• Marriage or divorce
• Birth or adoption of a child
• Dependent no longer eligible (due to age, full independence, or marriage)
• Death of spouse or other dependent
• Spouse's employment begins or ends
• You or your spouse have a change in hours affecting your benefits eligibility
• Relocation into or outside of your plan's service area
• Beginning or end of an unpaid leave of absence taken by you or your spouse
  

Mid year changes to the following benefits plans are permitted ONLY if you have experienced one of the above qualifying events:

• Flexible Spending Accounts (Medical or Dependent Care)
• Health plan
• Dental plan
• Vision plan

Please Note: Appropriate documentation is required for ANY requested change.

  What events are not considered Qualifying Events?
You would not be allowed to make a mid-year change to your benefits plan due to the following reasons:

• You have decided that you don't like the plan you elected
• Your doctor has dropped out of the network
• You did not realize when you enrolled that your doctor is not a network provider
• You can't afford it – unless Lee County has raised your premium at mid-year
• A child not on the plan moves home with you (there must be a loss of insurance)
• Your spouse has had a mid-year increase in premiums and our plan is now cheaper
• Changes for these reasons must wait for Open Enrollment.

  I just got married. Can I add my spouse and/or dependent(s) to my plans?

Yes, but ONLY to the plans in which you are currently enrolled yourself. You may not elect new plans such as Dental, Vision, or Optional Life Insurance for your new dependents/spouse if you do not already have them for yourself.

 

  I just got married. How long do I have to add my spouse and/or dependent(s) to my plan(s)?
You have 60 days from the date of your marriage to add your spouse and/or dependents to your plan. If the 60 days have expired, you must wait until the next Open Enrollment period to add them. Open Enrollment normally occurs mid-October through the first week of November each year. The benefits would become effective on January 1st of the following plan year.

  How do I add my spouse and/or eligible dependent(s) to my insurance plan(s)?
Provide the following documents:

• Enrollment Form(s)    
• Aetna Medical Enrollment Form
• Aetna Dental Enrollment Form
• Vision Enrollment Form
• Optional Life Enrollment Form
• A copy of the ORIGINAL marriage certificate – If you are adding a Spouse to your plan(s)
• Social Security card – Spouse & Dependents
• Birth Certificate – Spouse & Dependents (Spouse only can provide Driver's License in lieu of Birth Certificate)

Separate Enrollment Forms must be completed to enroll your spouse and/or dependents in any of the plans. Please Note: Your spouse and/or new dependents will NOT be added to the benefits plans WITHOUT the documentation.

 

  I just got married and added my spouse and/or eligible dependent(s) to my plan. When will the coverage become effective?
Coverage will be effective the 1st of the month following the date of the event.  Please Note: We CANNOT change the effective date even if you wait the full 60 days to add your spouse and dependents. Payroll adjustments will be made to cover the premiums missed for those first two months.

  I am getting a divorce. How do I drop my ex-spouse from my plan(s)?
The divorced spouse is no longer an eligible dependent and MUST be dropped from your benefits plans.
Within 60 days of the divorce you must complete and submit the following documents:

• Aetna Medical Enrollment/Change form
• Aetna Dental Enrollment/Change form
• Copy of the first & last pages of your final divorce decree

Your ex-spouse's coverage ends the last day of the month in which the divorce is finalized. Ex-spouses are offered COBRA for 36 months. You CANNOT drop a spouse mid-year if the divorce has not been finalized.

Please Note: It is fraudulent to keep a divorced spouse on the benefits plan. Any claims incurred after the end date of coverage will be reversed and your or your ex-spouse will be required to pay FULL charges for those services rendered.

  What will happen if I notify Human Resources of an ineligible spouse or dependent after the 60 day qualifying event period widow?
The spouse and/or dependent will be dropped from your plan(s) the last day of the month in which the qualifying event took place. However, you will continue to pay the higher premium until the end of the calendar year in which the qualifying event took place.

  I'm having a baby. How do I add my baby to my medical plan?
The following documents are required to add your baby to your plan:

• Medical Enrollment/Change form
• Copy of Baby's Birth Certificate
• Copy of Baby's Social Security Card

Before your baby is born you may complete a medical Enrollment/Change form. It will be held in the file until the birth of the baby.  When your baby is born, call us with the baby's name, gender, and date of birth. You have up to 60 days to submit the accompanying required documentation (i.e. SS card, Birth Certificate). You should enroll your baby as soon as possible after birth in order to avoid any claims issues.  Please Note:  Your baby should be enrolled regardless of whether or not you have the required documents.

 

  Can my grandchild be covered under my health plan? If so, what do I need to do?
Grandchildren may be added for a period of 18 months of coverage provided that they are born to your dependent that is covered on your plan at the time of birth.

Refer to the previous question – link to question on adding a baby to the medical plan to see what forms and documents you will
need. You must also complete the Affidavit of Grandchild Eligibility upon enrollment of your grandchild.

  Can I add other family members (e.g. niece, nephew, mother-in-law) as dependents to my plan(s)?
No. We can only cover other dependents if there is court-ordered guardianship/custody. Our plan does not cover any adult dependents other than the legal spouse. Adult dependents that you claim on your federal income tax return are not eligible for coverage under our plan. Exception:  Documented permanently disabled children who were covered on your plans prior to the date they turned 25 years old.

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CHANGE OF NAME
 I just got married. How do I change my name?

• Name Change form
• Social Security Card with your new name
• W-4 form

You will receive new cards from Aetna with your new name. Your new name will also appear on your paychecks and all future communications. Please Note: Your name cannot be changed in Outlook (email) until after your name has been updated in our database. The change to your Outlook name and/or email address is automatic – not optional.

VISION INSURANCE
 Do I need Vision Insurance? 
Your Aetna medical plan covers one eye exam per year. Additionally, Aetna provides a vision discount program called Aetna Vision Discounts. If you want more comprehensive coverage, you can enroll in the Vision Service Plan (VSP) either as a new-hire, or during our annual open enrollment in the fall of each year. VSP is a fully-insured vision care program designed to provide you and your eligible dependents with a variety of benefits including:

Access to the nation's largest eye care provider network.
Coverage for annual eye exam and necessary eyewear (lenses, frames, or contacts).
Discounts on additional eyewear, including contact lenses and laser vision correction surgery.
Coverage for out-of-network providers at higher out-of-pocket costs.

  How do I sign up for the vision plan?
You can only sign up for the Vision Service Plan (VSP) when you are first hired or during Open Enrollment each year.  Complete the VSP Enrollment form. Premiums can be found on our website.

  When I sign up for the vision plan, how does it work?
You will not get an ID card from the VSP. When you are ready to go to the eye doctor, you can visit their website at www.vsp.com to find a participating provider and check out your coverage. You may also call VSP Member Services at 1-800-877-7195. When you have chosen a provider and call to make your appointment, tell the office that you are a VSP member.

Please Note: When you choose eyewear, be sure to take advantage of the extra savings and discounts provided by our plan at no additional cost to you. Click here for more information.

  I didn't sign up for the vision plan. Do I have any vision coverage under the Aetna medical plan?
Yes, our medical plan covers an eye exam every year. Our medical plan does not cover the purchase of eyewear. To find an eye doctor (ophthalmologist or optometrist) visit www.aetna.com and use the DocFind® tool.  Aetna also provides a vision discount program. To learn more about Aetna Vision Discounts sign onto Aetna Navigator and click on Benefits, then Health Programs. You can also call Vision One Customer Service at 1-800-793-8616.

  I'm leaving my job. When does my insurance coverage stop?
Your coverage will end on the last day of the month in which you terminated your employment. Example: last day of work January 2nd – last day of benefits January 31st; OR, last day of work January 30th – last day of benefits January 31st. 

  What is COBRA continuation health coverage?
COBRA is a law passed by Congress that allows you to continue group health insurance coverage that otherwise might be terminated. COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporarily continue their health coverage at group rates.  This coverage, however, is only available when coverage is lost due to certain specific events.  Group health coverage for COBRA participants is more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants pay the entire premium themselves.  It is ordinarily less expensive, though, than individual health coverage.

  What benefits can I continue under COBRA?
You can obtain COBRA benefits for medical, dental, vision, and/or EAP as long as you had the coverage at the time you terminated your employment.

  What do I need to do to get COBRA coverage?
You will receive a letter from Aetna explaining your rights and costs under COBRA. COBRA gives you the right to have a temporary extension of coverage. You will have 60 days to decide whether to elect COBRA coverage. If you elect to have COBRA coverage, you will be given 45 days after electing coverage to pay your first premium.

  When does COBRA coverage begin?
Your COBRA coverage will begin on the 1st day of the month following your termination date. Once you elect COBRA coverage and you pay your first month's premium, your coverage is reinstated retroactively to the date that your active employee' coverage ended. You first payment generally must cover the period of coverage from the date of COBRA election retroactive to the date of the loss of your active employee' coverage. Any claims that you incurred during that period would be covered.  Generally, COBRA may continue for up to 18 months.  Coverage automatically ends if you fail to make the premium payment or when you notify our insurance carrier you no longer wish to participate. 

Please Note:  Make sure your department provides the termination paperwork to HR in a timely manner; otherwise, your COBRA coverage will be delayed.

  What's a HIPAA certificate and why do I need one? 
This certificate is evidence of your coverage under our medical plan. You may need this certificate to:

• Provide evidence of your coverage to eliminate (or reduce) a preexisting condition exclusion period under another plan
• Help you get special enrollment in another plan
• Get certain types of individual health coverage even if you have health problems

  I'm retiring next month. What do I have to do?
New retirees must schedule an appointment with a Benefits staff member to complete retirement paperwork and enroll in the insurance plans they wish to continue. To schedule your appointment, call 533-2363. When you come for your appointment you should bring the following documents with you:

• Birth Certificate
• Driver's License or Picture ID
• Spouse's birth certificate - may be needed, depending on the FRS Retirement option you choose.
  

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RETIREES
  I am already retired. I/my spouse will be going on Medicare soon. What do I need to do?

If you are already retired, you must enroll in Medicare Parts A&B as soon as you are eligible.  Medicare eligibility is the 1st of the month in which a person turns 65; or, after two years of disability.  BoCC employees hired prior to January 1, 2008, who retire and are Medicare Part B entitled, will pay a medical premium reduced by the amount of the monthly Medicare Part B premium.  It is the responsibility of the retiree to notify the Lee County Benefits Unit, and furnish a copy of the Medicare card.  Premium reduction will be effective the first of the month following receipt of the Medicare card. The continuation of this reduction in premium is subject to future Board action.  The County will pay secondary to Medicare whether or not the retiree chooses to take Medicare Part B.

 

  I am retired and want to terminate my insurance coverage with Lee County. What do I have to do?
Like active employees, retirees must have a qualifying event in order to terminate or make a change to their retiree plans.  Medicare eligibility and enrollment is considered a qualifying event.  You have up to 60 days following Medicare enrollment to request the termination of your health plan.

Enrollment in Medicare Part D or any Medicare supplement that includes prescription drug coverage will result in the automatic termination of your health plan.  

Once you have terminated a retiree plan, you may not re-enroll in the plan at any future date.

  I'm retired and live outside of Lee County. How do I find out what Doctors to go to?
Log in to Aetna Navigator, Aetna's web site for members, at www.aetna.com and click on Find Health Care in DocFind®. You may also call the Member Services number on your Aetna ID card. If there are no in-network providers in your area, and you have to see an out-of-network provider, you will pay a deductible and co-insurance.

  How long can my dependents remain covered under my plan?


Eligible dependent children are covered until age 19. Once your child is married, no matter what their age, they no longer qualify as your dependent, and are NOT eligible for coverage. However, they will be offered continuation coverage through COBRA. After age 19, dependents can remain on your plan through age 25 as long as the following conditions are met:

• Child is unmarried
• Child is dependent upon employee for support
• Child is full or part-time student at an accredited college, school, or university
• If not a student, the child is residing with the employee or a custodial parent
• More than 50% of the child's financial support is provided by the employee

If employed, the child MUST NOT be eligible for their own employer-paid benefits
You must complete the Affidavit of Dependent Eligibility once a year. If you do not return the signed affidavit, Aetna may deny or HOLD your child's insurance claims until you have provided proof of the child's continued eligibility as your dependent. Dependents who are over 25 years of age will automatically be dropped from the plan at the end of the year in which they turn 25, unless they are permanently disabled.

Please Note:  It is fraudulent to continue coverage on a child who is no longer eligible under the plan's definition of eligible dependents. 

  My child is no longer an eligible dependent. How can I remove him/her from my plan?
You must complete and submit an Enrollment/Change form removing the child from coverage within 60 days of the date your child becomes ineligible.

• Medical Enrollment/Change form
• Dental Enrollment/Change form
• Vision Service Plan Enrollment/Drop form
• Optional Group Life Insurance Enrollment form

  My child is going away to school. Can he/she still be covered under my plan?
Yes, if your child is eligible, coverage can continue.  He or she will still be able to remain enrolled in your chosen plan with you and/or the rest of the family. Depending on where your dependent resides while in school, his/her out-of-pocket expenses will vary.
In-network: If he/she resides in an area with an open Aetna Select Open Access or Aetna Choice POS II plan, he/she will pay the same co-pays as if they were residing at home.
Out-of-network: If they reside outside of an Aetna Select Open Access or Aetna Choice POS II network area, the coverage is 80/20 – the plan pays 80% and you pay 20% of reasonable and customary charges. Please let the Benefits Team know the address of your out-of-area dependent so that there will be no claims issues as a result of being out of the area.

  What about my dependents covered under my plan? How do I find care for my son or daughter who goes to college outside of the area?
To find care for out-of-area dependents, go to www.aetna.com and click on Find Health Care in DocFind.  If your dependent does not live in an open Aetna network area, he/she will pay 20% of usual and customary charges for the medical services he/she receives.

  Does it cost more for me to cover more than one child?

No. For current medical, dental and vision premiums, click here.

 

  What are pre-tax premiums? Why would I want to elect this option?
You have the option to pay for your portion of most insurance premiums with pretax dollars through convenient payroll deductions. Since your premium payments are deducted before taxes are withheld, you will not pay federal, Social Security, and in many cases, state and local income taxes on this money.

Paying for your benefits on a pretax basis will marginally reduce your Social Security benefits when you retire or if you become disabled. The exact amount of the reduction will depend on the length of time between now and when you draw your Social Security benefits. Studies have show that the savings employees realize through reduced taxes during their career usually make up for any reduction in Social Security benefits.

  How can I know that my premiums are being deducted pre-tax?
Look at your pay stub. The medical, dental, and vision premiums are deducted pre-tax. Optional Life and Short Term Disability are exempt from the pre-tax premium option.

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FLEXIBLE SPENDING ACCOUNTS
  How do I sign up for a Flexible Spending Account (FSA)?

• Healthcare Spending Account Deduction Authorization form
• Dependent Care Reimbursement Plan Enrollment form

If you enrolled as a:
New Hire – This benefit does not become effective until all new employee benefits take effect.
Current employee during Open Enrollment – This benefit becomes effective on January 1st of the following plan year.

  How do I file a claim to be reimbursed through my FSA?
Complete the following form(s) and mail or fax to the address or fax number listed on the form.

• Health Care Reimbursement form
• Dependent Care Reimbursement form
• Over-the-Counter (OTC) Health Care Reimbursement form
  

Make sure your read the instructions carefully on each form and attach the appropriate documentation (i.e. receipts, Explanation of Benefits).
Aetna also provides the following reimbursement options to Lee County employees.  You may enroll in these features online at any time by signing into Aetna Navigator and clicking on Requests & Changes at the top of the home page. Or, you may complete the following forms:

Streamline/Autodebit – Receive your reimbursement without filing a paper claim and pay your out-of-pocket pharmacy expenses automatically
Direct Deposit – Receive your reimbursement directly to your bank account

  How do I enroll in short term disability (STD)?
New Hires: You can sign up for this plan as a new-hire with no Evidence of Insurability required and the benefit becomes effective on the first of the month following one full month of service.

Existing Employees: If you are an existing employee and did not enroll at your new-hire enrollment period, you may apply for this coverage by completing BOTH the short and long STD enrollment forms. There is no guarantee the carrier will approve your application.

  I am going to have surgery next month and would like to use my Short Term Disability (STD) plan to cover my time out of work. How do I file a claim?
To file a claim for STD benefits, call the Benefits Help Desk at 533-2363, and ask to speak to a Benefits team member about using your STD benefits. There are claim forms that must be completed by the employer, employee, and your physician. These forms are not available online.

  How long will it take to receive my short term disability (STD) benefit checks once I have submitted the claim forms?
Remember, STD does not cover the initial seven (7) days of your absence from work. You must use your own accumulated leave or no-pay if you have no accumulated leave available to you. Usually, your benefits checks will begin arriving within two to three weeks after your claim has been received by the STD carrier.

  How will my benefit plan premiums be paid if I am out of work not receiving a County paycheck?
You will be billed by the Senior Fiscal Officer for premiums that have been missed during that time and will be able to write a personal check. If your absence from work is a month or less, you have the option of making up the payroll deductions upon your return to work, or keeping up with them via personal check.

  I just received my annual Benefits Statement and it doesn't show that I have Optional Life insurance, STD, and/or Vision coverage?
Your Annual Benefits Statement reflects ONLY employer-paid benefits. Optional Life, STD, and Vision are fully employee-paid and are NOT reported on your Annual Benefits Statement.

  My annual Benefits Statement showed that I have 120 hours of vacation time, but my pay stub shows only 47.5?
Your benefits statement shows the TOTAL possible annual accrual for your years of service – not actual hours accumulated.  Refer to your bi-weekly paycheck stub for actual hours available to you for both sick and vacation leave.

 What is OASDI?

Old Age Survivors and Disability Insurance (OASDI) is the familiar Social Security social insurance program into which participants make payroll contributions based on earnings. The OASDI tax rate for wages is set annually by law for employees and employers. Benefits are paid to insured workers and eligible family members when they retire or become disabled and to the survivors of deceased workers.