatically be logged into Premier Enroll. Click the"Open Enrollment - 2012 Benets" link.

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How to Enroll Onlinewww.dadeschools.net

2Enter your Login Username and PasswordNOTE: The first time you log in, enter your Employee Number andpassword (Check your District Account Status on the previous page forpassword details).

Password - Your birth month (2 digits), birth year (4 digits) and your first nameinitial and last name initial (Example: 011952DG)

Once logged in, click on the Employee Info tab at the top of the page.

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M-DCPS Employee info PageYou will be prompted to fill in the last 4 digits

of your Social Security Number, then click the greenSubmit button. A

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5Verify your Demographic InformationBegin your enrollment by verifying your demographic information. If you needto update your address, you may do so through the Employee Self Service (ESS) of SAP at

the Empoloyee Portal at the www.dadeschools.net home page.

Click the Start Benet Election button to begin benet selection for your dependents.

Note the following important information regarding dependent information:

Dependent Social Security numbers are required during Open Enrollment. If your

dependent's SSN is not provided, your dependent's coverage cannot be processed.

You will not be allowed to change any Social Security Numbers or Date of Birth for

any dependents that are already in the system.

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Once your demographic information is correct, clickon the "Start Benet Election" button.

6Select Employee Healthcare CoverageIf you are a current employee who is eligible for Healthcare coverage, you will

see the screen at the right. Choose your Healthcare plan and type of coverage or decline

medical coverage. Select dependent coverage after you select your healthcare plan or

decline healthcare coverage.

For the OAP 10 Plan, the rate displayed includes your Cost Share amount, which is

dependent on your base salary.

NOTE: If you do not successfully complete your enrollment information before the Open

Enrollment deadline, your current current benets will terminate March 31, 2012.

To decline School-Board provided Healthcare benets, you must select to decline

Healthcare coverage and agree to the provision set forth on the afdavit. In lieu of Board-Paid healthcare coverage, you will receive $100 per month paid bi-weekly through thepayroll system based on your deduction pay schedule (subject to withholding and FICA)as follows:

10-month employees will receive their payment in 20 pay checks. 11-month employees will receive their payment in 24 pay checks. 12-month employees will receive their payment in 26 pay checks.

NOTE: If you do not nish your enrollment, your current benets will terminate March

31, 2012 with the exception of your auto-assignment to Cigna OAP 20 healthcare

plan coverage. Your employee cost is based on your salary band. Mid-plan year salaryband changes do not qualify for a change in your employee cost.

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www.dadeschools.net




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Review Your Employee Benets Summary

After you have lled in all your enrollment information, review your selectionson the Summary of Benets Selection Page.

In order for your selections to be saved, youMUSTcomplete all of the following:

Agree to the terms and conditions (Check the box.)

Enter your name for Step 1.

Verify and enter the pre-tax deduction amount for Step 2 (Deductions are post tax, as

displayed).

If you do not complete these steps, your current benets will terminate March 31, 2012 and

you will automatically be assigned to Cigna OAP 20 employee only healthcare coverage.

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7Dependent Healthcare CoverageIf your dependents had benets coverage during the 2011 Plan Year, review thelisted dependent(s) on this screen for accuracy and be sure all dependent Social Securitynumbers and birth dates are correct. Add new dependents and their SSN as necessary.

If you are selecting Life Insurance or other benets, enter your Beneciary Information

on this screen.

If an ex-spouse appears in your dependent list, change the relationship from spouse to

ex-spouse. This will allow you to add your current spouse or update your ex-spouse's

information.

NOTE: If you are covering the children of your Domestic Partner, you must also cover your

Domestic Partner. Select "Employee, Child(ren), Domestic Partner and Domestic Partner

children" for the level Employee & family w/ Domestic partner; and Select "Employee,

Domestic Partner and Domestic Partner child(ren)" if you are not covering any of your own

children.NOTE:If you do not successfully complete your enrollment information before

the Open Enrollment deadline, your current benets will terminate on March 31, 2012

and you will be auto-assigned to Cigna OAP 20 Employee Only healthcare coverage.

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8Dental CoverageIf you select SafeGuard, a MetLife company, Standard DHMO Plan or HighDHMO Plan, you must enter a Primary Dentist Facility Number. If you do not know the

facility number, you can enter "9999" to assign coverage without a facility number.

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www.dadeschools.net




10Saving Your Enrollment RecordOnce you have reviewed your Benets Summary and veried that all

information is correct, thenclicktheConrm&Submitbutton.

A conrmation notice is automatically generated and presented at the end of your

enrollment session.

A

Printthispageforyourrecords.

11Review Your Conrmation StatementYou can view and print your Conrmation Statement immediately after

you have saved your benet selections. You will not receive another printed Conrmation

Statement. Please print a copy for your own records.

Sample Electronic Conrmation StatementUpon printing your Conrmation Statement, review it carefully for accuracy. Any benet

changes must be made online. After your enrollment deadline, enrollment changes will

be on an appeals basis only.

Current employees: To appeal an enrollment selection, you must go to the Ofce of

Risk and Benets Management at 1501 NE 2nd Avenue. Suite 335 in person before the

beginning of the Plan Year, April 1, 2012.

No faxes or phone calls are accepted.

NOTE: If your Conrmation Statement does not match your enrollment selections, please

contact the Customer Care Center at 1.800.342.8017, 7 a.m. to 10 p.m. ET. Current

Employees: Requests for all corrections, changes or appeals must be made prior to the

commencement of the plan year. NO EXCEPTIONS WILL BE ALLOWED.

New employees: Requests for all corrections or changes must be made within seven

days of receiving your Conrmation Statement.

You may make changes to your online selections as many times as you wish until the end of your enrollment period. However, make sure to close

all windows prior to re-enrolling to avoid errors on selections saved.

If you enroll multiple times, your enrollment selection for the 2012 Plan Year will be your last submission.

www.dadeschools.net




CURRENT EMPLOYEE Open Enrollment Facts

1Q. What is the Open Enrollment Period?A.The Open Enrollment Period is a period of time, determined by youremployer, during which you are allowed to make any changes to yourcurrent benets. This year is 2/27/12 - 3/9/12 for employees representedby Bargaining Units, UTD (1, 3), AFSCME (4), DSCMEC, (5) MEP and CEP(6). The remaining bargaining units enrollment are pending negotiations.

NOTICE: No changes are allowed after the commencement of a newplan year (see Page 29 for the Change in Status section for exceptions).

2Q. Must all eligible employees enroll forbenets effective April 1, 2012?A.Yes. This is a mandatory enrollment. Your current benet coveragewill not continue. If you do not enroll, you will be automaticallyenrolled in Cigna Open Access Plus 20 and Standard Short-Term

Disability. Your dependent coverage and exible benets will beterminated on March 31, 2012.

3Q. What if I decline healthcare coverage?A.If you are opting out of M-DCPS healthcare, you must providedocumentation of other group healthcare coverage. If documentationis not produced, you will be automatically assigned to Cigna OAP 20employee only coverage.

4Q. What do I need to submit to ensurethat my dependents have coverage?A.If you currently cover or plan to cover your dependent(s),

including domestic partners, you must provide their Social SecurityNumber or they will NOT be covered. You will need to submitdependent eligibility verication before the start of this plan year.

5Q. What is my effective date whenenrolling during the enrollment period of2/27/2012 - 3/9/2012?A. The effective date for these benets is 4/1/12 and the rst deductionwill be take on payroll 4/6/12.

6Q. If I am hired during this OpenEnrollment period, must I enroll forthe current plan year as well as the nextplan year?A.You will be automatically assigned to Cigna OAP 20 Employee Only.You must enroll for benets effective April 1, 2012.

7Q. What changes can I make during theOpen Enrollment?

A. During this period, you may purchase benets, delete or adddependents. Any dependent child who turned 26 in the year 2011(born in 1985)* cannot be covered or be added for 2012 Benets duringthe Open Enrollment period as a regular dependent. See Page 26 foprovision for adult dependents. If a covered dependent is disabledproof must be submitted in order for coverage to continue beyond 26years of age.

Disabled Children: Coverage may be kept in force beyond the age limifor any child who becomes totally disabled while covered under anyof the plans. However, if coverage is terminated, it can never again bereinstated. Proof of disability must be provided to FBMC - 1501 NE 2ndAvenue, Suite 335, Miami, FL 33132.

8Q. How will I know when to enroll?A. You will be permitted to enroll during your Bargaining Unit's OpenEnrollment period. You will receive an e-mail specifying your BargainingUnit's enrollment dates.

9Q. When is the last day to enroll forbenets effective, April 1, 2012?A. You must complete your online enrollment selections by midnighon March 9, 2012.

10Q. What happens if I do not enroll by

the enrollment deadline?A. If you do not re-enroll by the end of the Open Enrollment periodyour current benets and those of your dependents will terminate onMarch 31, 2012. You will be automatically assigned to Cigna OpenAccess Plus 20 healthcare and Standard Short-Term Disability. Yourcurrent employee-paid benets (including dependent benets) wilterminate on March 31, 2012.

11Q. What if I do not have a computer orInternet access available?A.If you do not have access to the Internet, you may visit the Ofce oRisk and Benets Management for assistance at 1501 NE 2nd Avenue

Suite 335. Enrollment Assistance is available weekdays from 8 a.m. to4:30 p.m., during this Open Enrollment period.

12Q. What if I enroll and I want to changemy benets selection?A. You may log on to the Internet and change your benets selectionas many times as you want throughout the Open Enrollment periodYour last saved and submitted selection will be your benets effectiveApril 1, 2012. Changes made during the Open Enrollment period o2/27/2012 - 3/9/2012 will be effective 4/1/2012.



CURRENT EMPLOYEE Open Enrollment Facts

13Q. Can I decline Healthcare coverage?A. Yes. You may decline Healthcare coverage. You must provide proofof other group healthcare coverage. Enrollment in individual does notqualify. Additionally, you must agree to the provision set forth on theafdavit. Refer to Page 63.

14Q. If I decline Healthcare coverage,what happens to the Board contributiontoward my healthcare coverage?A. In lieu of healthcare coverage, you will receive $100 per month paidon a bi-weekly through the payroll system based on your deduction payschedule (subject to withholding and FICA) as follows:

10-month employees will receive their payment in 20 pay checks.



If you do not provide proof of other group healthcare coverage, you willbe automatically assigned the Cigna Open Access Plus 20 (employeeonly) healthcare plan and standard Short-Term Disability.

If electing during this Open Enrollment to decline healthcare coverage,you are required to submit proof of enrollment in other group or state-funded program, even if previously submitted.

15Q. Can I select coverage for myselfthrough one Healthcare Plan and another

for my family?A. No. You and your eligible dependents must be covered with thesame healthcare plans.

16Q. Can I select coverage for myselfthrough one FlexPlan benet provider andanother for my family?A. No. You and your eligible dependents must be covered with thesame FlexPlan benet and provider.

17Q. How do I view the Cigna Healthcareor FlexPlan Provider Directories?A. Go to the www.dadeschools.net Employee Link button, then clickon the Provider Directory of the company you desire.

Conrmation o Benets18Q. Will I be able to view and print

a conrmation of my 2012 benetsselection?A. Yes. Everyone will be able to view and print their ConrmationStatement online immediately after benefit selections are savedsuccessfully.

A conrmation notice is automatically generated and presented at theend of your enrollment session.

Eective Date o Coverage19Q. When are benets for the new plan

year effective and for how long?A.This enrollment is for benets effective 4/1/12 - 12/31/12Changes made during the Open Enrollment Period of 2/27/12- 3/9/12 become effective 4/1/12 and will continue through12/31/12 as long as your full-time employment continues.

Termination DateShould employment terminate, coverage will cease at the end of thecalendar month in which employment terminates. Benets will remainin effect through August 31 for 10-month employees who terminateemployment during the last month of the school year.

NOTE: An individual who loses coverage under the plan becomesentitled to elect COBRA. The individual has the right to continue his oher medical, dental and vision coverage under COBRA law for a period o18 months and/or Medical Expense FSA deposits until the end of the planyear following termination of employment. The individual must notifythe COBRA Specialist at the Ofce of Risk and Benets Management.



NEW EMPLOYEE Open Enrollment Facts

You will receive an e-mail notifying you that your enrollment applicationis available.

Open Enrollment FactsFor New Employees1Q. Must all new employees enroll?A.Yes. You must complete your enrollment by logging on to www.dadeschools.net.

2Q. What is the deadline for completingmy online enrollment?A. The deadline date is indicated on the cover memo in your benetspackage. Enrolling in this time frame will ensure that you receive the

benets of your choice.

3Q. Can I elect not to be covered?A. In lieu of healthcare coverage, you will receive $100 per monthpaid on a bi-weekly through the payroll system based on your deductionpay schedule (subject to withholding and FICA) as follows:




If you do not provide proof of other group healthcare coverage, you willbe automatically assigned the Cigna Open Access Plus 20 (employee

only) healthcare plan and standard Short-Term Disability.If electing during this Open Enrollment to decline healthcare coverage,you are required to submit proof of enrollment in other group or state-funded program, even if previously submitted.

4Q. What if I do not enroll?A. If you do not complete your enrollment in the allotted time: You will automatically be assigned to Cigna Open Access Plus 20

(employee only) healthcare plan and no dependent healthcare. You will automatically receive Standard Short-Term Disability

coverage and Life Insurance at one times your annual base salary(amount is decided per your Bargaining Contract).

You will not have any exible benets (i.e. dental, legal, etc.) and nodependent coverage.

These benets will be effective for the remainder of this plan year aslong as your full-time employment with Miami-Dade County PublicSchools continues.

5Q. What if I do not have a computer orInternet access available?

A. If you do not have access to the Internet, you may visit the Ofce oRisk and Benets Management for assistance at 1501 NE 2nd AvenueSuite 335, weekdays from 8 a.m. to 4:30 p.m. ET.

6Q. What if after I enroll I want to changemy benets selection?A. You may change your benets selection as many times as you wishuntil the end of your initial enrollment period.

7Q. Can I select coverage for myselfthrough one Healthcare plan benet andanother for my family?A. No. You and your eligible dependents must be covered with thesame Healthcare plans.

8Q. Can I select coverage for myselfthrough one FlexPlan benet provider andanother for my family?No. You and your eligible dependents must be covered with the sameFlexPlan benet and providers.

9Q. How do I view the Cigna or FlexPlanProvider Directories?

A. Go to the www.dadeschools.net Employee Link button, then clickon the Provider Directory of the company you desire.

Confrmation o Benefts10Q. If electing dependent coverage oremployee-paid benets, when will myrst deduction be taken and what's theeffective date on these benets?A. The rst deduction for benets will be taken on the last paycheckof the month in which you enroll and your benets are processed. The

effective date is the rst of the following month after that rst deductionis taken.



Frequently Asked Questions

Eective Date o Coverage1Q. When are benets for the new plan

year effective and for how long?A. Current employee benets become effective on April 1, 2012 of thisplan year and continue through December 31, 2012 as long as full-timeemployment is continued. Should employment terminate, coverage willcease at the end of the calendar month in which employment terminates.Benets will remain in effect through August 31 for 10-month employeeswho terminate employment during the last month of the school year.

NOTE: An individual who loses coverage under the plan becomesentitled to elect COBRA. The individual has the right to continue his orher medical, dental and vision coverage under COBRA law for a period of18 months and/or Medical Expense FSA deposits until the end of the planyear following termination of employment. The individual must notify

the COBRA Specialist at the Ofce of Risk and Benets Management.

COBRA2Q. When will coverage terminate for mydependent child when he/she reaches age26?A. If your dependent child reaches age 26 in the 2012 Plan Year (bornin 1986), coverage for the ineligible dependent will be terminated atthe end of the current plan year.

Claims will not be paid nor will premiums be automatically refunded

for ineligible dependents:However, you may continue to cover your adult child until the end ofthe calendar year in which the child reaches the age of 30, if the child: Does not have a dependent of his or her own Is a resident of Florida, and Is not provided coverage as a named subscriber, insured, enrollee, or

covered person under any other group, blanket, or franchise healthinsurance policy or individual health benets plan, or is not entitledto benets under Title XVIII of the Social Security Act.

In addition, currently covered adult children who are turning age 30in 2012 are eligible for COBRA and a package will be sent.

Disabled Children: Coverage may be kept in force beyond the age limitfor any child who becomes totally disabled while covered under anyof the plans. However, if coverage is terminated, it could never againbe reinstated. Proof of disability must be provided to FBMC - 1501NE 2nd Avenue, Suite 335, Miami, FL 33132.

3Q. How can my qualied dependentcontinue coverage under medical, dental

or vision plansA. Within 30 days from the date of loss of eligibility, youqualified dependent must notify the COBRA Representative inthe Office of Risk and Benefits Management at 305.995.1285305.995.7137 or 305.995.7169. A qualifying event notice and anapplication will be forwarded to the qualied dependent within 30calendar days.

4Q. How long does the qualieddependent have to make his/her COBRAelections?

A. The qualied dependent has a 60-day period from the date onotication to elect whether to continue coverage. Once a qualieddependent has elected COBRA, he/she has 45 days to pay for thecoverage. COBRA is retroactive if elected and paid for by the qualieddependent. Initial payment must be for coverage of the initial COBRAeffective date for the current month. No payment arrangement can bemade.

5Q. What are the periods of coverage forCOBRA qualifying events?A. If the qualifying event is the employees termination of employmentthe employee, spouse, and dependent child are eligible for COBRAfor up to 18 months; if the event is a divorce or death of a coveredemployee, the spouse and dependent child are eligible for coverage foup to 36 months; and if the event is loss of a dependent child statusthe dependent child is eligible for 36 months.

You may elect to continue your Medical Expense FSA and continue toreceive reimbursements through the end of the plan year. To continueyour Medical Expense FSA, contact a COBRA Representative a305.995.7169, 305.995.1285 or 305.995.7137.

Board-Approved Leave

o Absence

6Q. If I take a Board-approved leave ofabsence, whom do I contact about mybenets?A. Once your leave is approved and the Ofce of Risk and BenetsManagement receives notication, you will be eligible for applicablebenets according to your Bargaining Unit and type of leave. You wilbe billed for employer-paid benets in accordance to the type of leaveand labor contract. Additionally, you will be billed for employee-paidbenets.



Miami-Dade County Public Schools implements the Family and MedicalLeave Act of 1993 (FMLA) through provisions contained in the SchoolBoard Rules and collective bargaining agreement.

For questions regarding your benets while on leave, please call305.995.7129 and ask to speak with a leave billing specialist.

7Q. What if I am unable to pay premiumswhile on leave?A. The benets for which you have been billed will be cancelled ifpayment is not received by the due date and any claims incurred willnot be paid unless otherwise provided by law. If you return to work andyour coverage is still active, owed premiums will automatically be takenfrom your paychecks.

Cancelled employer-paid benets will be automatically reinstated uponyour return to work. However, in order to reinstate any employee-paidbenets cancelled due to non-payment while on leave, you must requesta Change in Status Election form. See the Changes in Status eventinformation on Page 29 for further details.

Benefts at Retirement8Q. If I retire, whom do I contact forbenets information?A. When you complete your retirement papers, the Retirement Ofcewill notify the Ofce of Risk and Benets Management and a packagewill be mailed to your home containing the information you need tocontinue your Healthcare coverage, life insurance benets and exible

benets plans after you retire.

You will have 30 days from the date of notication to select your benets.Only those dependents which were covered under your medical andexible benets plan at the time of your retirement will be eligible tocontinue coverage. You may add or drop dependents during the annualOpen Enrollment for retirees. You may only continue life insuranceand accidental death and dismemberment at the same level in effectat your retirement. If you retire while on a leave of absence and haveno active healthcare and/or exible benets at retirement, you will notbe eligible to enroll in any benets not in effect. If you retired and haddeclined healthcare coverage, you will not be eligible to enroll as aretiree in healthcare coverage, even if you are Medicare eligible. You may

contact the Ofce of Risk and Benets Management at 305.995.7129for questions.

Termination o Employment9Q. Does my insurance coverage endwhen I terminate my employment?A. Benets for you and your dependents continue to the end of thecalendar month in which you terminate employment. However, benetsfor 10-month employees who terminate at the end of the school yearremain in effect through August 31, provided they work during the lastmonth of the school year.

NOTE: Benets for which total premiums have not been collected cannobe continued after termination of employment.

10Q. Can I continue my own and mydependents medical, dental and visioncoverage if I terminate employment?A. Yes. According to federal and state law, you can continue youown and/or your dependents coverage for currently enrolled medicaldental and/or vision for a period of 18 months following a terminationof employment by applying for COBRA. You will be notied of theserights when you terminate; or you can call the Ofce of Risk and BenetsManagement at 305.995.7169, 305.995.1285 or 305.995.7137. andspeak to a COBRA Representative to inquire further on what benetswill be available to you.

11Q. Can I continue my Board Lifeinsurance if I terminate?A. You may apply for a conversion policy for all or any portion oyour or your dependents life insurance in effect at termination. Youmust complete a conversion application, which is available fromMetropolitan Life Insurance Company by calling 305.995.7029 within31 days of termination.

12Q. What happens to my FSA contributionsif I terminate employment or retire?A. If you terminate employment or retire, your FSA contributions wilstop with the pay period preceding your last day of employment anduse of your Payment Card will be suspended. You cannot continue tosubmit expenses incurred after your benets end date for reimbursemenfrom your Medical Expense FSA unless you continue to make post-taxcontributions to your account through COBRA. Eligible Dependent Careexpenses incurred after termination of employment are reimbursableuntil funds in your account are exhausted.

Remember, you have until April 15, 2013, to submit a request foreimbursement for expenses incurred before your benets end date. Seethe Flexible Spending Accounts section of this guide for more details.

Claims and Claim Forms

13Q. What claim form must I complete formy dental and vision benets?A. Claim forms are available at the Ofce of Risk and BenetsManagement or online at www.dadeschools.net and click on EmployeeBenets, then on the Claim Form link.

14Q. When do I request a claim form formy Short-Term and Long-Term Disability?A. The Hartford must receive notication no later than 90 days afteyour elimination period. You must notify The Hartford at 1.800.741.4306




How does the Flexible Benefts

Plan aect other benefts?Your Retirement BenetsYour contributions to the FlexPlan do not reduce your future FloridaRetirement System (FRS) benets or current contributions to FRS.

Tax Sheltered AnnuityParticipating in the FlexPlan does not affect your Tax Sheltered Annuity(TSA) contribution. That is, FlexPlan contributions do not reduceincludable compensation* from which the maximum deferrable amountis computed under the 403(b) plan.

*Includable compensation is the gross income shown on your W-2 form.

Social Security

Social Security consists of two tax components: the FICA or OASDIcomponent (the tax for old-age, survivors, and disability insurance)and the Medicare component. A separate maximum wage to which thetax is assessed applies to both tax components. There is no maximumtaxable annual wage for Medicare. If your annual salary after salaryreduction is below the maximum wage cap for FICA, you are reducingthe amount of taxes you pay and your Social Security benets may bereduced at retirement.

However, the tax savings realized through the Flexible Benets Plangenerally outweigh the Social Security reduction. Call the CustomerCare Center at 1.800.342.8017 for an approximation.

Itemized DeductionsThe portion of your salary set aside for benet premiums and FSAsthrough the FlexPlan will not be included in the taxable salary reportedto the IRS on your W-2 form. However, your contributions to yourDependent Care FSA will appear on your W-2 form for informationalpurposes only. You will not have to claim these payments as deductionsat the end of the year. Your pre-tax FlexPlan reductions cannot be usedas itemized deductions for income tax purposes at the end of the year.

Pre-tax/Post-taxEmployees who wish to have their 2012 premiums deducted POST-TAXmay do so by indicating so during their enrollment. If a selection is notmade, applicable deductions and employer contributions will continueon a pre-tax basis. Regardless of your selection, Flexible Spending

Accounts are always PRE-TAX. Your Legal Plan, SeniorAdvocate Plan,and Long-Term Disability (LTD) are always POST-TAX.

When an employee elects pre-tax deductions, all employee-paidpremiums will be taken prior to federal withholding tax. All benetsare subject to pre-tax deductions except those that are not exempt fromtaxation Legal Coverage, LTD and the SeniorAdvocate Program. Whenan employee elects post-tax deductions, all employee-paid premiumswill be taken after federal withholding tax has been taken. All benetsare subject to post-tax deductions except those that are exempt fromtaxation.

If you elect to upgrade your Board-Paid Standard Short-Term Disabilityplan, your premiums will be deducted on a PRE-TAX basis and you wilreceive a W-2 form for the calendar year in which benets were paid

However, if your premiums were paid on a POST-TAX basis, benetspaid to you will not be taxed. The premiums paid by the School Boardfor the Standard Short-Term Disability plan will be on a PRE-TAX basis

A Domestic Partner and the child(ren) of a Domestic partner are eligibleAccording to IRS (Internal Revenue Service) Section 125 Regulationsall deductions for employee-paid benets for domestic partner coveragemust be taken on a post-tax basis. Additionally, employees must pay thetax liability on the monthly contribution (subsidy) the Board pays on theemployees behalf for any type of Domestic Partner coverage. Thereforethe value of these benets will be added to your taxable income andyour W-2 will be adjusted to reect the higher income level annually.

** Please see each product page for specic dependent eligibility informationEligibility for healthcare, dental, and vision will be verified by thecontract administrator, FBMC Benets Management. For a list of requireddocumentation, see Page 24. If proof is not submitted by 3/31/12, thedependent coverage will be terminated and claims will not be paid. Idependent coverage is terminated and premiums were deducted, refunds wilnot be automatically issued. To request a refund, if applicable, contact PayroDeduction Control at 305.995.1655. All other benets will be veried by theindividual insurance company at the time a claim is led. Please refer to Page24 for required documentation.

Over-the-Counter ExpensesOTC medicines and drugs, including bulk purchases, must be used inthe same plan year in which you claim reimbursement for their costThe list of eligible OTC categories will be updated on a quarterly basisby FBMC. It is your responsibility to remain informed of updates to

this listing, which can be found at www.myFBMC.com. As soon as anOTC item, medicine or drug becomes eligible, it will be reimbursableretroactively to the start of the then current plan year.

Newly eligible OTC medicines and drugs are not considered a validchange in status event that would allow you to change your annuaMedical Expense FSA election or salary reduction amount. Be sure tomaintain sufcient documentation to submit receipts for reimbursementYou may resubmit a copy of your receipt from your records if a rejectedOTC expense becomes eligible for reimbursement later in the sameplan year.

Eligible Over-the-Counter (OTC) drugs and medicines require aprescription from your physician to qualify for reimbursement. Its

important to remember that you can still use your FSA funds for othereligible medical expenses and prescription purchases at pharmaciesNon-drug and non-medicine items that aren't subjected to new OTClaws may still be purchased normally. Please visit www.myFBMC.comfor more information. If you have any questions, please contact theCustomer Care Center.



21/138www.myFBMC.com21 www.myFBMC.com

Dependent Eligibility

Who Is Eligible or Coverage*

Who is an eligible dependent? An eligible dependent is dened as:Spouse: Your spouse is considered your eligible dependent for as longas you are lawfully married.

Domestic Partner: Your Domestic Partner is eligible for coverage aslong as he/she: is of the same or opposite sex shares your permanent residence has resided with you for no less than one year is no less than 18 years of age and is not related to you by blood

in a manner that would bar marriage under applicable state laws is nancially interdependent with you and has proven such

interdependence by providing documentation of at least two ofthe following arrangements:

joint mortgage or lease for a residence joint ownership of a motor vehicle joint bank or investment account, joint credit card or other

evidence of joint nancial responsibility a will and/or life insurance policies which designates the other

as primary beneficiary, beneficiary for retirement benefits,assignment of durable power of attorney or health care proxy.

To add a Domestic Partner, an employee must register, under applicablestate or municipal laws or provide a duly sworn Afdavit of DomesticPartnership conrming the eligibility above. In addition, the denitionof domestic partner will be met as long as neither partner:

Has signed a domestic partner afdavit or declaration with anyother person within 12 months before designating each other asdomestic partner

Is not legally married to another person, or Does not have any other Domestic Partner, spouse or spouse

equivalent of the same or opposite sex.

NOTE: A Domestic Partner and the child(ren) of a Domestic Partner areeligible. They do not qualify for IRS Section 125. All employee-paidbenets will be on a post-tax basis. Additionally, you must pay thetax liability on the monthly contribution (dependent subsidy) that theBoard pays on your behalf. Therefore, the value of these benets will beadded to your taxable income and your W-2 will be adjusted to reectthe higher income level annually. Domestic Partners or their child(ren)who do not meet the eligibility criteria, will have benet(s) coverage

terminated and any claims incurred will not be paid. All other selectedemployee-paid benets will continue for the remainder of the plan yearon a post-tax basis. The Domestic Partner must also be included in thatcoverage. Domestic Partners and/or their children do not qualify aseligible dependents for FSA Reimbursement.

Children: Children can include natural born children, stepchildren,adopted children and children for whom you have been appointedlegal guardian. Children of your Domestic Partner are eligible forcoverage only if the Domestic Partner is also included in the coverage.

For Healthcare, Dental and Vision benets: your dependent ieligible for coverage through the end of the year that they turn26. Coverage applies whether they are/are not married or is/is

not a student. For the full denition of an eligible child, view theFSA FAQs at www.myFBMC.com.

For all other benets, your unmarried children are eligible frombirth until the end of the year in which the child reaches age25, if the child is: (1) dependent on you for support; or (2) livein your household; or (3) is enrolled full time or part time in anaccredited school, college or university.

Newborn Children: A natural born child, adopted child, the child of youDomestic Partner, or a child for whom you have been appointed legaguardian who is born or becomes eligible while a policy is in effecwill be covered from date of birth/event. However, coverage is noautomatic. You must request a Change In Status Election form within30 days of the event and add your newborn child(ren)'s information

NOTE: Your newborn will be covered free of charge (no premiumfor the rst 31 days. During these 31 days, you are still required tosatisfy the deductible and co-insurance. However, You must call andrequest a Change in Status (CIS) form within the 30 days for coverageto become active. If you request your dependents coverage be terminated within

the rst 31 days, the termination is effective the day you requesit, but or no later than the 31st day, You will have to submit youcancellation in writing.

If you do not submit your dependents termination of coveragein writing, your dependent will remain actively enrolled and youwill be billed from the 32nd day. You will pay the daily newborn

rate till the day prior to the next available payroll, then you wilpay the full prepay deduction. If you add your dependent after the 31st day but within 60 day

from birth/event, your dependent will be effective retroactiveto the day of birth and the you will be charged the full prepaydeduction.

Disabled Children: Coverage may be kept in force beyond the age limifor any child who becomes totally disabled while covered undeany of the plans. However, if coverage is terminated, it cannot bereinstated even during Open Enrollment. Proof of disability (SociaSecurity disability papers) must be provided to FBMC - 1501 NE 2ndAvenue, Suite 335, Miami, FL 33132.

Grandchildren: A newborn child of a covered dependent is eligiblefrom birth until the end of the month in which the child reaches 18months of age. However, if the parent becomes ineligible duringthe grandchilds 18 months eligibility period, coverage for both theparent and the child will terminate.

NOTE: Hospital Indemnity Plan Coverage offered by LINA does nocover grandchildren.

Adult Child: Rules governing dependent coverage have changed. Aprovision in the new Patient Protection and Affordable Care Ac(PPACA) Healthcare Reform allows for an employees dependent tobe covered under the employees healthcare plan until they reach age


22/138www.myFBMC.com 22www.myFBMC.com


26. However, the School Board will continue to provide coverage forregular dependents until the end of the calendar year in which theyreach the age of 26. The dependent will be deemed an Adult Child

the following calendar year. For the full denition of an eligible child,view the FSA Frequently Asked Questions at www.myFBMC.com.Under Florida law, a dependent adult child ages 2630 may beconsidered an eligible dependent for the purpose of healthinsurance.

For medical coverage offered under the M-DCPS plan, you may addor continue to cover your dependent until the end of the calendaryear in which the child reaches the age of 2630, if the adult child: Is dependent upon you for support; Is not provided coverage as a named subscriber, insured, enrollee,

or covered person under any other group, blanket, or franchisehealth insurance policy or individual health benets plan, or isnot entitled to benets under Title XVIII of the Social Security Act.

In addition, the following dependent eligibility documents must besubmitted with your completed enrollment form prior to the adultchild dependent being added to your healthcare coverage: Afdavit of Eligibility Birth certicate or court documents of adoption/guardianship/

legal custody Social Security Number Driver License Number

NOTE: A currently covered adult child will not automatically remaincovered for next year, they must be re-enrolled.



Flexible Spending Accounts

Whose medical expenses can I include in my Medical Expense FSA? Youcan include medical expenses you paid for your spouse or dependent. Aperson generally qualies as your dependent for purposes of the medical

expense deduction if:1) That person lived with you for the entire year as a member of your

household or is related to you2) That person was a U.S. citizen or resident, or a resident of Canada

or Mexico for some part of the calendar year in which your tax yearbegan, and

3) You provided over half of that persons total support for the calendaryear. You can include the medical expenses of any person who is yourdependent, even if you cannot claim an exemption for him or her onyour return. Domestic Partners and their children are ineligible.NOTE: Certain Over-the-Counter (OTC) drugs and medicines requiresa prescription to qualify for FSA reimbursement. Its important toremember that you can still use your FSA funds for other eligiblemedical expenses and prescription purchases at pharmacies.Unaffected OTC items are still reimbursable, as well as affected OTCitems with a doctors prescription. Please visit www.myFBMC.comfor more information. If you have any questions regarding this newlegislation, please contact the Customer Care Center.

Whose dependent care expense can I include in my Dependent CareFSA? Your child and dependent care expenses must be for the care ofa qualifying person.

A qualifying person is:1) Your dependent child who is 12 years of age or younger when the

care was provided and for whom you can claim an exemption,2) Your spouse who was physically or mentally not able to care for

himself or herself, or3) Your dependent who was physically or mentally not able to care for

himself or herself and for whom you can claim an exemption. Seethe Dependent Care FSA section of this guide for more details.

A partial list of eligible dependent care expenses, include: babysitting fees day care services elder care services summer day campsAdditional information is found on Page 72.

NOTE: This account cannot be used to pay for dependent healthcarepremiums. This is not dependent healthcare, but a reimbursementaccount for dependent care expenses.

Online Claims Submission InstructionsFollow these simple instructions to submit your completed claim formand supporting documentation online through www.myFBMC.com.Instructions are also available online, or contact the Customer CareCenter for assistance.

PLEASE NOTE: Acceptable document formats are .pdf .jpg, .bmp or .gif.

Individual le sizes cannot exceed 3 megabyte. Be sure to have your completed claim form and supporting

documentation scanned before beginning the process. Refer to you

scanners instruction manual for information on saving your documentsin the proper format and within the acceptable le size limit

How to Submit your claim:1. To use FBMCs Online Claims Submission process, you must rst log

in to your account at www.myFBMC.com.2. Once you have logged in, click on the Claims tab at the top o

the screen, then choose Online Claims Submission from the dropdown menu.

3. From here, simply follow the online instructions: Choose the account type for which you are submitting a claim. Enter the dollar amount of the claim in the appropriate box. Click Next.

4. Follow the instructions on the next page: Attach your completed and signed claim form. Attach your supporting documentation (receipts, invoices, etc). Click Submit.

5. Be sure to write down the conrmation number for future referenceIf you receive any errors or the conrmation page does not load, iis possible that the le sizes of your scanned documents exceeds 3megabyte or they are not the appropriate document format. Doublecheck the le sizes and make adjustments if necessary by rescanningthe oversized documents and making sure they are .pdf, .jpg, .bmp o.gif les. Contact the Customer Care Center if you have any questions

Important Notice:Please note that your deductions may change during the calendar yeaa result of missed payrolls. If while still employed you miss a paycheckthe system will automatically recalculate your annualized amount andadjust your per pay to assure that your requested annual contributionis satised.



Documentation Requirements


Employee Signature __________________________________________________________________________________ Date _________________________________

FBMC/M-DCPS/0212

Dependent Eligibility DocumentationReturn To: School Mail: US Mail:

WL 9112 Ofce of Risk & Benets ManagementSuite 335 1501 NE 2nd Avenue, Suite 335

Miami, FL 33132Fax To: 305.995.1425

Employee Number ___________________________________________________

Social Security Number _______________________________________________

Employee Name _____________________________________________________

DEPENDENT NAME (print clearly)Last Name First Name MI

BIRTH

DATESOCIAL SECURITY #

RELATION-

SHIPGENDER

DOCUMENT PROOF INCLUDED(birth certicate, marriage certicate, etc.)

Important Inormation Proof of eligibility must be on le for all listed dependents. If proof was not submitted to FBMC previously or if you are adding new dependents

you must submit proof of eligibility with your enrollment form. Otherwise, coveragmay be terminated for any dependent whose eligibility has not been veried. Claim

incurred will not be paid and any premiums deducted will not be automatically issued Print, complete and include this form with the required documentation. If not previously submitted, you must provide your covered dependent's Social Security

number.

Dependent Relationship Documentation Requirements

Spouse Marriage Certificate

Natural Child Birth Certificate (must list employee as a parent) NOTE: birth registration, SS card orpassport is not valid proof

Stepchild Birth Certificate (must list employees spouse as a parent) and Marriage Certificate.

Adopted Child Court Documentation of adoption

Legal Custody or Guardianship Court documentation defining guardianship or legal custody. NOTE: Notarizedaffidavit is not acceptable documentation

Disabled Dependents Over Age 26 Social Security Disability Documentation. Disabled dependents are eligible only ifcovered by a School Board Healthcare plan or Flexible Benefits plan prior to the dateof disability. Additionally, if coverage is terminated, it cannot be reinstated.

Adult Child(between the age of 2630)

Affidavit of Eligibility Birth certificate or Court Documents of Adoption/guardianship/le gal custody Proof of Florida Residence (Florida Driver License)

GrandchildrenFor specific eligibility requirements,see each benefit's page.

UNDER 18 MONTHS OLDBirth Certificate (must list employees child asa parent) NOTE: the parent must be a covereddependent; if not, same as Legal Custody orGuardianship

OVER 18 MONTHS OLDLegal Custody or Guardianshipdocumentation



Documentation Requirements

Domestic Partner Eligibility

Relationship Documentation Requirements

Afdavit of Domestic Partnership and any two of the following, demonstrating a minimum of a

year (12 months) partnership: Joint mortgage or lease of residence Joint ownership of a motor vehicle Joint bank or investment account Joint credit card or other nancial responsibility Will naming the partner as the beneciary Life Insurance policy naming the partner as the beneciary Assignment of durable power of attorney or healthcare proxy

Children of Domestic PartnerBirth Certicate (must list Domestic Partner as a parent) and DomesticPartner documentation as dened above. NOTE: Domestic Partners must be included incoverage. You must select "Employee and Domestic Partner with children" coverage.

Grandchildren of Domestic Partner

Birth Certicate (must list Domestic Partners child as a parent) and children of Domestic Partnerdocumentation as dened above. NOTE: Domestic Partners must be included in coverage. You

must select "Employee and Domestic Partner with children of a Domestic Partner" coverage.Legal Custody or Guardianship documentation

Important InormationProof of eligibility must be provided for Domestic Partner and all listed Children or Grandchildren of Domestic Partner(Include this form with the required documentation).

Employee Number _____________________________________________________

Employee Name _______________________________________________________

Social Security Number _________________________________________________

PRINT AND RETURN BY U.S. MAIL TO:Ofce of Risk & Benets Management1501 NE 2nd Avenue, Suite 335Miami, FL 33132

RETURN BY SCHOOL MAIL TO:Work Location 9112, Suite 335

OR FAX TO: 305.995.1425

Indicate the relationship of your dependent on the form below.

DP = Domestic Partner DC = Child of Domestic Partner DGC = Grandchild of Domestic Partner

DEPENDENT NAME (print clearly)Last Name First Name MI

BIRTH DATE SOCIAL SECURITY #RELATION-

SHIPGENDER

DOCUMENT PROOF INCLUDED(birth certicate, joint mortgage, etc.)

Employee Signature __________________________________________________________________________________ Date _________________________________

FBMC/M-DCPS/0112

Domestic PartnerA copy of the Domestic Partnership Afdavit isavailable on the Open Enrollment website atwww.dadeschools.net.



Afdavit o Domestic Partnership

Sworn to before me this _____________ day of ___________________ , 20 ________ .

The undersigned, being duly sworn, depose and declare as follows:

We are each eighteen years of age or older and mentally competent.

We are not related by blood in a manner that would bar marriage under the laws of the State of . We have a close and committed personal relationship, and we are each others sole domestic partner not married to or partnered with any

other spouse, spouse equivalent or domestic partner.

For at least one year we have shared the same regular and permanent residence in a committed relationship and intend to do so indenitely.

We have provided true and accurate required documentation demonstrating a minimum of a year (12 months) partnership.

Each of us understands and agrees that in the event any of the statements set forth herein are not true, the insurance or Healthcare coveragefor which this Afdavit is being submitted may be rescinded and/or each of us shall jointly and severally be liable for any expenses incurredby the employer, insurer or Healthcare entity.

I understand that, per IRS Section 125, all deductions for employee-paid benets will be taken on a post-tax basis.

I understand that I must pay the tax liability on the monthly contribution (dependent subsidy) that the Board pays on my behalf.

________________________________________________________NOTARY PUBLIC

________________________________________________________Print Name

________________________________________________________Print Name

________________________________________________________Signature

________________________________________________________Signature

Return To: School Mail: US Mail:WL 9112 Ofce of Risk & Benets ManagementSuite 335 1501 NE 2nd Avenue., Suite 335

Miami, FL 33132Fax To: 305.995.1425



Adult Child Notice

Important Notice!!!In order to continue coverage of your currently to enroll your Adult Child, you must re-enroll and re-submit the dependent eligibility documentationby the March 9, 2012 enrollment deadline.

Rules governing dependent coverage have changed. A provision in the new Patient Protection and Affordable Care Act (PPACA) Healthcare Reformallows for an employees dependent to be covered under the employees healthcare plan until they reach age 26. However, the School Board willcontinue to provide coverage for these dependents until the end of the calendar year in which they reach the age of 26. The dependent will bedeemed an Adult Child the following calendar year. For the full denition of an eligible child, view the FSA FAQs at www.myFBMC.com. UnderFlorida law, a dependent adult child ages 26 30 may be considered an eligible dependent for the purpose of health insurance.

For medical coverage offered under the M-DCPS plan, you may add or continue to cover your Adult Child until the end of the calendar year inwhich the adult child reaches the age of 26-30, if the adult child: Is dependent upon you for support; Is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group,

blanket, or franchise health insurance policy or individual health benets plan, or is not entitled to benets under Title XVIII of the SocialSecurity Act.

In addition, the following dependent eligibility documents must be submitted with your completed enrollment form prior to the adult childdependent being added to your healthcare coverage: Afdavit of Eligibility Birth certicate or court documents of adoption/guardianship/legal custody Social Security Number Driver License

NOTE: To continue to cover or add your adult child dependent, you must re-enroll and re-submit dependent eligibility documentation with yourenrollment form. If dependent eligibility is not received, your current covered adult child will be cancelled March 31, 2012.

NOTE: If you do not re-enroll your Adult Child coverage will automatically be terminated March 31, 2012.

Adult Dependent Healthcare Premiums:

Cigna HEALTHCAREPER PAY RATE PER

ADULT DEPENDENT CHILD

Open Access Plus (OAP) 20 10-month $295.80, 11-month $246.50, 12-month $227.54

Open Access Plus (OAP) 10 10-month $322.20, 11-month $268.50, 12-month $247.85

To request an Adult Dependent enrollment package, call the Customer Care Center at 1.800.342.8017, M-F, 7 a.m. to 10 p.m. An enrollmentform and Afdavit of Eligibility will be mailed to your home address the following business day. Your completed form, afdavit, and dependenteligibility documentation must be received by the due date noted on the form.

If you are covering other children, your adult child must be covered under the same healthcare plan, and the adult dependentpremium is in addition to the under age 26 children rate. Adult child rates are not subsidized by the Board.



Adding/Dropping Your Dependents During the Plan Year

1Q. Can I add or delete dependentcoverage and make changes in my benet

elections during the year?A. A participant is permitted to make changes to his or her electionsmid-plan year only for a legitimate Change in Status (CIS). Meaning,on account of and corresponding with a Change in Status that affectseligibility for coverage." If you experience a qualifying CIS Event,the election changes must be requested and submitted with properdocumentation within 30 days from the qualifying event and the changemust be consistent with the type of event. However, you cannot changeyour medical or dental plan insurance provider. You may add dependentsto your existing coverage or delete your dependents. Please refer to theChange in Status events information on Page 29 of this guide.

2Q. If I experience a CIS event, how andwhen must I request the CIS form in orderfor the change to be approved?A. You must call the Customer Care Center at 1.800.342.8017 within30 days from the date of the valid event and request a Change In StatusElection Form.

Documentation supporting the Change in Status must be submittedwith the form. Requests and form submissions made after the 30thday from the valid event date, will not be granted. You will have towait until the following annual Open Enrollment period to make anychanges to your benets.

3Q. When I add dependents through a CISevent, when do their benets become effective?A. Coverage for your dependents becomes effective on the 1st of themonth following your rst payroll deduction, except for newborns**and adopted dependents. Your newborn dependents are covered fromtheir date of birth; adopted dependents are covered effective the dateof placement. Documents validating the CIS event and dependent'seligibility are required at time of request.

** Your newborn will be covered free of charge for the rst 31 days.However, you are still responsible for the claims incurred on thedate of birth. Your newborn child is not automatically enrolled byyour employer or group health plan. You must add your newborn

dependent within 30 days, even if your current coverage includesemployee and children, or employee and family coverage oremployee and Domestic Partner and their child(ren). Dont forgetto include the proper documentation when adding a dependent.See Page 24 through 26 of this guide for more details.

If you request your dependent's coverage to be terminated withinthe rst 31 days, the termination is effective the day you request it,or no later than the 31st day.

If you do not request to terminate your dependent, your dependentwill remain actively enrolled and you will be billed from the 32ndday. You will pay the daily newborn rate till the day prior to thecommencement of the next available payroll, then you will pay thefull premium.

If you add your dependent after the 31st day but within 60 days frombirth, coverage will be effective retroactive to the day of birth andyou will be charged the full premium.

4Q. When I delete a dependent througha Change In Status, when does theircoverage terminate?A. Coverage for your dependent(s) is terminated effective the last dayof the month after receipt of a completed Change in Status Form andsupporting documentation.

NOTE:Any 10-month employee submitting a Change in Status Form aftethe end of the school year will have the form processed with a benettermination date of August 31.

5Q. If I decline School Board Healthcare

coverage, but I lose my other coverage, can Ire-enroll under a School Board plan mid-year?A. You may only enroll in a School Board Healthcare plan mid-year iyou have lost other group insurance coverage. Supporting documentationwill be required. Enrollment in an individual policy does not qualify.

Domestic Partners & their Child(ren)The Internal Revenue Service (IRS) Section 125 Change In Status: Rules andGuidel